Certified Child Life Specialists Research Articles

Supporting Children and Families in Medical Settings: Insights from Child Life Specialists During the COVID-19 Pandemic.

Medical settings can be frightening and stressful places for pediatric patients and their families. During the COVID-19 pandemic fear and anxiety associated with receiving medical care increased as medical facilities dramatically altered the way they functioned in attempts to stop the spread of the virus. Certified Child Life Specialists (CCLSs) are medical professionals who provide psychosocial support for pediatric patients and their families by helping them understand and cope with medical procedures and the medical environment. In this role, CCLSs are likely to have important insights into the experiences and needs of pediatric patients and their families during COVID-19. Using a mixed-methods design, 101 CCLSs completed an online survey and 15 participated in follow-up interviews examining their experiences with and observations of children and families in medical environments during the pandemic. Participants emphasized a need to maintain a focus on child- and family-centered care for the well-being of patients and their families. While recognizing the need to socially distance to limit the spread of COVID, participants expressed concern about restrictive policies that did not balance the physical and mental health needs of patients and families. Participants also discussed the important role of child life services during the pandemic and the unique and multifaceted contributions CCLSs made to support patients, families, other medical professionals, and communities. Recommendations for supporting children and families in medical environments moving forward are discussed in light of lessons learned during the pandemic.

“Working with What You Have:” Child Life Group Play Programs in North America

Since the early twentieth century, group play programs have been a staple offering in children’s hospitals across North America, however little research to date has explored or evaluated these programs. Therefore, the purpose of this narrative inquiry study was to describe child life specialists’ experiences coordinating and contributing to group play programs in healthcare settings across North America. Interview responses from 32 Certified Child Life Specialists clustered around four emerging themes: (1) “working with what you have,” (2) assessing patient and family needs, (3) implementing the group play program, and (4) intended benefits of group play programs. Thus, organizational supports, adequate funding, individualized assessment, and appropriate staffing appear instrumental to the creation, implementation, and maintenance of child life group play programs in pediatric healthcare settings.

Exploring the implementation of child life services with facility dogs.

Many children's hospitals around the United States have programs in which a trained facility dog goes to work daily with a psychosocial healthcare worker, typically a Certified Child Life Specialist (CCLS). CCLSs help children and their families cope with the stress of a healthcare experience by utilizing evidence-based, developmentally appropriate interventions. The purpose of this study was to explore how CCLSs incorporate facility dogs into their treatments and gain their perspectives on handling a facility dog. Participants, four CCLSs, completed a checklist, which assessed patients seen by facility dogs for 10 workdays, and a semi-structured interview. Participants primarily saw patients of ages three to five years and aided with general anxiety and coping support. Findings indicated the dog's specific training, therapeutic value, and ability to bond with patients allowed these interactions to be successful and impactful. This study provides information about the benefits of facility dogs for child life programs and presents data for programs that are considering incorporating this therapeutic modality into their services offered.

Child Life-Facilitated Coping Support With Adult Patients Undergoing Cardiac Surgery: A Pilot Program

Purpose With little empirically known about the translation of child life services into adult patient populations, the purpose of this pilot project was to explore the feasibility of offering non-pharmacological child life support to adult cardiac surgery patients. Specifically, the aims were to explore the practical feasibility of extending and integrating child life care into this adult healthcare service, as well as the preliminary perceptions of adult patients who participated in the pilot program. Methods A pilot program was designed to provide child life care to an initial group of 11 adult patients undergoing cardiac surgery at a large academic medical center in the midwestern United States. Patients were randomized into a control condition consisting of standard pre- and post-cardiac surgery care or an intervention condition that involved five coping support interactions with a Certified Child Life Specialist serving as a “comfort coach.” Patient perceptions were gathered via telephone survey at the conclusion of the study, and insights into practical feasibility were gathered from associated study staff, clinical team members, and leadership to understand stakeholder experiences with the program. Results According to the feedback gathered, it appears that Certified Child Life Specialists can be clinically and practically integrated into adult cardiac surgery populations without patient care disruption. Additionally, feedback from program participants suggested that child life services were appreciated and seen as a beneficial component of the cardiac surgery experience. Conclusion This study suggests that it is both possible and practical to extend non-pharmacological coping support from Certified Child Life Specialists into adult cardiac surgery care, and this appears to be a desirable service from patient and staff perspectives. Future research is needed to evaluate the effects of child life services on specific outcomes in this population specific to anxiety, pain management and overall patient experience and care satisfaction.

