Forum 2: Developmental Theory
Mrs. Wright has brought her 8-month-old, Brooks, to the hospital ER for not eating. Brooks was diagnosed with insulin-dependent diabetes mellitus at 4 months of age. Brooks is small for her age and whimpers anytime you approach her. She is not interested in toys that are shiny and withdrawals into her mother’s arms when a toy is offered. Is she having difficulty developing trust? If so, what interventions can the CCLS implement to promote achievement of this developmental stage?
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New! CHILD LIFE – JEN MAY
Hello and Happy 4th of July! My name is Jen and I am currently the Training and Volunteer Manager at a mental health agency in St. Louis, MO. I coordinate and connect volunteers to different opportunities within our organization and assist employees as they work on their professional development. Though not directly working with children at the moment, I am excited to use the skills I gain in this position in the more administrative side of the Child Life Specialist’s role, specifically in working with volunteers or students. My partner Sam and I hope to move out west, ideally to Denver or another Colorado city, once I have completed my Child Life Certification. Though I do hope to find a new place to live, I will always be a Cardinals Fan! I play competitive Ultimate Frisbee and enjoy trying new recipes, learning to play the guitar, laughing loudly and dancing often.
I am currently volunteering with the Child Life Playroom at St Louis Children’s Hospital, which has allowed me to play with and learn from patients and Child Life Specialists alike. I worked for numerous summers with the Serious Fun Children’s Network, which provides residential summer camps with full medical facilities so that children with chronic and threatening illnesses can enjoy a week of camp. Through this experience working with children with cardiac diseases, cancer, kidney disease, epilepsy, Crohn’s disease, and other diseases in both the United States and Europe, my passion for Child Life was born. I have my Bachelor’s Degree in Psychology, and though this course is essential for me in my path towards certification, I’m sure I would have taken it anyway as all of the objectives are topics I am excited to learn more about, particularly objective number 3. As a person who understands and communicates better by viewing the big picture first, developing a care plan for a specific child population will challenge me to organize my thoughts better for patients and their families, in order to give them the personalized care each deserves.
As I shift my focus towards becoming a Child Life Specialist, there are countless pieces of the child’s experience that need to be considered. It is important to remember that while each child’s experience may mirror another’s, they are each unique. Child Life Specialist are essential when a child is welcomed into a frightening and new place such as a hospital all the way to the communication with family members and patients who have called a hospital home for many weeks or months. Something which unites most (if not all) children is the action of play, and for me, the notion of play therapy is as brilliant as brilliant can get. Richard Thompson put it well with, “Play liberates laughter. It blows up and deflates, builds up and knocks down. It takes bits of this and that and makes a new thing. It imitates life and elaborates on it,” (2009, pg. 5). Child Life Specialists are able to help a child feel safe and thus braver and ready for the next medical steps they must take by using laughter, play, and comfort. What will make this energetic and essential piece of the job so challenging, however, is the unique aspects of each child, especially in our current technology fueled landscape. No one child will find all the same jokes, games, or riddles as entertaining as the next. Paired with this is the stressful hospitalization, which may make play and laughter all the more hard to imagine. It is the role of the Child Life Specialist to bring positive energy and create a safe environment for each child and their family, leaving them the time to heal and process this change in their reality, as noted in the Child Life Competencies (2015).
Child Life Council. (2015). Official documents of the Child Life Council. Rockville, MD: Child Life Council, Inc.
Thompson, R. H. (2009). The Handbook of Child Life: A Guide for Pediatric Psychosocial Care. Springfield, Ill: Charles C Thomas.
New! NICOLE LOHRIUS
Hi everyone! My name is Nicole Lohrius and I just recently graduated from the University of Delaware with a BS in Human Services, which some of you may know as Human Development and Family Studies. After graduating I moved back home to Long Island, NY, living with my two parents, older brother, and younger sister. I am spending my summer babysitting, relaxing on the beach, and volunteering with Child Life at the Cohen Children’s Hospital in New Hyde Park. By taking this course I hope to not only be qualified for the Child Life internship but to learn more about the profession itself. I was always interested in helping children as a Human Services student but it wasn’t until right before my last semester of college that I learned about and became interested in Child Life. That last semester I spent my time at a full time internship working with children with illnesses in a school setting that was located in a hospital, and fell in love. My goal is to eventually work with Child Life on Long Island at the Cohen Children’s Hospital or in New York City. In order to reach this goal the course objectives are all relevant. It is important to understand the concepts of different healthcare settings, theory and research, plan of care, professionalism, and foundations, in order to adjust well and help children and families to the best of my ability. Learning to apply these different objectives will also help me to improve currently as I continue to volunteer and observe my supervisors.
When working with children and families in the setting of a pediatric hospital it is very important to consider certain behaviors, actions, and principles. After working at my last internship in Delaware and beginning volunteering in New York, I learned that medical and cultural diversity is significant wherever you go. Becoming competent in the areas relating to positive behaviors towards patients and families is important when making them feel comfortable and happy throughout their time in the hospital. One of these behaviors is communication. Whether it is verbal communication, body language, or facial expressions, communicating is key in making a positive influence not only with the child, but with the family as well. A principle that I found important after my last internship that can also be important to remember is professional collaboration. I worked in a very small school located in a hospital where a medical and educational staff collaborated to help the children strive. I could tell that the different professionals coming together as a supportive and comforting community made a huge impact on the children’s lives because not only were they ill, but they had come from challenging backgrounds. Lastly, the concept of therapeutic relationships with children and families is something to consider. From volunteering I notice, art, play, and music are significant in creating a healthy and positive mindset for children with illnesses. Allowing children to be creative and expressive without having to verbally communicate can sometimes be more beneficial for them in their time of need.
