Nurses came into our school to administer immunizations, so I created a “waiting room” for students that included bubble wrap, stress balls, and focus tools to help decrease needle anxiety. Students and I discussed coping plans as they waited (Will they look or not look? Do they need a distraction
or prefer that I sit with them?) After their poke, students approached me in the hallways saying how much fun they had blowing bubbles and playing tricks on the nurses with whoopie cushions. Older students were upset that they didn’t have the “waiting room” last year.
Students often show behavioural signs of separation anxiety on their first day of kindergarten, much in the same way that patients worry about going to the OR without their parents. To minimize this anxiety, I initiated “happy visits” to help normalize the school environment. In collaboration with the early learning multi-disciplinary team, we invited next year’s students for an hour-long kindergarten test run. I helped transition some of the more anxious students into the classroom by getting on their level and playing (e.g., driving a truck to the classroom). This initial school experience of reading books, dancing, and free play was a positive one for most of the students and they were excited to come back in September.
A student in Grade 2 required accommodations to complete his work without becoming frustrated and violent. However, the teacher expected academic achievements similar to the other students in the class. To help, I first needed to build rapport with the teacher and create a therapeutic relationship with the student to better understand both parties’ needs and vulnerabilities. To establish a safe and understanding environment, I provided developmentally appropriate explanations of the student’s multiple diagnoses and life experiences to both the student and the teacher. We discussed the student’s motivators and strengths to create optimal interventions and interactions. I encouraged the teacher to employ a child-centered approach and help the child identify feelings rather than just sending him to the
office. Surprisingly, winning over teachers is very similar to winning over nurses!
A student in Grade 1 was diagnosed with autism spectrum disorder. I reviewed the psychological assessment with his mother to help with comprehension and direct her focus towards his strengths. With the help of the family school liaison worker, we also connected her to community resources for further support. The student and I discussed his new diagnosis by watching a video and reading some books so that he would have a better understanding of his own diagnosis and we could then present our findings for his class to cultivate awareness and empathy in his peers as well as his teacher.
A student was developmentally at a Grade 3 level but was cognitively functioning at a kindergarten level. By encouraging the student to voice what he wanted to learn about to his teacher, we all came up with tactile-based learning strategies and fewer learning objectives so that he could complete similar projects to those of his peers. Learning through play promoted inclusion, empowerment, mastery, and fewer challenging behaviours in the classroom.
In preschool, one child got upset during clean-up time and would scream, cry, or sometimes flop to the floor and bang his head. The child was often overwhelmed by the large number of staff in the room helping to support the teacher and students. I introduced the idea of only having one person handle a situation at a time, similar to the One Voice concept used in procedures (Wagers, 2013). Everyone was informed about the individualized behaviour plan to follow so that the same message could be communicated to the student every single time he got upset.
In addition to providing the traditional interventions described, I have also been able to focus on the hospital to school transition in my role. When I was a child life specialist in the hospital, I did not see myself playing an important role in the transition of a patient back to the school setting. Looking further into evidence-based practice, research reflects the benefits of school reintegration programs for children, which are associated with fewer behaviour problems, higher social self-esteem, higher rates of student adjustment, and increased knowledge gains for both teachers and classmates (Heffer & Lowe, 2000). Now that I have taken a step into the school system, I see a large gap in this important transition, both in the reintegration from hospital to school, but also from school to hospital.
Many child life specialists who deliver services within the school system run “teddy bear clinics” to help prepare students for going to the hospital or other healthcare related settings. By playing and experimenting with medical sup plies, students work through misconceptions and become familiar with healthcare related topics. Similarly, I brought in my medical play supplies to our preschool classroom after they expressed an interest in having a hospital play center. I went into the classroom to initiate medical play and support them in trying out the doctor and nurse roles with teddy bears. Next year we are planning a field trip to our local children’s hospital for a “happy visit.”
A number of students at our school have medical issues (cerebral palsy, scoliosis, a cancer survivor, emergency surgeries, etc.) and have returned to school after a hospital visit; however there was no plan in place to support this transition. I initiated a medical play group that utilizes therapeutic play opportunities (puppets, medical play, sand tray worlds, projective drawings) to promote mastery, control, understanding, and emotional expression. This group allowed these students a safe place to interact with peers who have experienced similar life events, and in response we have seen positive changes in these students’ classroom behaviours.
A girl in junior high was having surgery to remove a tumor in her leg, so we made a cake with a “tumor” and performed the “surgery” in front of the class. A junior high boy had a brain tumor, so we made Jello “brains” with marbles in them. By showing how hard the marbles were to cut out, his peers understood why he had to get radiation instead of surgery. A Grade 1 girl had leukemia, so we read a book about losing hair and played a movement game (where children moved differently depending on the type of cell they were pretending to be) to show how chemotherapy works to help clean out her blood. These presentations made cancer less scary and more approachable because the students had more
information to understand. Making the unknown known resulted in a more accepting attitude towards their peers with cancer.