Replicating a Therapeutic Art Group Protocol for Parents of Youth With Chronic Pain

Interventions for parents are important during intensive interdisciplinary pain treatment (IIPT) for youth. Therapeutic art reinforces parent strengths and promotes healthy coping during their child’s treatment. This study measured the feasibility of implementing a published, parent-only group-based therapeutic art intervention in an IIPT program, delivered by a Certified Child Life Specialist (CCLS) with training in therapeutic art. While their child participated in IIPT, forty-two parents participated in at least one therapeutic art group. Content rotated through four modules designed to promote reflection on interpersonal relationships, cultivate support, identify values, acknowledge personal struggles and barriers, and increase artistic self-expression (Pielech et. al., 2013). Following each group, parents completed measures of perceived satisfaction and helpfulness as well as open-ended questions for qualitative analysis. The mixed method design was used to provide depth to the understanding of these parents’ experiences. Supporting feasibility, the full intervention was replicated in a different setting with different providers. Parents attended 69% of sessions, reported little difficulty attending, and reported a high degree of satisfaction, helpfulness, and support. Following each group, parents completed measures of perceived satisfaction and helpfulness as well as open-ended questions. A mixed method design was used to provide depth to the understanding of these parents’ experiences.

Integration of child life services in the delivery of multi-disciplinary differences in Sexual Development (DSD) and Congenital Adrenal Hyperplasia (CAH) care

Multiple studies have demonstrated the benefit of incorporating certified child life specialist (CCLS) services in various aspects of pediatric care. Although the significance of psychosocial support of patients with Disorders of Sexual Development (DSD) and Congenital Adrenal Hyperplasia (CAH) is increasingly recognized, the involvement of CCLS services into the DSD and CAH multidisciplinary care model has yet to be described. To evaluate the feasibility, acceptability, and patient and family experience of routinely incorporating CCLS services into the multidisciplinary DSD and CAH care model. As part of a quality improvement initiative, CCLS services were routinely incorporated in the multidisciplinary DSD and CAH clinics at our institution. Encounters for patients seen in clinic between July 2018 through October 2019 were reviewed for demographic information, DSD diagnosis classification, CCLS documentation, and whether an exam under anesthesia (EUA) was required due to an incomplete clinical exam. CCLS documentation was reviewed for assessments, interventions, whether patients tolerated their physical exams, time of CCLS services, and additional CCLS support beyond the physical exam. All patients were limited to one physical exam per clinic visit. Out of the 45 encounters with CCLS involvement, 42 (93.3%) exams were well-tolerated. CCLS assessments considered patient development, communication considerations, temperament, medical stressors, coping preferences, and patient preferences for activities and distractions. Interventions included preparing patients for their physical exams, encouragement before and during exams, addressing patient stressors, distractions and coping mechanisms, and advocating for the patient. No patients required an EUA. The CCLS aimed to provide families with a sense of control during clinic visits and teach them to advocate for themselves. The CCLS helped prepare and distract patients for their clinic visit and addressed the sensitive nature of the physical exam by focusing on the emotional and development needs of patients. CCLS contributions to a positive patient experience are consistent with multiple studies demonstrating the benefit of CCLS services for pediatric care. This quality improvement initiative ultimately helped to create a positive experience for patients and families. This study demonstrates the feasibility, acceptability, and positive impact of CCLS services in the delivery of patient and family-centered care for patients with DSD and CAH as part of the multidisciplinary team model.

Prenatal Considerations and Outcomes for Girls Aged 14 and Under: Development of a Multidisciplinary Team in a Large Tertiary Care Facility.

Adolescent girls account for 11% of all births that occur globally every year. Among developing countries, the United States continues to have one of the highest adolescent birth rates, despite a decreasing trend between 1990 and 2010. Pregnant adolescents are a vulnerable population who are at increased risk for maternal morbidity and mortality. Additional risks are noted within the early adolescent population, usually defined as age 10 to 14. At Parkland hospital, a large tertiary care facility in Dallas, Texas, a multidisciplinary team was created in 2017 to care for this vulnerable population. The team consisted of a certified nurse-midwife (CNM), a Certified Child Life Specialist, a maternal fetal medicine physician, a social worker, and a Spanish interpreter, with additional services consulted as needed. Between 2017 and 2020, this team grew to include 8 CNMs and provided care to 76young adolescents ages 14 and younger. Of the young adolescents who attendedprenatalvisits with theAdolescent Prenatal Care Team at Parkland, 87%presented toParkland for birth.Eighteen percent had pregnancy-induced hypertension or eclampsia. Only7% of adolescents in the program gave birthprior to 37 weeks. Seventy-four percent had vaginal births. Sixty percentof the adolescents attendedknown postpartum visits. In contrast to most studies, this Adolescent Care Team did not find a high rate of premature birth in early adolescents. Further work by this team is needed to compare the data obtained during this period with data on similar adolescents who have given birth at Parkland in prior years. In addition, comparing outcomes of early adolescents with those aged 15 to 19, who were not included in the Adolescent Care Team, will help to understand the impact that such a team or similar intervention might have on this vulnerable population.

