Making Hospitals More Hospitable with The Tongue Depressor Challenge

 

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My colleague, child life specialist Jon Luongo, is one of the most playful professionals that I have the pleasure of knowing. He taught me all about the “tongue depressor challenge”, which is described in detail in our co-authored chapter in the Handbook of Medical Play Therapy and Child Life.  Below is a brief introduction to the activity by Jon:

I encourage the doctors to tap into their imaginative playfulness to complete what I call the ‘tongue depressor challenge.’ The task is to co-construct a teaching tool alongside a patient to explain a part of the body, a particular medical condition, or piece of medical hardware. The challenge for doctor and patient is to use at least one tongue depressor in their design; like a single LEGO brick in a set of construction toys, the tongue depressor represents a humble piece of medical paraphernalia with limitless creative building potential.

 

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As with many great ideas, I borrowed Jon’s and tweaked it a bit. This past July, I brought the activity with me to the Klicek Foundation Summer Camp in Malejovice, Czech Republic. Camp directors Jiri and Marketa Královcovi graciously allowed me to lead the campers in a slight variation on Jon’s theme. Continue reading

Equity During Transitions

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At the 2018 commencement ceremony of the BankStreet College of Education this past week, graduates weren’t the only ones juggling feelings of excitement, nostalgia, and anticipation. Cheering on our Child Life Program students brought forth memories of some watershed moments in my own career. When a colleague reached out to the Child Life Forum today asking for child lifers to share thoughts about advocacy and empowerment in times of transition, I began to think more deeply about who and what supported me as I pursued my passion to work with children in hospitals.
As a career changer, I  worked as a coordinator in the volunteer department (a paid position) at a large cancer hospital for over seven years. I discovered the field of child life while attending a professional development workshop at my workplace. A participant introduced herself as a child life specialist, and I wouldn’t be surprised if the lightbulb that went off in my head lit up the whole room. I had found my calling.   She recommended the BankStreet College, and I enrolled soon thereafter,  minoring in child life within a masters in early childhood special education. The hospital paid for my degree, and it took me almost 4 years to complete as I worked full-time.
When I finally graduated, I very much wished to work in the same hospital on the pediatric ward where I had placed, trained, and supported over 125 volunteers. My colleague, the director of pediatric recreation, (child life wasn’t yet in existence there) told me that although she would enjoy working with me, she felt that if I didn’t leave the hospital and spread my wings that I would regret it. I listened to her and left for a large city hospital, working in the emergency department, pediatric wait and play room, and the child abuse clinic, where I learned more than I ever could have imagined. It was a very important time of growth for me and my colleague had been so right.
Another moment of transition came when I took on some of my first private clients. Two professors from my studies at Bankstreet referred me to work with children in their homes, to help them cope with medical procedures and the loss of a family member. My mentors provided supervision for me as I tackled this new and exciting challenge. They showed faith in me where I had little in myself, and they made it possible for me to take this next step. I am forever in their debt and I do my best to pay it forward in my work now as a professor in child life. My mentors’ investment scaffolded me to accomplish far more than I ever could have managed alone. It makes me think of Vygotsky’s zone of proximal development, and how children can accomplish more within a trusting and supportive relationship with an adult than they can on their own. But what does that mean for people who may not have access to these kinds of helpers?
With each step I have taken in my career, someone has always stepped forward to show me the way, cheering me on and acknowledging my abilities and place in the world. Some mentors have been teachers, some colleagues or friends. But that feeling of having someone opening a door for me and having my back as I walked through it, is something I have perhaps taken for granted. I may have always been grateful, but it never occurred to me that all this support could be the result of White Privilege. In her Integrated Masters Project study of Diversity and Social Capital in the Field of Child Life, BankStreet graduate Madalyn Marshall examines the obstacles for people of color entering the field of Child Life. Her research shows how social capital paves the way for White women in our profession. Given the fact that Child Life is dominated by White women, it behooves us to consider ways in which we can take action to change the face of our profession to include more people of color, to better meet the needs of the diverse populations we serve.
In the words of one of this year’s student speakers at commencement, Elise Hebel, “BankStreet’s mission and creed call on students, graduates, and teachers to enter with all five senses alert, to never stop learning, to be flexible, creative, gentle, and just, and to advocate for the rights and dignity of all.” She further entreats us to “nurture tolerance, understanding, and appreciation for the many differences and similarities that unite us, not only standing on the shoulders of giants, but stepping into the role of giant and empowering the vision and actions of others.”
Are we ready to take this first giant step? Recognizing our own positions of privilege is a start.
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Walli Kids: Spotlight & Giveaway

