Above: Four-year-old Abigail Phillips tries out a pulse oximeter like the one she’ll wear in surgery during one of Child Life’s Pre-Op Parties. Child life specialist Ashley Norman led Abigail and her parents, Katie and Justin, through what they could expect on the day of surgery. Katie was even able to join Abigail during the OR setup process through CoxHealth’s Family Surgery program.
A few days before her tonsillectomy, 4-year-old Abigail Phillips came to the Pediatrics unit at Cox South for a party that was a bit outside of the typical pre-school social scene. The toys and refreshments were there, but they were paired with an in-depth look at what will happen on the day of her surgery.
On a Thursday evening, Abigail and her parents, Justin and Katie Phillips of Springfield, came to one of the weekly pre-operative parties presented by the staff of CoxHealth’s Child Life department. The events are designed to offer education and help reassure young patients and their families before their procedures. Child life specialist Ashley Norman walked the trio through the surgery process, demonstrating the surgical attire and equipment and taking the whole family on a tour of the operating room.
Abigail and her parents were able to ask questions and see first-hand how the process would work. Katie even planned to don one of Surgery’s “bunny suits” and join Abigail in the operating room as she awaited anesthesia.
Not many hospitals offer that kind of behind-the-scenes access, but it’s possible at CoxHealth because of the work done by the Child Life department. Several child life specialists work with children throughout the hospital in a variety of areas, from pre-surgery education to providing support for patients and their families on the Pediatrics unit.
This month, Child Life is celebrating 20 years of service at CoxHealth. Now, as the field of child life is growing nationally, the department is looking toward the future and seeing an increasing number of young patients.
“Parents may not be seeking services until kids are really sick, so we’re finding ourselves working with more families who have kids in critical situations,” says Rana Post, Child Life coordinator. Over the last 20 years, length-of-stay times have also dropped, meaning that Child Life staffers work with more families than ever before. Post says that increased volume is also raising the profile of Child Life, a great thing for a department whose work is widespread, but not always understood.
“There’s more awareness now, when staff members see a child come into a waiting room, they’ll pick up the phone and call us,” Post says. “They know we’re here to help, not just with pediatric patients, but with any children who come into contact with the hospital system.”
The department’s role
Post has worked in the department for 13 years and she says she regularly encounters co-workers who are unclear on what, exactly, she and her staff do. It happens frequently enough that she jokes about having a sort of five-minute “elevator in-service” speech to sum it all up.
“It can be hard to put it into a nutshell, but basically we offer the psychosocial aspect of health care,” Post says. “We’re seeing what things we can provide for patients and their families that are going to get them through their medical situation.”
Explanations are occasionally required since one of the ways Child Life staff members are most frequently seen is visiting patient rooms with toys and games for children.
“People say we’re the fun ones or the play ladies,” child life specialist Amanda Eddington says. “But there’s a lot more substance to what we do.”
Behind the high-visibility toys, Eddington, Post, Norman and the Child Life team spend their days educating kids and families, helping parents who are coping with a child’s illness and supporting medical staff who are providing care to children.
“Of course, we are also very fun,” Post adds with a grin.
On a typical day, the team begins with patients scheduled for surgery at Cox South, Meyer Orthopedic Center and CoxHealth Surgery Center. They do the final preparation for parents and they facilitate coping for children – anything that’s needed to make the experience as smooth as possible.
“That’s what our role always goes back to: How do I get this individual child through this particular experience and have the best outcome?” Post says. “Is it through supporting staff? Are the parents upset and do they need support? Does the child need a distraction?”
After the surgery preparation, they round on the patients in Pediatrics. They meet with patients and families and assess how the kids are doing and what their goals should be to help them get home as quickly as possible.
Post says a lot of Child Life’s work with patients involves helping children comply with doctors’ orders. For example, patients may need to consume a certain amount of fluids and getting a child to do that can require some creativity. Post recently helped a 3-year-old boy get all of his fluids by making snow cones, with him crushing the ice and choosing his flavors.
“We try to allow children some control,” Post says. “We can offer options, but it’s ultimately up to them to eat or take medication – we offer support to make the process as smooth as possible.”
The support Child Life offers also extends to parents and hospital staff.