Child Life Council. (2015). Official documents of the Child Life Council. Rockville, MD: Child Life Council, Inc.
Thompson, R.H. (2009). The Handbook of Child Life: A Guide for Pediatric Psychosocial Care. Springfield, Ill: Charles C.Thomas.
New! WEEK 2
Brooks appears to be scared and exhibiting a difficult time developing trust. She may appear that she is not interested in any toys, but I feel that there can be two reasons why Brooks is reacting this way. She was diagnosed with diabetes 4 months ago, I wonder if she has any past memories of a place like this that was not pleasant which would make her scared or she does not feel comfortable because she is in a new atmosphere and strangers are attempting to engage her, so like most 8 month old, she naturally turns to her mother for comfort. There are different interventions a CCLS can do with patients depending on the developmental level, self- directed interests, medical condition, and physical abilities (“Child Life Services” e1471-e1478). There are many different interventions and are not limited to; therapeutic play, Play Therapy, and Art Therapy. I believe that therapeutic play would be most successful on Brooks because of her age and cognitive level. “Therapeutic Play – A set of activities designed according to psychosocial and cognitive development of children to facilitate the emotional and physical well-being of hospitalized children” (CLC Website). I believe that play therapy is very successful for children who are experiencing fears and anxiety because “play in the healthcare setting is adapted to address unique needs based on developmental level, self-directed interests, medical condition and physical abilities, psychosocial vulnerabilities, and setting (eg, bedside, playroom, clinic)” (“Child Life Services” e1471-e1478). It appears that Brooks already has trust developed with the mother because she is embracing her and hiding behind her. I really like play therapy because it does focus in on the unique developmental level of the child. In this situation, Brooks is 8 months, the mother can play a huge role in helping the child have a successful Doctors visit. A CCLS can encourage the mother to participate in play therapy with the child. This will help Brooks feel more comfortable to open up and have positive interactions with the CCLS. Play therapy can also be beneficial for the parents because it can give them a chance to help the child feel more comfortable and safe. It can help the mother feel part of the situation rather than on the outside with fears and anxiety about their child being scared. This gives them the opportunity to be part of the process and feel more at ease. When the mother is happy and feels comfortable it will be contagious with the child.
“Child Life Services”. PEDIATRICS 133.5 (2014): e1471-e1478. Web. 12 July 2016.http://pediatrics.aappublications.org/content/133/5/e1471.full
Child Life Council Website. “Therapeutic Play in Pediatric Health Care”
Through evaluation of Brooks’ behavior, including whimpering when others approach and withdrawing into her mother’s arms, she seems to be having a hard time developing trust. Erik Erikson’s psychosocial theory views development as a dynamic and continuous process whereby the individual attempts to adjust to issues that arise at key interaction points (Thompson, 2009, p. 29). Erikson uses psychosocial stages to describe conflicts that occur throughout the life of a child. From birth to age 1, the psychosocial stage is trust vs. mistrust. During this stage, children often have issues with separation from caregivers, as well as unfamiliar environments, routines, and people (Thompson, 2009, p. 30). At 8 months old, Brooks fits into the age range of this psychosocial stage, and she displays the issues described above. Brooks was diagnosed with insulin-dependent diabetes mellitus at just 4 months old. Through this diagnoses, it can be assumed that Brooks has been in a healthcare environment before. This environment can be overwhelming and unnerving in general, but it is also possible that Brooks maintains memories of her prior experiences, increasing her level of anxiety. It is important to create a positive association between healthcare environments, such as a hospital, in order for Brooks to feel more comfortable and be less anxious in these settings.
Child Life Specialists can “apply temperament theory as an organizing framework to describe individual characteristics of the child observed in relation to specific characteristics of the environment (Thompson, 2009, p. 30).” Temperament qualities such as adaptability, irritability, activity level, emotionality and anxiety may account for some individual differences in behavior. Also, environmental factors are considered to influence the expression of these (Thompson, 2009, p. 29). Child Life Specialists should make every effort to provide a supportive environment that meets the needs of each individual child while also meeting the demands of the healthcare setting. Child life interventions to the conflict of trust vs. mistrust include prompting consistent care and encouraging parent involvement to meet both physical and emotional needs (Thompson, 2009, p. 30). Since Brooks seeks comfort from her mother in uneasy situations, it would be a good idea to involve her mother while interacting with the CCLS. The CCLS should strive to keep routines similar while encountering Brooks, as change can create anxiety, but consistency will increase her trust. Another intervention that a Child Life Specialist could use is therapeutic play, which refers to specialized activities that are developmentally supportive and facilitate the emotional well-being of a pediatric patient. Psychological and behavioral outcomes of therapeutic play include diminishing children’s anxiety and increasing their willingness to revisit the hospital (Koller, 2008). Brooks’ level of trust can and should increase through the use of therapeutic play. Combining the techniques listed above, I feel that it would be appropriate to involve Brooks’ mother during play. Initially, rather than the CCLS handing Brooks toys directly, the CCLS could use the mother as a link to Brooks. Brooks can witness the CCLS handing her mother the toys, and then the mother can show Brooks. Due to the comfort level with her mother, Brooks should be more accepting of this. Eventually, Brooks’ anxiety around the CCLS should decrease.
Koller, D. (2008). Therapeutic Play in Pediatric Health Care: The Essence of Child Life Practice. Child Life Council.
Thompson, R. H. (2009). The Handbook of Child Life: A Guide for Pediatric Psychosocial Care. Springfield, IL: Charles C. Thomas.