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Many parents arrive in hospitals for unexpected visits, sick or injured child in tow. In emergency situations, they probably don’t have a child’s favorite toy or game with them,  and they may find themselves waiting long hours without a way to distract or occupy their unhappy child. Even during expected hospitalizations, there are times when a child has to visit and wait in areas of the hospital, for tests and procedures, where they have nothing but institutional walls to greet them. Child Life Specialists know the value of great distraction tools to soothe anxiety during long waiting periods and painful procedures.

With this in mind, I would like to welcome guest blogger Patricia Montouchet, the founder of  Walli-Kids. She has a great product for parents, child life specialists, hospitals, and doctors’ offices. 

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Today I am going to tell you about Walli-Kids, the company I created a few years ago.

You might wonder what started Wallikids ?

Difficult to pinpoint exactly how the idea and the vision fell into place, but …

Many years ago, as every mother, I recall being awfully stressed when my son crashed his bicycle, hard enough to break open his helmet. We had to rush to the emergency room and… I will skip all the details. Needless to say, we had to wait long hours on that Saturday afternoon…

What to do? How to distract Lucas? What could I do to ease his pain, anxiety and hide the waiting.

Nothing, I had nothing… In our hurry, I forgot to take his books, games or even his favorite stuffed animal friend as time was of the essence. There was no picture on the walls to help distract him, no child books.  Without any doubt, this was a difficult and striking experience for me.

When my children left for college, I decided it was time to do something I would really enjoy. My daughter Margot is very creative and together, we started  drawing Ralph the Giraffe© and  Mitch the Fish© which would, after a few years, be part of our Animal Buddies collection.                              

 

Coleman the Pelican© was created after a family vacation at the beach.

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Myrtle the Turtle© after reading about the Great Coral Reef and

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           ED ABIGAIL 36x30 Abigail the Snail© to remember our  many summer vacations in our native French Alps.

Walli-Kids Animal buddies Collection is for younger kids that don’t know how to read: they have to look for numbers and pictures, soon they will start having fun. Under an adult supervision, all the many details can be highlighted such as a frog group or a crab family… These colorful designs are a conversation starter for the medical staff as it is easy to start a storytelling or ask to find other hidden animals. These posters are perfect for kids to learn new words and discover new places

At that point, we had something for younger kids but nothing for the ones who could read, so our Puzzle-Jumbles collection was created…

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This was countless hours of assembling arrays of diverse and colorful objects. Enough to keep the children entertained for a while and well-hidden to make their focus last longer…

Nevertheless, we had a lot of fun figuring out what would go into each activity-poster and then counting and re-counting each object to make sure that it was all there. The hardest Puzzle-Jumble activity-poster you might wonder? Without any doubt Animal XL© and #8 XL©

 

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We are still working on our 3rd collections: Same difference. I will keep you posted soon…

Now, the best part is that I can write about how excited I am to share with you our newest product: Acry-Walli. Our designs are reverse printed on a rigid 1/8  inch thick sheet of clear acrylic with a white vinyl backing. The end product displays vivid colors and is very durable. It is very easy to clean with any antibacterial solution, it will not be damaging to the ink as it is reverse printed. These activity-posters can be screwed on to the walls , hardware and color snap-caps are provided to hide the screws. All our designs have rounded corners to avoid catching little fingers.

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You might ask where is the best place to put the Acry-Walli? On walls, in waiting rooms, consulting and treatment rooms. Note that since we design and manufacture every product here in Atlanta, we are able to offer any size, or even incorporate our customers’ mascot or logo in the design.

There is another product that  I should mention as it has become Child Life Specialists’ best friend: our Walli-Kids lap-posters printed on a high quality styrene. All of our designs are available in this 12”x10” hand held size. We came up with this smaller dimension to make it portable and help young patients focus on something colorful and attention grabbing during medical procedures such as treatments, vaccinations… I must mention that many hospitals use them in their waiting room to help with the waiting.

