Utilizing CCTV and YouTube in Pediatric Health Care
ACLP Bulletin | Summer 2021 | VOL. 39 NO.3
Chantal K. LeBlanc, BPs, MHS, CCLS, IWK Health, Halifax, NS.
Cleveland D. Sauer, MSW, RSW, IWK Health, Halifax, NS
Krista J. McKeage, BA, CCLS, IWK Health, Halifax, NS
We are all aware of the significant time spent by children watching television or utilizing screens, such as phones, computers, and tablets for digital media. The American Academy of Child and Adolescent Psychiatry (2020) has determined that children between the ages of 8-12 years watch screens between four and six hours per day, and teens interact with screens for up to nine hours per day. Because of the influence television may have on the life of a child, it is incumbent upon child life professionals and others in health care to consider the utilization of television and other screen experiences in hospital settings.
Hospitalized children watch more TV than non-hospitalized children and are exposed to more adult content (DiMaggio et al., 2003; Guttentag et al., 1981, 1983). Researchers have consistently recommended commercial-free, alternative programming to support developmental and coping needs of pediatric patients. Across North America, child life professionals have been utilizing closed-circuit television (CCTV) for decades (Guttentag, 1986; Guttentag et al., 1981). In 1983, Guttentag et al. reported alternative children’s programming and live broadcasts by child life were preferred by patients (compared to commercial broadcasting) and had positive effects for patients and staff. Importantly, viewing CCTV had not replaced children’s time in the play spaces but rather filled a void. In 1986, Guttentag summarized the “state of the art” in pediatric television after sending 178 surveys to child life directors at pediatric hospitals and general hospitals with more than 65 pediatric beds using the 1984 Directory of Child Life Programs in North America. Responses from 128 hospitals (85 pediatric hospitals and 43 general hospitals) provided insight into the tremendous variability across CCTV stations in terms of funding, staffing, content, source of content (video) and/or live programming, and broadcast duration and capabilities. This range demonstrated that CCTV stations operated at various levels and could be instituted with very limited resources.
IWK Health in Nova Scotia, Canada, began the use of CCTV for patients and families in 1981 (learn more about the program in the sidebar on page 23). Since there has been no new research in the last 30 years regarding the use of CCTV programming for pediatric patients, child life staff at IWK Health made the decision to investigate if and how other child life programs across North America were utilizing CCTV. In 2018, a survey was launched to gather foundational information from 25 Canadian hospitals and 12 US hospitals with Seacrest Studios and/or known CCTV programs. We recognize this was a small sample of the number of programs that may exist. However, it was felt to be sufficient for our purpose: to inform our CL-TV programming and provide foundational information for research grant submissions. The purpose of this paper is to share the findings of this survey and explore implications for child life programs and practice.
Participants and Demographics
Nineteen of 37 participants completed the survey, an overall response rate of 51%. See Figure 1 for the breakdown of surveys distributed and the number of respondents with CCTV, hospital YouTube, and child life YouTube channels by country. Most respondents were from independent children’s hospitals while the remainder were from various types of facilities (see Figure 2).
Child Life oversaw the CCTV Channel for 70% of the organizations while Public Relations (PR) managed most of the organizations’ YouTube Channels. Child Life oversaw the one child life YouTube channel reported. Half of the organizations did not capture numbers of patients watching CCTV while the other half mentioned having done audits, surveys, or real-time counts.
CCTV content varied and included: hospital information, TV programming, movies, videos by and for patients/families, celebrity visits, live shows with special guests, patient education, and videos by staff or outside groups. More specifically, CCTV contained primarily children’s TV programs (cable/TV shows) and videos created by employees for patients and families (hospital information, educational materials, etc.). Figure 3 illustrates the type of content primarily shown on these CCTV channels.
Child Life and Seacrest/ Studio staff were most often responsible for determining content to be used, while PR was also noted. Eighty percent of respondents indicated they provided live shows for their patients, 70% indicated they provided on-site pre-recorded videos (primarily in the activity area or patient rooms), and 60% indicated they provided third-party videos (see Figure 4a). Those with live shows indicated they can have interactive capabilities via telephone, live studio audience, and social media platforms (see Figure 4b).
Patient and Family Involvement in CCTV. Ten of 19 organizations have CCTV in their pediatric areas. The level of patient and family involvement in video creation varied: some patients and families assisted with writing, directing, and producing; some created content or participated in videos; and some assisted with technical support and video editing of CCTV programs. See Figure 5 for further details.
When asked about patient and family programming, respondents listed live broadcasts (game shows, Seacrest Studio live stream, celebrity visits), hospital and foundation education, information, and virtual tours. This also included live or pre-recorded shows with music, storytelling, science, Lego©, art, interviews, Clown TV, mindfulness, and trivia.
Location of CCTV Video Creation. Shows and videos were created in various locations. Six of the ten respondents with CCTV reported videos were made within the hospital and/ or in a studio space (2 Canadian respondents; 4 U.S. respondents), as well as patient rooms (50%) and activity areas (50%). Interestingly, 40% of these respondents indicated recordings also took place on location, outside the hospital.
