Hospital Play in Iceland

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After the 99 degree weather in Japan, travel to Iceland called for wooly socks and a winter hat. During my first day in Reykjavik, I met with Dr. Drífa Björk Guðmundsdóttir, a psychologist who served as her country’s delegate at the first global summit on psychosocial pediatric care in 2014. She hosted me at Landspitali, the National University Hospital of Iceland.

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Our morning together included a tour of the pediatric inpatient unit, physical therapy department, clinic and NICU, and  an hour spent in conversation with some of Dr. Drifa’s colleagues, a physical therapist, hospital play specialist, nurse, nurse manager and social worker from a non-profit agency that serves hospitalized children and their families. We discussed best practice for helping parents support and prepare their children for hospitalization. It was clear to me that these professionals held many of the same values and goals for supporting children that we have in the US.

I enjoyed our conversation tremendously, but I must admit, I treasured my time with Sigurbjörg Guttormsdóttir (thankfully nicknamed Sibba, but pronounced “Sippa”!).  Sibba is one of the two hospital play specialists, and she has worked at the hospital for 25 years. A kindergarten teacher who received training in Sweden and Oregon, she wrote a thesis on play materials to use with children.  Sibba welcomed me to her playroom and proudly shared its history and resources, inviting me to sit down and play almost immediately.

Here is the game of choice, Rush Hour.

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Continue reading

Learning from Hospital Play Specialist Hideko Konagaya in Japan

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While teaching in Shizuoka, Japan, I had the pleasure of spending a morning with Hideko Konagaya, a hospital play specialist, at Shizuoka General Hospital.

Hideko hosted Maria Busqueta  (a child life specialist and psychologist from Mexico City) and me in her bright and cheery playroom. Professor Chika Matsudaira of Shizuoka University assisted us by translating so that we could all communicate.

When we entered the playroom, two preschoolers already sat at a small table busily making slime. The children and their mothers gave us permission to photograph them.

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Now I have made slime in my play course, but never slime as lovely as this! Hideko had set out brightly colored water in several plastic cups. She provided the boys with small glass jars (recycled baby food jars) and chopsticks for stirring. One at a time, Hideko and the children added rice glue, orange or lime essential oil for fragrance, sodium borate, and  a magical touch of glitter. The mixture came together to create a wonderful substance that smelled amazing and was positively addictive – no one could put it down or stop playing. The boys stirred like mad, and then ran the slime through their fingers until it hardened enough to hold shape. They used cookie cutters and plastic tools to manipulate it. I broke a cardinal rule of mine and touched one of the boy’s slime without asking. I just couldn’t help myself! He was a very good sport. Continue reading

A Day with Hospital Play Specialist Kazue Goto in Japan

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One of the best parts of my trip to Japan was the fact that I  learned more than I taught. Yes, I traveled there as a child life professor to teach play techniques to hospital play specialists (HPS). But they had just as many wonderful techniques to share with me, and I cannot wait to incorporate them into my teaching repertoire here in the States.

On our first day in Tokyo, Kazue Goto hosted Maria Busqueta and me at the National Rehabilitation Center for Children with Disabilities for a day of play with the inpatients on their orthopedic ward. She had prepared the children for our visit, and one by one, they approached us, shook our hands Western style, and introduced themselves by name. Kazue presented us with handmade name tags written in Japanese.

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I taught the kids how to play the American game “Spot It!”, and Maria taught them how to play Mexican Lotteria. We all made volcanoes together, and then the fun REALLY began. Kazue taught us all how to make poop.

Yes, you heard it right — we all made poop out of bran cereal. The activity is designed to teach kids about their digestive systems. Many hospitalized children have issues with constipation or diarrhea, and this activity brings up helpful discussion about self care and gives children a chance to normalize something that can cause great pain and embarrassment. Continue reading

Play the Japanese Way

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Trepidation was the word of the day as I prepared to teach play techniques in Japan. How would I  cope with teaching in eight hour increments to students and professionals whose primary language was Japanese?  How would the participants respond to me? I barely ever lecture at Bank Street College, but here it would be the expected modality of teaching. I worried for my students who would have to listen to my English first before Chika Matsudaira, my hosting professor,  translated everything I said.

But I should know by now that everything works out in the end. Here are some highlights from the four groups we taught, some new to the profession, others in it for years. They included students, hospital play specialists, nurses, nursing administrators, nursery nurses (early education professionals working in hospitals), occupational and physical therapists and one child life specialist. In the span of 5 days, we taught a total of 91 people. The photos and video footage below include scenes from all 4 classes.

The first group in Shizuoka were new hospital play specialist (HPS) students who had travelled from all over the country, and the day began with a ceremony welcoming them to Shizuoka University. The university president and administrators attended, as did a local reporter. The students first appeared very serious and somber. Here is the before shot taken during the ceremony:

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But we all warmed up to each other pretty quickly. Here we are at the end of the second day.