As you read my article to the end, you deserve “a little something”, so if you enter your contact information on our website, Facebook or Twitter, your name will be entered in our drawing for 2 free lap-posters, one from each of our collections.

Should you have any questions on our products, do not hesitate to email me at patricia@wallikids.com.

Get Well Maps: Road to Recovery

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Please welcome our guest blogger, Christina Connors, who I interviewed after she connected with me on Linked In and sent me samples of her incredible Get Well Maps.

What inspired you to create these maps? My son’s medical experience in 2014, and my desire to help other children and families facing medical challenges, inspired me to create Get Well Maps. Andrew was 5 years old when he was hospitalized with bilateral pneumonia and H1N1 flu, and his condition quickly became life threatening. He was air lifted to our closest pediatric hospital (~2 hours away) and was transferred to the PICU secondary to respiratory failure. I felt completely helpless to care for him. There were so many uncertainties. My “Mama Bear” impulses were raging, and yet my background as an Occupational Therapist was underpinning every effort I made to advocate for my child.

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I felt compelled to have a visual that would depict his “Road Home”, because despite the uncertainty of prognosis, timeline or discharge plan, we needed to SEE our goal of getting home in the midst of adversity. I asked my childhood friend to make a map that had a road, photo of our home and matchbox car to move along as his condition progressed (My son has always loved anything with wheels). She was eager to do anything to help, but found it strange that my request of her was a “craft project” (Child Life Specialists & OTs get it). She graciously obliged, anyways. What began as a desperate mother’s attempt to provide a tool to help her child, began to draw interest from his medical team, and sparked communication that connected us throughout his care (“Is that your house?”, “Do you like to play outside?”, “Buddy, you’ve already rounded that bend”…). It was months after our experience, and after becoming involved in our pediatric hospital’s Family Advisory Committee, that another parent encouraged me to develop this idea in a way that would help other children and families throughout their medical experiences.

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What was the process like from your idea to creating the product and your company? I would be lying if I said I wasn’t scared! I was exposing a time in our family’s life that held much vulnerability. But I was also excited about the possibility of having a creative outlet that helped me process our experience in a way that helped others. My faith was strengthened by our experience, and I felt like I was being called into this work. I felt that this was a unique opportunity to combine my experience as a parent and healthcare professional (& my husband is an educator) to make a positive impact in the healthcare experiences of other children and families. I began slowly. Brainstorming, then drafting prototypes, researching materials, production options, searching for the right illustrator, and learning the basics of establishing a business. I use the analogy of a foggy road when I think about the process of transforming an idea into a company, and even now as I continue to navigate and evolve. I can’t always see where I am headed because the road is foggy, but when I have faith enough to move forward, the fog lifts briefly and becomes a little clearer just in front of me, which in turn gives me the confidence to keep going. (Just can’t seem to get away from the road/car analogies!)

Can you tell us a bit about your work as an OT and your experience as a mom? I graduated from the Occupational Therapy program at Towson University in 2002, and have been practicing as an Occupational Therapist for 15 years. I became interested in Occupational Therapy after my Aunt was in a car accident and sustained a C4-C5 spinal cord injury. It was the 1st time my family was truly impacted by disability and I was inspired to learn more about the professionals that were helping her. Since beginning my career as an OT, I have always had an equal love of pediatric and adult rehabilitation. I have experience in hospital, inpatient rehabilitation, home healthcare and school settings. I have always found my work as an OT very rewarding, and am very passionate about working with individuals with neurological disorders and sensory needs. My greatest loves… my hubbie, Mike, and my 2 children are at the center of my world. There was a lot we experienced emotionally as a family during and following my son’s hospitalization that changed my perspective as a mom. I don’t worry as much about small decisions and details, don’t take as much for granted, and really value the importance of finding moments of “calm” in our hectic day-to-day routines. Their love, support, and boundless energy are driving forces behind Child Inspired.