Exploring child life specialists’ perspective on the role and benefits of child life in pediatric sexual assault forensic examinations

ABSTRACT The purpose of this study was to describe Certified Child Life Specialists’ (CCLSs) perspectives on their role and the benefits of their role during pediatric sexual assault forensic examinations (PSAFEs). Using a structured interview, discussed roles included preparing the patient for and supporting the patient during the examination and supporting the multidisciplinary team. Perceived benefits of child life services included increasing patient coping and completion of the examination, decreasing re-traumatization, and minimizing parent stress. The findings highlight how CCLSs feel they support the emotional safety of PSAFE patients and families. Thus, healthcare programs providing PSAFEs should consider staffing a CCLS.

Attitudes of Child Life Specialists Towards Telehealth

Telehealth is the use of virtual platforms to facilitate interactions between patients and medical providers, and its use has increased in recent years and especially during the COVID-19 pandemic. Studying attitudes of medical providers towards telehealth is an important first step to effectively providing services virtually. Previous researchers have explored the attitudes of physicians towards telehealth, but none have surveyed Certified Child Life Specialists (CCLSs). CCLSs provide coping strategies and support for children in medical settings (e.g., hospitals and rehab centers). The main goal of this study was to explore the attitudes of CCLSs in the hospital setting towards telehealth and how they have implemented it during the pandemic. Using an online survey, researchers collected data from 63 CCLSs to better understand the use and perceived effectiveness of telehealth. Data collected indicates that participants agree telehealth has substantial benefits for both patients and providers. The findings from this study highlight the attitudes of CCLs towards telehealth and give us a better understanding of these services which are critical to children and their families.

Utilization of a Pediatric Ethics Committee by Certified Child Life Specialists: Barriers and Opportunities

By Anna M. Zhao, John Encandela & 3 more. The aims of this study are to understand the perspectives and experiences of CCLSs within the Pediatrics Ethics Committee and to explore the role of CCLSs in requesting ethics consults.

Perceived Screen Use in Hospitalized Children: Child Life Experts’ Perspectives on More Meaningful Engagement

Children’s environments are rich with screen media, however, very little research describing screen media use for children in the hospital setting exists. Despite innovative uses of screen media by Certified Child Life Specialists to strengthen coping and provide comfort to hospitalized children, there is little guidance for how best to use screen media in addition to the gap in research. This study surveyed child life specialists in pediatric inpatient settings to describe screen media use in hospitalized children. Using online surveys, child life specialists reported some novel uses of screen media to aid in patient care and education and identified underutilization of media to educate patients. Further studies can build off of ours to assess the potential benefits and setbacks of screen use in hospitalized children.

A certified child life specialist influences the emotional response during polysomnography setup

ObjectivesTo examine if the presence of a certified child life specialist (CCLS) had a positive impact on patient emotion at the time of polysomnography setup and to determine the optimal timing of CCLS intervention prior to polysomnography (PSG) in our sleep center. MethodsWe implemented a study which measured the impact of a CCLS on the emotional manifestation score (EMS) of pediatric patients (4 months–17 years, median 7 years) during PSG setup. CCLS intervention was either at the time of sleep medicine consultation (daytime) or during PSG setup (evening). We used Emotional Manifestations Scores (EMS) as well as patient/caregiver satisfaction data to measure the impact of a CCLS and inform decision-making regarding ongoing employment of a CCLS in our sleep lab. ResultsHigh EMS scores were noted during PSG setup in all groups indicating the emotional distress of children undergoing PSG. The EMS improved more when CCLS was present at the time of PSG setup. Statistically significant improvements occurred in level of cooperation, pain/discomfort, and child coping. Based on the results of the study, we hired a CCLS to work in our sleep center at the time of PSG setup 2 evenings per week. ConclusionsPSG is emotionally stressful for pediatric patients as seen on EMS. A CCLS present in the evening at our sleep lab led to an improvement in EMS in children being prepared for PSG set-up. After implementation of a CCLS two nights per week in our sleep lab, parents/caregiver satisfaction scores were higher on nights a CCLS was present at setup.