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Thanks to the reporter, an article featuring our class appeared in the next day’s Shizuoka paper.

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We began with my theory of a “Play Needs Continuum”. It describes 9 ways to deepen play opportunities for children in hospitals. Chika had translated my power point into Japanese.  When we spoke of raising awareness about the value of play, students paired off to share play memories from childhood.

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When we addressed the use of self as a distraction tool to use during medical procedures, we all shared songs  and hand games from our cultures (click on bold green to see videos). Maria Busquetta from Mexico got everyone singing “Twinkle Twinkle Little Star” in Japanese, which impressed everyone very much. I taught them the invisible needle and thread trick.

When we needed to move our bodies to keep alert, Chika demonstrated “laughter therapy”. On most days, I started the day with the game “whoosh”, where the group passes an imaginary ball around a circle making sound effects as they go along. I had never tried this with more than 15 students, but it worked well even with the large group of 40 from Tokyo. Their improv skills with action and sound effects were great.

The students enjoyed making volcanoes (Kaduson, 1997), throwing wet toilet paper at a drawing of things which angered and frightened them (Kaduson, 1997), making oobleck and playing with shaving cream. Rolling up their sleeves to play helped them understand first hand the value of these techniques for hospitalized children.

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The students traced one another on paper and dry erase board for the “Wonders of the World”  activity (Carman, 2004). This activity helps traumatized kids and teens find hope and connect with a vision of the future as they draw what they would like to see with their eyes, smell, hear, taste, do/make with their hands, and where their feet will take them.

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And last, but not least, we  demonstrated and practiced child-centered play techniques (Landreth 2012).

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The students were so willing and playful that the eight hours flew by each day. I have no doubt that children will be playing their hearts out throughout hospitals in Japan where these folks are training and working. Playing the Japanese way is a wonderful way to go.

Free New Child Life Tool for Bettering Hospital Playrooms

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I am thrilled to announce the release of a new tool for your child life toolkit. It is an assessment form to help you make your playroom the best it can be. There is a dream playroom in all of our imaginations. Time, space, budget constraints and infection control guidelines aside, we all know what we would provide children and families if we were able to do so. The  VIPAR (Vilas Playroom Assessment Rubric) is intended to present the best possible scenario, and to measure how your playroom is meeting the needs of all pediatric patients and families at your hospital. Child life specialists and administrators can use this rubric as a quality checklist to assess playroom design and operation.

This rubric is several years in the making and has been test driven by many Bank Street College alumni. They kindly tried it out in their playrooms and gave me feedback to improve the document, making it as accessible and flexible as possible.

Tara Horan reports that the rubric gave her staff  “feelings of empowerment to make positive changes.”

Kelsey Frawley shared, “Another AHA moment was the cultural competency piece. I think as specialist’s we are taught to BE culturally competent, not judge, ask questions, be aware of differences, but incorporating it into a room is something I have not thought of. The developmental appropriate piece really stuck out, it is something we have struggled with as a site and recently have committed to revamping.”

Kate Shamzad states ‘In fact, it inspired us to order a wall mirror to be installed in the infant/toddler section of the hem/onc room.”

I owe them and others many thanks for their input. But the VIPAR is and should be a work in progress. So please give me feedback if you use it at debvilasconsult@gmail.com

It is pretty easy to use. Score each category based upon observation and investigation. Add together the 18 category scores to reach a total. Use the key at bottom of rubric to interpret total score.

It can be helpful to underline or highlight specific items to be improved within each category. Once a score is obtained, determine which improvements are within your department’s ability to improve. Set goals and deadlines for improvement. This rubric is not intended to make you feel that your playroom is substandard in any way. The hope is that it will guide you towards making some small or significant changes that will improve the quality of play available in your hospital.

Click below link to access and download the pdf.

VIPAR Vilas Playroom Assessment Rubric

Teaching Playwork in the Czech Republic

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I could not have asked for a more thoughtful welcome to the Czech Republic. Disembarking the plane in Prague after my overnight journey,  I was greeted by the Královec family bearing an American flag and sweet smelling purple flowers from their garden in Malejovice.IMG_3975

Jiri and Markéta Královec, the founders and directors of the Kliček Foundation, generously sponsored my visit to teach play techniques to hospital workers at several locations in their lovely country. I had the honor of teaching one seminar at Charles University in Prague. Founded in 1348, it is the oldest and largest university in the Czech Republic and Central Europe. I was also welcomed at the Mendelova nursing school in Nový Jičin. My students ranged from a mixed group of working hospital play specialists, nurses, teachers and social workers at the university, to young students at the nursing school (our equivalent of high school students). All of the students were bright and enthusiastic learners.