What do you want parents and medical staff to know about children in hospitals? I think many already know, but I think ALL medical professionals need to know that (many, if not most) children and families are not processing auditory information effectively during stressful medical events. Children and families want (and need) medical teams to disclose accurate and honest medical information, but it needs to be delivered with a compassionate, child-centered approach. Don’t be scared of informing children and parents of setbacks or regressions in progress. They know setbacks occur. They just need consistent, jargon-free language that helps them understand what is happening and supports them through the disappointment. Families and medical professionals also need to know that emotional healing will often take much longer than physical healing, and need to be educated on resources that the family can access if emotional or behavioral concerns arise after discharge.

 

What are your hopes for your company? My hope for Child Inspired is that our Get Well Maps will become a model for child-centered discharge planning, and that our tools will also help children and families visualize their progress as they re-integrate back into school and community activities after medical events. In this fast-paced, digital age where much of what our children encounter is instant gratification, many children need support and encouragement as they work towards goals that require time and perseverance. It is my hope that our Maps facilitate positive, encouraging language and communication between children and the adults providing their care.

 

Do you have any tips for how parents and child life specialists might use these maps? I love your profession and the amazing work that you do with children, siblings and families, as well as the work you do to model and advocate for child-centered care among your other medical colleagues. I think that Child Life Specialists can play a pivotal role in daily medical rounding and discharge planning, and that Get Well Maps provide a method for facilitating child-centered communication and visually tracking medical progress. A Get Well Map is fun, and individualized to the child’s interests and goal, therefore, it reduces anxiety by helping you relay and reinforce information discussed in medical rounding (often laden with medical jargon) in a way that is developmentally appropriate and child-centered. Contact us to learn more about how a CCLS is using Get Well Maps with children after bone marrow transplants, and how her unit now has a physician order and pathway to initiate Child Life assessment and intervention (including Get Well Maps) from diagnosis to discharge.
Anything else you want us to know? Thank you for all that you do! As always, I would love to collaborate with you and your teams to develop solutions for your patient populations and healthcare organizations.

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Prescription for Play: How Pediatric Play Promotes Health and Healing

I was honored and so excited to be interviewed by Photographer & Guest Writer, Marj Kleinman for her article at TocaBoca.com. She and I have much in common, including a deep passion for child life and play in hospitals, and the fact that we are both alums from Saint Ann’s School in Brooklyn, NY. She is a talented artist and used her creativity to write a photo journal of child life and play at Maimonides Hospital. I will publish that here next week. The Toca Boca article is reprinted here in full below.

Child life specialists support kids and families in a hospital environment, reducing stress and increasing joy.

Marj Kleinman
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Marj Kleinman, Toca Magazine Guest Writer

When I tell someone that I volunteer in pediatric hospitals, I usually spot a sad face across from me. That response is understandable, given that hospitals can be scary and sometimes painful and upsetting. But in fact, there’s no greater place to see joy and resilience on display, all through kids’ natural passion for play.

Whether at their doctor’s office or in the ER, kids find a way to play, particularly with encouragement. Most children’s hospitals today come equipped with a playroom and a bevy of materials and activities, so kids can be kids while hospitalized. Once they see a playroom full of toys, messy finger paints and a silly guy blowing bubbles, they know this place is made for them and they will probably feel safe there. There’s even a team of people whose job is to play with your child: the child life specialists. They become parents’ partners in health and healing.

Meet the child life team: Your play partners

Many parents are surprised to learn that there’s a person solely focused on your child’s emotional health during a hospital stay — and they do it mainly through play. Child life specialists (CLSs) help kids and families adapt to the hospital environment and support them in understanding what’s taking place, thereby reducing the stress of a hospitalization. CLSs are trained in child development and play theory, as well anatomy, research methodology, sociocultural issues, ethics, family systems and bereavement, among other things. They also act as a bridge and advocate with your medical team. Child life departments often include art and music therapists, and are visited by yoga and mindfulness teachers, clowns and other practitioners.

Language of play

Play is the universal language of childhood — in fact, when CLSs assess their patients, they’re watching how kids communicate via play. I spoke to Deborah B. Vilas, a CLS and social worker who teaches child life graduate students at Bank Street College of Education. Vilas says, “Young children won’t sit down and say, ‘I felt sad today and I think I’m anxious about the medical treatment I’m getting.’ When children are playing, they act out scenarios and show us what they’re feeling; they show us what they understand, what they’re capable of and what their coping mechanisms are.” This may seem obvious, but in some hospitals, there’s a misconception that play is frivolous or low on the priority totem pole.

