Exam 1 Content

AAP Statement on Child Life Services: 

• Who is a Child Life Specialist (CLS)?

• Recognized as a “quality benchmark of an integrated patient- and family-centered health care system”

• Child Life Services are an essential component of quality pediatric healthcare and are integral to family-centered care and best-practice models

AAP Statement on Child Life Services: 

• What are the Minimum Requirements to become a Certified Child Life Specialist (CCLS)?

• Minimum Requirements:

  • Bachelor’s degree or master’s degree with specific coursework (human growth and development, family studies, psychology, and related fields)

  • Minimum 600-hour internship

  • Passing the certification examination

AAP Statement on Child Life Services: 

• What Does a CLS do? 

• Focuses on the psychosocial aspect of hospitalization

• They play as a tool to help reduce stress and enhance coping. 

• Provide targeted interventions to express childhood reactions to healthcare events 

AAP Statement on Child Life Services: 

• List Examples of CLS Services/Interventions

• Services/Interventions:

  • Non-medical preparation for tests, surgeries and other medical procedures

  • Support during medical procedures

  • Therapeutic medical play

  • Developmental assessments (Birth-6)

  • Grief and bereavement support & sibling support

  • Activities (group, 1:1, bedside)

  • Coordinating volunteers and special events 

  • Promoting Family-Centered Care 

AAP Statement on Child Life Services: 

• What are the Documented Results of Child Life Interventions? 

• Less emotional distress, better overall coping, clearer understanding of procedures, positive physical recovery, better post-hospital adjustment

AAP Statement on Child Life Services: 

• What is the Child Life Process (APIE)?

• Assessment

• Planning

• Intervention

• Evaluation

AAP Statement on Child Life Services: 

• Describe the Stages of APIE?

• Assessment:

  • Establishing a trusting relationship, gathering information (from the healthcare team, family, and child and observing the child and family.) Reviewing variables to assign a stress potential

• Planning:

  • Determining the Child Life specific intervention

• Intervention:

  • Implementation of the plan

• Evaluation:

  • Determining if the intervention was successful and documenting the intervention/goals in objective terms

AAP Statement on Child Life Services: 

• Why is the Psychosocial Importance of Hospitalization Key for CLS?

• Child Life focuses on the psychosocial aspects of hospitalization

• Care providers can provide psychosocial support through communication, respect, engaging the child in play, and providing accurate information and reassurance

• Supporting psychosocial issues helps promote resiliency 

Play:

• How is “True Play” Defined, According to Rubin, Fein, and Vandenberg (1983)?

• True play has six recurring criteria: Intrinsic motivation, orientation to means rather than ends; internal rather than external locus of control; non instrumental rather than instrumental actions

• Freedom from externally imposed rules and expectations ; and active engagement

• Play is defined as ones of the most powerful processes by which children regulate their experiences and environments

Play: 

• List Parten’s Six Categories for the Social Development of Play

• Parten’s Categories:

  • Unoccupied Behavior

  • Onlooker Play

  • Solitary Independent Play

  • Parallel Activity

  • Associative Play

  • Cooperative or Organized Supplementary Play

Play:

• Ways a Child Life Specilist can use Play 

• Children to process experiences and as a “healing modality”

• Play helps children gain control and mastery and its used for procedural preparation, desensitization, expression of feelings, and rehearsal of copings strategies

• Use separation play to address separation issues 

  • Symbolic play like peek-a-boo

  • Dramatic Play

Play: 

• List Developmentally Appropriate Toys for Infants (0-1 year)

• Crib mobiles

• Mirrors 

• Cardboard books 

• Rattles 

• Balls 

• Nesting and Stacking toys 

• Music box 

• Teething rings 

Play:

• List Developmentally Appropriate Toys fro Toddlers (1-3 years)

• Push and pull toys

• Riding toys

• Small blocks

• Nesting blocks

• Shape sorters

• Toy cars

Play:

• List Developmentally Appropriate Toys for Preschoolers (3-5 years)

• Dress up clothes

• Housekeeping materials

• Dolls

• Toy cars

• Books

• Construction paper & crayons

• Balls

• Puzzles

• Music makers

• Miniature people

• Board games

• Play kitchen equipment

Play:

• List Developmentally Appropriate Toys for School-Age Children (6-12 years) 

• Construction paper & crayons 

• Puppets 

• Word games 

• Card or board games 

• Organized group games 

• Play-doh

• Dolls 

• Puzzles 

Play:

• List Developmentally Appropriate Toys for Teens (13+ years)

• Arts & crafts

• Journals

• Games (with peers)

• Movies

• Music

• Puzzles

Hannah’s Gift:

• Basic Summary of Hannah’s Gift

• Tells the story of Maria’s three-year-old daughter, Hannah, who dies of cancer but teaches powerful lessons about love, honesty, courage and living fully. Through Hannah’s wisdom and bravery, Maria learns to appreciate life, accept death, and find peace and meaning in every moment. The story reminds readers to live authentically, love deeply, and cherish the present