“We may touch base with these families three, four or 10 times per day, to see how they’re doing and see what they need,” Eddington says. Child Life staff members serve as an advocate for parents, listening to concerns and offering suggestions. They also support medical staff as they care for children, helping kids stay calm by providing interaction or a distraction.
“We’re always working on how we can best assist a patient or a family,” Eddington says. “Sometimes we’re working with the patient, sometimes the family and sometimes we’re supporting the staff. Sometimes it’s all three.”
A leader in the field
It’s rare for a general hospital to have a dedicated child life staff and in CoxHealth’s case it’s made possible through funding from Children’s Miracle Network Hospitals. Through CMN Hospitals’ support, the department is staffed 77 hours per week and is available to patients 12-14 hours a day. That kind of presence is key to one of the department’s main goals: providing service that goes beyond what one might expect from a children’s unit in a community hospital.
“We really pride ourselves on doing cutting-edge things; the types of things that metro children’s hospitals do,” Post says.
In fact, there are several areas in which CoxHealth’s Child Life department is leading the way in services for children.
When Abigail Phillips went into the OR for her tonsillectomy, her mom was able to come along through Child Life’s Family Surgery Program. The program allows one parent or support person to be present in the OR with their child until they are calm or asleep for their surgery.
It’s an idea that many hospitals are just now coming around to, but the program at Cox has been in place for 15 years.
“We were doing that earlier than a lot of hospitals and we’re seeing more hospitals now who are wanting to do something similar,” Post says. “They’re using our charting, our programming and our education to build their programs.”
In recent years, Post has done presentations about the program in front of national audiences, including at Mayo Clinic.
“When we go to conferences, we find that other hospitals are asking about that program. They want to know about our policies and how we educate our families,” Eddington says. “It’s really cool to be able to have the Family Surgery Program here.”
In addition to sharing their work at conferences, Post and Eddington keep track of what other professionals are doing through the Child Life Council’s online forum, a worldwide network of specialists that tracks issues in the field.
Eddington says the forum is key to problem solving and finding solutions for patients. She recently spoke with a specialist in Florida about a new technique that uses a medication to numb the area before an IV stick. While the medication has never been used at CoxHealth, in Florida it has been successful in emergency rooms. Eddington is currently working with a representative to trial the medication on the seventh floor.
“That’s a big part of our jobs, advocating for children and one of the easiest ways is pain management,” Eddington says.
“We look at family-centered care and the overarching trends so we can address them here,” Post says. “We want to see what’s working in other places and bring it here.”
Technology’s evolving role
Post says that in her 13 years with the department, she’s seen a variety of changes, ranging from the acuity of pediatric patients to the need for more staff and family support. By far, though, the biggest changes have been in technology, on both the clinical side and in Child Life itself.
Educational materials for a variety of medical procedures have to be updated more frequently than ever and the Internet is changing the way specialists reach out to patients. With more patients traveling to Springfield from outlying areas, and more pre-admission interviews being conducted by phone, child life specialists are relying on an online tour created with help from Marketing and Planning. The online presentation covers much of the same information as the live class, presented in an easy-to-understand format that helps orient patients prior to their surgery.
Funding from CMN Hospitals has helped the department add computers and the latest video games on the Pediatrics floor and Eddington says a grant may soon allow the addition of another technology that’s becoming popular with patients: the iPad.
The device’s portability and versatility are proving to be effective in other hospital settings around the country. Post says there are apps that can distract kids during a procedure – helping them hold still during a test, for example – as well as apps that can illustrate procedures with video that will supplement the in-person education Child Life already offers.
“When a child is going for their first CT scan, for example, we can do preparation with photos and videos and then with the same iPad they can play games or look at something distracting to help them hold still for the test,” Eddington says. “The iPad has been very successful out in the field and there are some exciting possibilities with it.”
No matter what technology brings, though, child life leaders say it will only be a more advanced supplement to the basics of what child life specialists offer. They point to one wall in the Child Life office, lined with bins that are filled to the brim with those brightly colored toys that they’re so often seen with.
“Those are our distraction bins; those toys are like our tools, our armor,” Post says. “It’s all about doing anything we need to do to support children. We can talk to kids on their level and put them at ease, which ultimately supports them in getting better and getting to go home.”
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