Meeting the Needs of Children With Autism Spectrum Disorder and Their Families in Hospital Settings: The Perspectives of Certified Child Life Specialists and Nurses

Children who have Autism Spectrum Disorder (ASD) have complex psychosocial, behavioral, and physiological profiles and are hospitalized at higher rates than their typically developing peers. This study examined the perspectives of two key members of the health care team, certified child life specialists and nurses, on how to meet the needs of children who have ASD and their families in hospital settings. Participants included seven health care professionals from two urban hospitals in the Northeast. One-on-one interviews were held with four child life specialists and three nurses. Qualitative analyses yielded six themes that addressed ways to serve children who have ASD: partner with the family, individualize care, advocate for more education, understand ASD is a spectrum of differences, think psychosocially not just medically, and emphasize consistency in care. Findings illustrate the complexity of the ASD diagnosis in light of the limited training and education health care professionals receive and are discussed with regard to their implications for the ways that institutional policies, including those within the child life profession, can facilitate the delivery of optimal care for this population in hospital environments.

Using Quality Improvement Science to Create a Navigator in the Electronic Health Record for the Consolidation of Patient Information Surrounding Pediatric End-of-Life Care

BackgroundIt is important to document the domains surrounding end-of-life (EOL) care in the electronic health record (EHR). No pediatric navigator exists for these purposes. MeasuresMedical charts were reviewed for documentation surrounding code status and care at the time of death from January 2017 to June 2019. InterventionCreation of a navigator in the EHR to consolidate advance care planning documents, code status orders and notes and EOL flowsheets. OutcomesAfter implementing the navigator, 96% code status changes had supporting documentation, an increase of 35%. The percentage of deaths supported by a psychosocial team (social worker, chaplain and certified child life specialist) increased by 25%. Post-mortem documentation became electronic. Patient level metrics began to be electronically collected. Conclusions/Lessons LearnedLittle has been published regarding use of the EHR to consolidate EOL documentation in pediatrics. Development of a systematic approach to documentation is critical to providing EOL care and standardizing care delivered.

Strategies to perform magnetic resonance imaging in infants and young children without sedation.

Given the increasing use of MRI in the pediatric population, the need for sedation in MRI performed in young children is a topic of growing importance. Although sedation is generally tolerated well by children, the financial and operational impacts of anesthesia on MRI workflow, as well as potential adverse effects of anesthetic medications, highlight the need to perform MRI in children without sedation whenever possible. This review focuses on current techniques to facilitate non-sedation MRI in children, including exam preparation with MRI simulation; asleep but not sedated techniques; awake and relaxed techniques using certified child life specialists, animal-assisted therapy, a child-friendly environment and in-scan entertainment; and non-sedated MRI protocol modifications such as shorter scan time, prioritizing sequences, reducing motion artifact, noise reduction, limiting use of gadolinium, employing an open MRI and modifying protocols.

Exploring Child Life Role and Impact of Providing Psychosocial Care During Short-Term Medical Missions

Certified Child Life Specialists (CCLSs) have been engaged with other health profession-als to provide care within international short-term medical missions (STMMs). However, there is minimal research describing the care they provide, their professional roles, and the impact of their services on the beneficiaries, as well as the volunteer CCLSs. This exploratory, survey-based, descriptive study reports findings regarding roles and experiences of 55 CCLSs who volunteered to provide psychosocial care for children and families on STMMs. They reported providing play, normalization, psychological preparation for medical procedures, and emotional support, resulting in observable reduction in patient and parent anxiety. Nonpharmacological pain management and education for capacity building regarding psychosocial care were not routinely provided. Using Campinha Bacote’s cultural compe-tency framework and Knowles’ adult learning theory, we explored the reciprocal impact for CCLSs volunteering on STMMs. CCLSs reported improvement in their own cultural competency, professional skills, and child life competencies. Findings suggest providing psychosocial care on STMMs benefited patients, families, and the CCLSs. A brief commentary on children’s rights and ethical considerations for those in a child life role on STMMs is included. Practice and research implications are provided to enable greater understanding of the child life role in STMM contexts and to inform prospective CCLS volunteers of this opportunity, as well as to educate STMM organizations about the role of child life.