Young children won’t sit down and say, ‘I felt sad today and I think I’m anxious about the medical treatment I’m getting.’

Vilas reminds us, “It’s been proven that when children have play opportunities that they need less medicine, less anesthesia, are more compliant and get better faster. The benefits of play reach beyond the child to assist medical personnel and influence the hospital’s bottom line.”

Benefits of play

According to the American Academy of Pediatrics (AAP), “Play is essential to development because it contributes to the cognitive, physical, social, and emotional well-being of children and youth. Play also offers an ideal opportunity for parents to engage fully with their children.” Why would all that stop at the hospital? The AAP goes on to state that hospital play is a necessity that helps kids cope with treatment and stay on track, developmentally. The uses and benefits of play in medical settings are varied and significant.

At its essence, play provides a safe space for kids to experiment with unfamiliar and often scary experiences. Through open-ended play, kids can take in new information at their own pace, re-create situations and play out fears until they are familiar enough to gain a sense of mastery over the situation. When supported by an empathetic parent or CLS, this process is deepened and they can better process and release feelings.

At its essence, play provides a safe space for kids to experiment with unfamiliar and often scary experiences.

Open-ended and child-centered play, in particular, are highly beneficial, as they provide opportunities for kids to immerse themselves more deeply in play and lead from a sense of agency. Unfortunately, free play has been on the decline due to our hurried and jam-packed, overscheduled and tech-filled lifestyles, yet it is necessary for skill development, self-regulation, independent thinking and creative problem solving. In the hospital, where kids lack choices, it’s even more crucial to let kids be in charge.

Medical play

One of the roles of the CLS is to normalize the hospital experience through play. They might do familiarization activities, for example, building a robot using a bedpan, tongue depressors and IV tubing, all taped together with bandages. Suddenly medical supplies aren’t scary, cold, weird objects that only doctors and nurses use, and kids can “hack” the hospital.

Going a step further, medical play with a toy doctor’s kit and/or real medical supplies can 1.) educate children about an upcoming procedure, 2.) let them process their experience, before, during or after a procedure, and 3.) put the child back in the driver’s seat.

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Meghan Amorosa, CLS, engages Jan, age 4, in medical play at Brooklyn Hospital Center, Brooklyn, N.Y. Photo by Marj Kleinman.
 

Children experience a strong sense of helplessness, vulnerability and anxiety when faced with uncertainty and misconceptions (let’s face it, so do grownups). Procedural support helps educate, greatly reducing feelings of unpredictability, and increases a level of mastery.

Meghan Amorosa, child life specialist at Brooklyn Hospital Center in Brooklyn, N.Y., says, “A really big part of medical play is about giving patients choice and control over their own hospital experience. Instead of being the patient, they become the doctor and play on their own little patient.” She observed that Jan (pictured above) gave the doll a lot of shots, which is typical in patients who’ve been poked a lot. In fact, “If a kid gives a doll a million shots, they’re showing you how painful that was for him,” says Vilas.

A really big part of medical play is about giving patients choice and control over their own hospital experience.

Movement plays a key role in healing.

Movement also plays a key role in healing, which is why doctors want patients up and walking almost right after surgery. If kids can get out of bed and step on bubble wrap or a floor piano, ride a hospital wagon around the unit, or skate down the hallway on their IV pole, they get the blood circulating, feel more energized and also empowered at the same time.

Play is powerful and can be tailored towards your child’s individual age, temperament and tastes. Read on to find out 10 ways to support kids going to the hospital, as patients or visitors.

Marj Kleinman is a Brooklyn based photographer and children’s media producer with a master’s in educational psychology.

Less anesthesia – More play for MRIs

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Erik Ranschaert and Ben Taragin

Dr. Benjamin Taragin knows a lot about what kids need when facing radiology scans. He has spearheaded the production of a miniature MRI model using toy building blocks, so that children can play about their experiences before and after scans. When I asked Dr. Ben about how this all came about, he shared the following narrative. We hope you will be inspired by his story and jump on board to help make his I Love MRI kits available to any child in need of an MRI.  Continue reading