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Authors:
Kim Corey, MS, CCLS: Kim has been a child life specialist for 3 years at UPMC Children's Hospital of Pittsburgh, working in Same Day Surgery, Infusion/Dialysis and as part of the Adaptative Care Team (ACT). Outside of direct patient and family care, Kim is passionate about supporting students through their child life journey.
Danyah Hasan, MS, CCLS: Danyah is a child life specialist with four years of experience at UPMC Children's Hospital of Pittsburgh, working in the PICU, orthopedic, neurology, trauma, and general medicine units. She is currently applying skills she gained in child life to transition into a career as a physician assistant, continuing her commitment to supporting patients and families in a new capacity.
Ashley Lee, MS, CCLS: Ashley is a child life specialist in the PEDS/PICU unit at Providence Alaska Children's Hospital in Anchorage, AK. As a first-year specialist, she values the opportunity to work in a smaller unit that offers diverse experiences engaging with members of the Alaskan community.
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Supervisor Education: Lean into Uncomfortable Conversations – A Growth Mindset
Performative DEI is Harmful – Acknowledge it’s Okay to Make Mistakes
Embracing DEI is more than just saying, “We support diversity, equity, and inclusion”. It should include open conversations, empathetic listening and a willingness to lean into uncomfortable conversations. As an intern, I was very excited about the fact that my internship site offered a DEI in-service. I was disappointed when I went to that in-service. When I pointed out phrases on slides, I was met with stares and silence. When I voiced experiences, I was similarly met with silence. I became increasingly uncomfortable as the only person of color in the room. I did not want to come off as someone who was “lecturing” my white peers, and this experience made me feel “othered”. At the end of my internship, I provided feedback about this in-service and positive changes were made that included a complete overhaul of the presentation and incorporation of different media styles, graphics, and open discussion. One thing that is now included in this presentation is the acknowledgement that people make mistakes, and when they do, it’s an opportunity to learn from mistakes rather than an indicator that makes you a bad person.
Cultural Sensitivity/Awareness in Feedback & Coping Styles
Being mindful of differences in culture as well as promoting more DEI-committees and opportunities for BIPOC students to share their own perspectives would be a great step in supporting BIPOC students. There may be cultural differences that aren’t shared from the start between an intern and their supervisor which can often lead to misunderstandings and miscommunication. Therefore, having these conversations from the beginning can be important for the rest of the internship.
A prime example relates to sharing feelings. Based on my recent experiences and feedback, I was told numerous times that "sharing feelings" and being "vulnerable" were ways to help myself cope with the struggles and challenges of the internship. Although internally, I wanted to— a cultural limitation hindered me from being able to do so completely. Personally, talking about "feelings" while growing up was often limited and less encouraged. Sharing feelings of sadness or despair, in particular, was often seen as a sign of "weakness." When my supervisor suggested that I share my personal feelings—whether I was burnt out or struggling to communicate effectively—and advocate for a break, I found this difficult to do. This was not only because, as interns, in general we aim to give our very best effort and demonstrate perseverance and resilience, but also because communicating feelings of burnout is even more challenging for someone like me, who was raised with the motto of "no pain, no gain." Although I recognize the intent behind my supervisor's encouragement and understand that expressing feelings and emotions is a healthier habit, I believe it’s important to also acknowledge that each intern copes differently, similarly to how each patient copes differently. Sharing feelings is genuinely challenging and takes time. Rather than expecting interns to share vulnerably right away, it might be helpful for supervisors to consider this during their training to foster a supportive/therapeutic relationship first. Recognizing these cultural and individual differences, rather than blaming an intern for not being "communicative enough" about their limits, I believe is an important aspect to address in internship supervision training.