Work felt like play as we all rolled up our sleeves for some interactive lessons. I demonstrated loose parts work as well as activities to share with angry or withdrawn children, such as making volcanos and oobleck, as well as toilet paper targets. Continue reading

Loose Parts Play in the UK

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Cath Hubbuck is a Registered Hospital Play Specialist in the UK. She authored Play for Sick Children — Play Specialists in Hospitals and Beyond in 2009. After 9 years in the field, she is currently a stay-at-home mother to four small children. She keeps up her skills volunteering on the pediatric neurology ward of a large children’s hospital. Cath attended a conference presentation of mine two years ago, and has been an avid fan of loose parts since then. When she recently shared some photos of a loose parts intervention on FaceBook, I encouraged her to share the backstory of the photos. Here it is in her own words.

“On one Monday morning, I visited Christopher, a seven year old boy who was due to be inpatient for five days throughout which he would be the subject of a Video EEG (VEEG). This required him to be wired up to epilepsy monitoring equipment for 24 hours a day, via a continuous video recording (and hopefully documenting an epileptic absence or seizure) and approximately 23 electrodes glued to his head, neck and chest.

I had only dropped in to find out what sort of activities he wanted at his bedside, but as I arrived he was having his last few electrodes attached and was beginning to wriggle a little. I stayed and just talked with him as the Neurophysiologist finished the job – an informal distraction, if you like – but then Christopher suddenly grabbed his much loved Rabbit and said “Rabbit needs some wires, too!” Continue reading

Target Practice Part II

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… Reentering Steven’s room, I stopped at the sink to fill the bedpan with warm water, placing the filled bedpan on Steven’s rolling bedside table. The sheets and towels went on the floor against the wall opposite the foot of his bed. Steven’s eyes followed my every movement, showing curiosity and anticipation

So, here’s the deal.” I said. “Lots of kids have stuff happen in the hospital that they find upsetting or scary. Sometimes it helps to get these feelings out in a physical way. I am setting up a target game, where you will get to throw wet toilet paper at what is upsetting you until it is completely destroyed. The question for you now is, do you want to destroy the drawing of your hand, or is there some other thing you could draw that you’d like to obliterate?”

Steven picked up a marker, so I brought over the big piece of chart paper. He got right down to work, drawing a huge needle that took up the entire sheet of paper.

“Oh,” I said. “That looks like the needle that might have to go in your hand.”

He nodded. When he finished, I took it from him and taped it on the wall opposite his bed.

“Now for the demonstration,” I said, reaching for the roll of toilet paper. “See, you take as much as you can to make a nice, big wad.” Continue reading

Target Practice Part I

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As a child life specialist, I’ve seen countless examples of play transforming a child’s mood in the hospital environment. I remember well the day when Steven lay curled in a ball beneath the covers in his hospital bed, his caffe latte bald head hiding beneath the sheets. He had not showed up in the playroom that afternoon, which was unusual. This was one of those kids who waited eagerly outside the door each day for the playroom to open and was often the last to skate his IV pole back to his room at the end of the day. I had yet to see Steven without a smile on his round, open face. He was a content child with a quiet maturity that went well beyond his seven years. He took his medical treatment in stride and enjoyed the company of his brother and sisters, as well as just about every activity the playroom had to offer.

But not this day. It was mid-afternoon and we had yet to see a glimpse of Steven. His mother stopped by and informed me that Steven had an infection in his Broviak catheter and that it would have to be surgically removed.

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The Box

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 Juan was a 7-year-old, sturdy kid with shortly-cropped black hair in the first grade at an inner city public school. Juan’ teacher asked me to work with him on his social skills and impulsivity. My mode of working with children is based on the principles of the child-centered approach, which calls for unconditional positive regard for the child and trust in the child’s ability to find his own way towards healing. This removes the adult-driven agenda as one creates an emotionally supportive play space in which the child explores avenues of his own healing.

The first time I brought Juan into the playroom, he knew exactly what to do.

The toys in my portable play toolkit were chosen to encourage expressive and dramatic play: human figures, rescue vehicles, a toy medical kit, crayons, and playdough. During our weekly sessions, the room itself became part of the play space as well, with its piles of school materials. Each session, Juan would initiate play and instruct me how to play. I served as a willing participant, but I strove to remain in a subservient role, allowing him to direct my actions to suit his needs. I acted as both participant and witness, narrating his play and giving words to the emotions that he played out before me.

Themes emerged, as did routines. One in particular was a challenge for me. At the end of every session, he would avoid putting a stop to his play and refuse to return to the classroom. He would hide behind furniture and boxes, making me feel like an ogre as I prodded and cajoled him out the door. Continue reading