Some psychosocial needs are not necessarily related to a child having a health-related issue; however that does not mean that the skill set of a child life specialist cannot attend to these types of needs and childhood challenges. The benefit of being a child life specialist in a school is that I can proactively prepare hundreds of students with coping skills before they even reach the hospital. The following school-based interventions encompass child wellness and behavioural health, playing a critical role in how students generalize and adapt skills to challenging life events.
A girl in Grade 6 found her school work too difficult and did not know how to ask for help, so she often tried to escape doing it at all by leaving the classroom. We practiced calming techniques like grounding and muscle relaxation for her to use at her desk. We also came up with a plan that she would check in with an adult before starting an assignment. If the academics were still challenging, she would close her eyes, visualize the beach, and go over everything she sensed. Once calm, she would raise her hand and ask for help.
Many behaviours in the classroom stem from a student being dysregulated due to sensory overload, overstimulation, or a stress response. Ideally we want students to regulate independently at their desks, but they may need a quiet space in the classroom or another room altogether. I collaborated with the occupational therapy team to create a regulation room with sound machines, crash pads, alternative seating, bubbles, fidgets, and feeling visuals from Generation Mindful’sTime In Toolkit (Tucker, 2019). Regulation bins will be available this year in all early learning and elementary classrooms, which include items like handstamps, bubbles, pinwheels, I Spy books, kinetic sand, etc. Teachers can use an item of the student’s choice to help calm them before trying to problem solve. I also recently received a grant to upgrade our regulation room to a multi-sensory room for students with disabilities. The equipment is now being set up for the students to use in the upcoming school year.
I ran a district-wide professional development presentation that focused on the brain functioning behind a stress response, sharing how sometimes a student’s frontal lobe “switches off” and therefore needs to be calmed down before their “rational brain” will start working again to problem solve. Teachers now have a better understanding that students cope differently based on their previous experiences with stress, and that their behaviour is affected by other ecological variables as well.
A Grade 4 student with conduct disorder had challenges with keeping his hands to himself, as well as with socialskills and problem solving. My assistant and I were able to teach his whole class about whole body listening, ignoring muscles, personal space, respect, “I” messages, and problem solving. I have also collaborated with the school social worker to present on healthy friendships and boundaries. By including the whole class in these lessons, the student was not singled out and everyone benefited from the lessons. Universal Language help children regulate their behaviours appropriately. If the situation is predictable then students are more likely to perceive themselves as being able to cope. They will then utilize problem-focused coping to have an enhanced sense of control over the perceived stressor (Jaaniste, Hayes, & von Baeyer, 2007).
According to ACLP’s position statement, “there is significant value in including child life professionals in a variety of community based settings” (ACLP, 2018, para. 4), which is not only limited to school systems. No matter where you find yourself working as a child life specialist, remember that we are all trying to accomplish the same thing: We assess psychosocial needs, promote resilience, minimize stress, and ultimately help families and their children cope with new or stressful situations. Our child life tools can be used in multiple settings and environments. Sometimes our work will be carried out in reaction to a child’s problem; however, generally our child life expertise assists us in being proactive, thus preventing the problem from ever manifesting itself behaviourally in the first place. If our profession continues to reach beyond the hospital walls and out into the community, think of how many more lives our profession will positively impact, leaving a lasting imprint of resiliency and proactively preparing children for any change, challenge, or crisis they may face. At a staff meeting, I spoke to the teaching staff about the importance of the language we use with students, highlighting the difference between using responsive rather than
reactive language. By creating positive, strength-based rules, all teachers speak the same universal language and students know what they can do instead of focusing on what they can’t (e.g., “walking feet” instead of “no running”).
Preparation for a test or upcoming change in a student’s daily routine is similar to preparing a child for a surgery, since both interventions increase certainty and coping while decreasing uncertainty and stress. Self-regulation theory suggests that accurate preparation information can help children regulate their behaviours appropriately. If the situation is predictable then students are more likely to perceive themselves as being able to cope. They will then utilize problem-focused coping to have an enhanced sense of control over the perceived stressor (Jaaniste, Hayes, & von Baeyer, 2007).
According to ACLP’s position statement, “there is significant value in including child life professionals in a variety of community based settings” (ACLP, 2018, para. 4), which is not only limited to school systems. No matter where you find yourself working as a child life specialist, remember that we are all trying to accomplish the same thing: We assess psychosocial needs, promote resilience, minimize stress, and ultimately help families and their children cope with new or stressful situations. Our child life tools can be used in multiple settings and environments. Sometimes our work will be carried out in reaction to a child’s problem; however, generally our child life expertise assists us in being proactive, thus preventing the problem from ever manifesting itself behaviourally in the first place. If our profession continues to reach beyond the hospital walls and out into the community, think of how many more lives our profession will positively impact, leaving a lasting imprint of resiliency and proactively preparing children for
any change, challenge, or crisis they may face.