Hannah’s Gift: 

• Important Psychosocial Issues that Hannah and her Family Faced

• Book prompts discussion about the stressful issues faced by Hannah and her family. Quotes relate to finding the “rightness you feel” when you know you are loved, and changing the way one lives with truth 

Hannah’s Gift:

• How a Child Life Specialist Could be Effective

• A CLS could help Hannah gain mastery and control of her medical experience. They would employ techniques to help her cope with her diagnosis and hospitalizations by providing consistent supportive interactions, psychological preparation, and play interactions 

Developmental Theories:

• List Erickson’s Psychosocial Stages

• Psychosocial Theory (Erickson):

  • Trust vs. Mistrust (birth - 1 year)

  • Autonomy vs. Shame and Doubt (1 - 3 years)

  • Initiative vs. Guilt (3 - 6 years)

  • Industry vs. Inferiority (6 - 12 years)

  • Identity vs. Role Confusion (12 - 18 years)

Developmental Theories:

• List Piaget’s Cognitive Stages 

• Cognitive Theory (Piaget): 

  • Sensorimotor (birth - 2 years)

  • Preoperational (2 - 7 years)

  • Concrete Operational (7 - 11 years)

  • Formal Operational (11 years - beyond)

Developmental Theories:

• Hospital Interventions Based on Developmental Theories: Infant (0 - 2 years) 

• Fears: 

  • Separation, Stranger Anxiety, Pain, Parental Anxiety, Lack of/Over-Stimulation

• Interventions:

  • Use soft music

  • Pacifier

  • Encourage parental involvement/holding

  • Providing medical explanations to parent

  • Calming touch

  • Develop a relationship where basic needs are met 

Developmental Theories:

• Hospital Interventions Based on Developmental Theories: Toddler (18 months - 3 years)

• Fears: 

  • Separation, Loss of Physical and Emotional Control, Pain, Needles

• Interventions: 

  • Provide choices

  • Comfort item

  • Distraction

  • Encourage play

Developmental Theories:

• Hospital Interventions Based on Developmental Theories: Pre-School (3 - 5 years)

• Fears:

  • The Unknown, Loss of Body Function, Pain, Needles

• Interventions: 

  • Provide choice 

  • Participation in procedure 

  • Comfort object 

  • Distraction 

  • Assure the procedure is NOT punishment 

Developmental Theories:

• Hospital Interventions Based on DevelopMental Theories: School-Age (6 - 12 years) 

• Fears: 

  • Loss of Body Function, Loss of Control, Pain, Death

• Interventions:

  • Provide full explanation/preparation

  • Allow the child to ask questions

  • Participation in procedure

  • Encourage play and normalcy

  • Create opportunities for self-expression

Developmental Theories:

• Hospital Interventions Based on Developmental Theories: Adolescent (13+ years)

• Concerns: 

  • Body Mutilation, Loss of Body Function, Change in Physical Appearance, Loss of Control/Independence, Invasion of Privacy

• interventions: 

  • Offer in-depth medical explanation

  • Respect for privacy

  • Offer choices

  • Encourage/facilitate communication with friends and peers

  • Encourage Engagement in ‘normal’ activities 

Characteristics of Hospitalized Children:

• What is Separation Anxiety and its Context in Hospitalization? 

• Separation from parents, family, and the familiar environment/routines at home is one of the greatest stresses associated with hospitalization for the young child

Characteristics of Hospitalized Children:

• What are the 3 Stages of Separation Anxiety (Robertson 1958 and Bowlby 1960)?

• Protest

• Despair

• Detachment

Characteristics of Hospitalized Children:

• What are Interventions for Separation Anxiety?

• Maximizing parental presence and participation manimizes disruptive effects

• Interventions Include:

  • Using stories about separation ending with joyful reunions

  • Facilitating ongoing communication with family at home

  • Using Symbolic Play

    • Pek-a-boo

    • Going and coming back games

    • Hiding/finding games

    • Dramatic play with figures

Characteristics of Hospitalized Children:

• Vulnerable vs. Resilient Children 

• Vulnerable Children:

  • Young children, previously hospitalized kids an children who are sensory impaired neurologically compromised, or developmentally delayed

• Resilient Children:

  • Have the ability to return rapidly to a previous psychological or physiologic state

Characteristics of Hospitalized Children:

• What Information is Provided about “David” (Child Life in Hospitals-Chapter 1)? 

• David was a 7-year-old boy treated fro a second-degree burn

• His primary psychosocial stressor was the misconception that his painful treatment was punishment

• Child life specialist utilized therapeutic play to allow expression, addressed his fears directly and used a comfort item to promote coping. 

• Goal: For David to leave the hospital emotionally as well as physically healed 

Characteristics of Hospitalized Children:

• What are Sources of Stress and Phases for Parents?

