Below is an excerpt from the original version published in the ACLP Bulletin, Fall 2019 issue.

By: Courtney Rosborough, MSc, CCLS
Edmonton Catholic School District, Edmonton, AB, Canada

Child life specialists typically work to address specific health-related issues through individualized interventions. With advances in modern medical science, research, and technologies, there are more children with special healthcare needs entering the school system and creating diversity in the classroom (Weiner, Hoffman, & Rosen, 2009). By employing the unique and proactive child life perspective in my school-based role, I have incorporated several traditional child life interventions into our school setting.

Traditional Child Life Interventions in the School Setting:

Poke Preparation

Case Example: 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. 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.

Normalization

Case Example: 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.

Therapeutic Relationships and Rapport

Case Example: A student in Grade 2 required accommodations to complete his work without becoming frustrated and violent. However, the teacher expected academic achievements like 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.

Diagnosis Explanation

Case Example: 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. 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.

Developmentally Appropriate Education

Case Example: 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.

One Voice

Case Example: 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, like the One Voice concept used in procedures (Wagers, 2013).

Supporting the Hospital to School Transition

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. The following examples are how I tried to provide direct support for students and more information for teachers.

Teddy Bear Clinic

Case Example: Teddy Bear Clinics help prepare students for going to the hospital or other healthcare related settings. By playing and experimenting with medical supplies, students work through misconceptions and become familiar with healthcare related topics.

Medical Play and Mastery

Case Example: 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.

Cancer in the Classroom (Diagnosis Explanation)

Case Example: A Grade 1 girl had leukemia, so we read a book about losing hair and played a movement game 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 which resulted in a more accepting attitude towards their peers with cancer.

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). 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. 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.

References:  

Association of Child Life Professionals. (2018). Association of Child Life Professionals position statement on child life practice in community settings. https://www.childlife.org/docs/default-source/ about-aclp/cbp-on-cl-practice-in-community-settings.pdf

Heffer, R. W. & Lowe, P. A. (2000). A review of school reintegration programs for children with cancer. Journal of School Psychology, 38(5), 447-467.

Tucker, S. (2019). Time-In Tool Kit. Generation Mindful. https://genmindful.com/products/time-in-toolkit

Wagers. D. (2013). Speaking up for children undergoing procedures: The One Voice approach. Pediatric Nursing, 39(5), 257. https://onevoice4kids.com/

Weiner, P. L., Hoffman, M., & Rosen, C. (2009). Child life and education issues: the child with a chronic illness or special health care needs. R. H. Thompson (ed.), The Handbook of Child Life: A Guide for Pediatric Psychosocial Care (pp. 310-326). Springfield, IL: Thomas.