Workplace Relationships and Professional Burnout Among Certified Child Life Specialists

Objective: Certified Child Life Specialists (CCLS) work within a complex medical system, comprised of multiple interpersonal relationships including those with their immediate supervisors, peers, and non-child life medical staff. The job demands of a CCLS often place them in situations that involve high levels of stress and anxiety, placing them at risk for burnout and job turnover. This study examined which types of work relationships are associated with levels of burnout. Method: The study included a sample of CCLS (n = 214) working a minimum of 20 hours a week in clinical settings in the United States. Participants completed an online survey containing the Caplan Social Support Instrument, the Maslach’s Burnout Invento-ry, and an open-ended question related to burnout. Results: Multiple linear regression was used to identify factors associated with burnout. Having a positive relationship with one’s direct supervisor, a positive relationship with peers, or positive relationships with non-child life medical staff were associated with lower rates of burnout. Age, years of experience, exposure to trauma and bereavement, and exposure to chronic or terminal illness were not found to be significant predictors of burnout. Conclusion: Qualitative analysis identified additional stressors that participants considered contributors to burnout including compensation, workload, and respect and understanding of the child life role by other medical professionals. Disclosure Statement: No potential conflict of interest was reported by the author(s). Funding Statement: No funding sources were provided by the author(s).

Empirical Evolution of Child Life

Certified Child Life Specialists are a well-documented component of family-centered care; however, because they typically work as members of multidisciplinary teams, it can be difficult to immediately recognize the scope of their contributions to health care research and practice. As the field continues to grow and evolve, it is even more essential that health care practitioners recognize, implement, and evaluate empirically supported child life services for patients and families across settings. Although the importance of scholarship for practice is well-recognized, there have not yet been any systematic analyses of the child life literature base. Therefore, the purpose of this study was to complete a scoping review of Certified Child Life Specialist authorship, participation, and presence in peer-reviewed journal articles published from 1996 to 2017. Results demonstrate statistically significant increases over time in research that is driven by and focused on Certified Child Life Specialists, as well as emerging trends in populations and interventions studied and the publication outlets in which these articles can be found. These findings highlight that although child life presence in research is increasing, there is more work to be done to improve academic and clinical training related to research, to expand the literature base as it stands, and to advocate for the inclusion of Certified Child Life Specialists in collaborative scholarship to improve psycho-social care for children and families.

How are Certified Child Life Specialists perceived by healthcare professionals?: A call for interprofessional collaboration

ABSTRACT Certified child life specialists (CCLS) depend on collaboration with healthcare professionals for awareness of patient needs; however, historically other healthcare professionals misunderstand the CCLS role. The purpose of this study was to examine how healthcare professionals perceived the CCLS role and provide implications on the contribution of the CCLS to interprofessional collaboration (IPC). This study was a partial replication of two previous survey studies. Participants (N = 67) consisted of 26 child life and 42 other healthcare professionals who were employed at one freestanding children’s hospital in the southern United States. Qualitative analyses revealed CCLS responsibilities could be explained with seven categories. Child life professionals were more likely to report CCLS responsibilities as providing patient support and family support and documenting psychosocial assessment and interventions in the medical record than other healthcare professionals. Child life and other healthcare professionals are mostly aligned in their perception of the CCLS role, specifically patient education, play, and normalization and development. Previous misconceptions about the CCLS role may be diminishing among other healthcare professionals; however, continued education about the CCLS role and communication with CCLSs would likely promote IPC.

The role of child life in pediatric radiology.

Pediatric radiology departments rely heavily on a dedicated, efficient and collaborative multi-disciplinary health care team to provide efficient service and quality care to patients and families. Certified child life specialists are an essential part of this multi-disciplinary team. The main goal of the child life specialists is to improve the overall experience for patients and families. In addition, child life specialists, working in collaboration with the medical care team, help decrease the need for general anesthesia by providing patient pain management, distraction and coping techniques. These interventions result in improved patient safety, increased departmental efficiency and increased revenue. The role of child life specialists extends into the exam room, where their interventions help decrease procedure times and improve imaging quality. In this article, the authors discuss the key role of child life specialists in a pediatric radiology department and provide examples of how child life can impact patient safety, patient and family satisfaction, and operational efficiency.