• Sources of Stress:

  • Diagnosis, hospital environment, length of stay, changes in child’s behavior/routine. Parents may feel guilt and generalized anxiety

• Parental Phases:

  • Initial, Information Seeking, and becoming Strong Advocates for their children 

Characteristics of Hospitalized Children:

• What are the Effects and Fears Experienced by Siblings? 

• Siblings under age 7 are most vulnerable. They fear their brother/soster may die, and 50% fear they will get the same illness. They are vulnerable to separation from parents and may believe their actions “caused” the illness 

Characteristics of Hospitalized Children:

• Describe the Film Two-Year Old Goes to the Hospital

• The film features Laura, a 2-year-old admitted for 8 days for an umbilical hernia repair. This film, and subsequent research, led to a change in family visitation policies

Characteristics of Hospitalized Children:

• Define Attachment

• An enduring emotional tie to a special person, characterized, by a tendency to seek and maintain closeness, especially during times of stress

Characteristics of Hospitalized Children:

• Describe Secure Attachment 

• May exhibit distress when separated but greet the parent’s return with positive behavior. They seek comfort and prefer the parent to a stranger 

Characteristics of Hospitalized Children:

• Describe Ambivalent Attachment

• Exhibit considerable distress by separation. May passively reject the parent and fail to find comfort. They are often described as clingy and over-dependent

Characteristics of Hospitalized Children:

• Describe Avoidant Attachment

• Avoid parents and caregivers. upon reunion, they look away or actively avoid the caregiver. They show little or no preference between a caregiver and a stranger

Characteristics of Hospitalized Children:

• Describe Disorganized Attachment 

• Associated with Reactive Attachment Disorder. Characterized by a lack of trust, negative self-perception, and a negative perception of others. The behavior is often bizarre and lacks an observable goal. 

Stress and Coping: 

• Define Stress 

• An ongoing transaction between a person and the environment that results in an emotional appraisal that the situation is threatening or harmful to some important aspect of well-being 

• Can be unconscious or conscious 

  • Unconscious: unaware of the stressor

  • Conscious: aware of the stressor

Stress and Coping: 

• Define Coping

• What a person does to remove, avoid, minimize, or “get through” a stressful situation. Coping strategies can be “problem-focused” or “emotion-focused”

Stress and Coping: 

• What is the Information Processing Model? 

• Input → Process → Store → Output 

• How children take in, understand, remember, and use information 

• Helps healthcare workers communicate and teach children at their development level 

Stress and Coping: 

• List Ways Care Providers Provide Psychosocial Support

• Supportive Time, Communication, Respect, Accurate information and reassurance, being Empathetic and nonjudgmental, sincere interest, engaging the child in play, and providing support and information

Stress and Coping: 

• List Techniques for Effective Communication for Information Processing

• Consistent supportive interactions, psychological preparation, anticipatory guidance, play interactions, and expressive activities

Healthcare Play: 

• List the 4 Types of Healthcare Play

• Expressive Play 

• Familiarization Activities

• Dramatic Play/Medical Play

• Playing “for” Children (Vicarious Play)

Healthcare Play:

• Define and Give Examples of Expressive Play

• Definition: Identify & Express emotions

• Examples:

  • Target shooting with syringes, paper fights, pounding activities, painting with syringes, messy activities, graffiti posters, and hospital books

Healthcare Play:

• Define and Give Examples of Familiarization Activities

• Definition: 

  • Explore health-related objects

• Examples:

  • Collages, painting with toothettes, mobiles, plaster finger casts, IV pole and traction bed decoration, and magic wands

Healthcare Play:

• Define and Give Examples of Dramatic Play/Medical Play 

• Definition: 

  • A symbolic reproduction of invasive physical procedures necessary for medical treatment . Helps children gain mastery, desensitize, express feelings, rehearse coping, and clarify misconceptions

• Examples:

  • Medical art and directed medical play

    • Child leads but the adults interjects to address a specific issue 

Healthcare Play:

• Define Playing “For” Children/Vicarious Play

• Definition: 

  • Dramatic play with puppets, family figures, personalized dolls, or creative art activities like window painting

Special Programs: 

• What are Animal Assisted Activities (AAA) and Animal Assisted Therapy (AAT)? 

• AAA:

  • Casual visits with animals to provide comfort and enjoyment

  • Focus on emotional support and improving mood or social interaction

  • Example: Therapy dog visiting hospital

• AAT:

  • Goal directed therapy involving animals, led by a trained professional

  • Focuses on specific treatment goals

  • Example: child practicing motor skills by brushing a therapy dog

Special Programs: 

• What is Music Therapy 

• Definition: 

  • The use of music by a certified music therapist to meet therapeutic goals

• Goals:

  • Reduce stress and pain, improve mood, encourage expression, support coping

• Collaborating with Child Life:

  • Specialists and music therapists work together to help children relax, express feelings, and adjust to hospitalization

Special Programs: 

• What are Examples of Special Programming?

• Hospital celebrations, holiday events, or themed weeks

• Teen nights, art or games sessions, volunteer activities 

• Designed to normalize the hospital environment and support social interaction and coping