Dedicated Resources for CCTV. Sixty percent of respondents indicated there was a dedicated budget for their CCTV program, and half had dedicated human resources assigned. Staffing included various roles: child life specialists, media program technicians, videographers, studio managers, child life specialist technician, volunteers, interns, and/or patient technology coordinators, with a range of part-time to full-time staff.
|CCTV at IWK Health in Nova Scotia, Canada
The use of CCTV for patients and families at IWK Health in Nova Scotia, Canada, began in 1981 as TV-4U (Television For You) with VHS video looping technology, broadcasting in-hospital-created videos as well as VHS shows/movies, 7 days a week during the day. Our CCTV program, now called Child Life Television (CL-TV), was relaunched in 2011 after a five-year hiatus. Two years later, CL-TV extended programming from inside the hospital walls to our IWK Child Life YouTube Channel with over 450 followers and nearly 200,000 views to date.
Patients and families can create patient*-led videosnearly anywhere in the hospital or in the theatre/studio. The recordings are edited and broadcast through our CCTV channel, and with consent, uploaded onto our Child Life YouTube channel. We believe co-creating a patient-led video
with members of the child life team provides a form of play/expression, allows patients to take control of and be distracted from their environment and hospital experiences, explore their personal narrative, and move beyond the sick role.
* For brevity, “patient” in the context of this article represents child and youth patients as well as siblings
Six of 19 respondents had hospital YouTube channels, and only one had a child life YouTube channel. In the United States, all hospital YouTube channels were overseen by PR whereas in Canada, child life and PR were mentioned. The hospital YouTube channels contained videos created by employees for patients and families (83%), such as practical hospital information (67%) and advertising of products and services (33%), as well as cable/purchased programming (17%) and videos created by patients and families (17%).
Child life YouTube channel content was either created by patients and families or by employees for the benefit of patients and their families. The videos were recorded in studios/ dedicated spaces, activity areas, and/or patient rooms. Child life services determined and managed the content, while patients and families participated in video development, created content, wrote, directed, produced, edited, and assisted in the technical production (see Figure 5). Some patients and families also received assistance from a videographer/ technical support person.
Discussion and Implications for Practice
The purpose of the survey was to gain a better understanding of the hospitals who have CCTV in their pediatric units and how CCTV is used with/for pediatric patients and families, as well as human and financial resource information related to this programming. We also asked about the use of YouTube channels for patients and families. Although the survey was not as widely distributed as Guttentag’s survey in 1984, the variation in programs, types of CCTV content, pre-recorded and live programming, who manages the CCTV content, and human resource issues remain similar nearly thirty years later. In Canada, funding to provide regular, creative, and/or live programming remains a challenge for many hospitals.
Diverse programs, large and small, with varied resources are using CCTV for pediatric patients, and some are providing video creation or live programming with patients. We believe video creation and live programming with patients improve outcomes for hospitalized children and their families, however, more research is needed. Child life professionals can utilize these survey results in their own settings, collaborate with one another, share ideas and program content across settings, develop best practices, and advocate for quality viewing for hospitalized children.
Since this survey and the onset of the worldwide COVID-19 pandemic, more child life specialists are exploring CCTV and virtual technologies as tools to provide therapeutic interventions, social engagement, play programming, and virtual guest visitors. Child life specialists have been brainstorming and sharing innovative uses of CCTV and various technologies to support and mitigate the sense of isolation because of COVID-19 restrictions impacting playrooms, group programming, and decreased social interactions. Technology is quickly evolving, and we have confidence that video creation and sharing will continue to offer alternative therapeutic programming to hospitalized children. New technologies are making video creation easier, and it is common for children and youth to upload their own videos and/or watch videos created by others.
Our survey findings provide insight to what currently exists and help us appreciate the similarities and differences among CCTV programs in North America. Of special interest to us was that about half of hospitals surveyed provide opportunities for patient and family participation in the development and creation of videos to be shown on their CCTV channels for pediatric areas. Our child life team believes the creation of videos with and for patients and families has enhanced television viewing for young patients at our centre and provides a valuable therapeutic tool to promote coping and resiliency. We believe it can positively influence their personal narrative, while making the hospital a place of discovery, expression, and accomplishment. These survey results provide foundational information about CCTV in pediatrics and can inform grant/research funding applications. The findings can also act as a steppingstone for child life professionals to utilize this creative therapeutic medium, whether their budget and resources are large or small. Research is needed to explore the benefit of this therapeutic tool, and we are committed to contributing to this body of knowledge and evidence to support our clinical observations.
Acknowledgements: A special thank you to Kate Morrison, former CCLS and current IWK Child Life Television volunteer whose support and contribution to this work was so valued; to our colleagues at the Hospital for Sick Children in Toronto who took the time to provide feedback about the survey questions; and to all the individuals who completed the survey, glitches, and all!
American Academy of Child & Adolescent Psychiatry. (2020). Screen Time and Children. https://www.aacap.org/AACAP/Families_and_Youth/Facts_ for_Families/FFF-Guide/Children-And-Watching-TV-054.aspx
DiMaggio, D.M., Sharif, I., & Hoffman-Rosenfeld, J. (2003). TV guides: Exposure of hospitalized children to inappropriate programming. Ambulatory Pediatrics, 3(2), 98-101. https://doi.org/10.1367/1539-4409(2003)003<0098:TGEOHC>2.0.CO;2.
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