Language Considerations
Given that some BIPOC students' first language is not English, I believe it would also be beneficial to keep this in mind during supervisor training. Recognizing that the way things are done or said with a patient is not limited to a "one-way" approach is crucial as well. Throughout my internship, there have been numerous moments where I phrased certain words or sentences in a way that best fit my style while still being appropriate to the conversation with the patient. However, my supervisor would often correct my sentences to make them sound more "proper" or "well-educated." This added stress to my experience, as I worried about grammatical errors in my phrasing and felt pressured to adhere to the concept of "code-switching" more than being able to truly focus on the patient themself. My supervisor would frequently go over specific phrases or alternative ways of saying things in a more "proper" sense before entering a patient’s room, which only heightened my nerves. I believe it would be helpful for future intern supervisors to consider that phrasing can differ for each intern or individual while still being appropriate and effectively getting the point across. Being mindful that English is also not the first language for some BIPOC students like myself, can also help alleviate the additional stress of an internship. Instead of focusing on perfecting grammatical errors or phrasing in both verbal and written contexts—such as assignments—this understanding can create a more supportive and inclusive environment overall given my personal experiences.
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Financial Burdens & Relocation
Personally, as a first-generation Korean American student and daughter, one of the major obstacles I faced when applying for child life internships was the idea of future financial burdens and relocating to a new state to complete an internship. With two immigrant parents supporting my family through their small local Korean grocery store in Alaska, it was hard to convince them of my passion for this field initially when they were well aware of the financial limitations in pay and the need to move to secure an internship or even a practicum. Although I was fortunate enough to obtain a practicum in the same state where I was pursuing my undergraduate/master’s degree, for many students, especially first-generation BIPOC students, this is a huge struggle.
In addition to future financial limitations, considering that many child life internships are unpaid, this also posed a significant barrier within the process. For many BIPOC students who may already face economic hardships, these additional financial costs and burdens can further become mentally draining, even when wanting to pursue this field. With additional costs such as transportation, hospital attire, housing, etc., BIPOC students with already limited resources can face further challenges within the child life field. I often had to secure multiple jobs during the summer and even during the academic year to save enough money to keep myself afloat when it came time to pursue an internship and relocate to a new state. On top of the coursework of my master’s program, completing a practicum, and juggling two other jobs, it was definitely a struggle to manage it all. However, I knew it was one of the only ways I’d be able to support myself financially for the future of an internship.
With immigrant parents who have worked hard and sacrificed so much to help me receive my education and pursue my career, I felt that the pay and ability to keep myself afloat within this field made it more difficult to commit at times. Moreover, I also felt the guilt and fear of not being able to provide for my parents as they grow older as many CCLSs have portrayed this field of being very underpaid and more often, not enough to support themselves. As a Korean American, I often faced the immense pressure of becoming successful for my immigrant parents, especially when the time comes when I may have to take care of them as they grow older. Assisted living care facilities/elderly homes are most often not an option within Korean culture, and so I also think of the pay as a CCLS on how I may support my parents as they grow older in the future when they may have to live with me.
Additionally, I am aware of the diversity scholarship that the ACLP provides; however, only a few are selected, and the amount given is not in full. I believe the funds should be provided in full at the start of an internship to help budget for immediate expenses such as rent, utilities, and transportation, especially considering BIPOC students who may lack resources to fund these necessities from the start.
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Action Steps Forward
Similarly to Part 1 of this series, as child life specialists, we embrace Maslow’s Hierarchy of Needs, including the need for “safety”, and we strongly encourage this child life mindset of growth to meet this need for “safety” to expand our field and support BIPOC students through their child life journey. We caution against reading some of these experiences and thinking, “well we can’t do anything about that”. Rather, we encourage introspection regarding what else can be done to make students feel safe coming to your program. Based on these handful of perspectives, there are more and less involved steps that every program can take; many of these insights that have been stated and are summarized below are supported by both the ACLP and research.
Provide resources or highlight the resources your department has to support students. Whether that be a list of affordable accommodation options, food bank resources, information regarding use of public transportation, or secondhand clothing options. Create these resources if they don’t exist. The culture and resources of a child life program directly impacts a student’s experience.
Offer a DEI In-Service for interns: make sure the in-service incorporates opportunity for discussion and that supervisors know how to facilitate discussion
Highlight the importance of apologizing and a growth mindset: for example, we talk to our students about the use of pronouns and what to do if you accidentally use the wrong pronoun. It can be intimidating to engage in conversations around DEI because people are so afraid of making mistakes. Especially as supervisors, we often don’t want to come across as “not knowing” since we’re the experts expected to teach. However, the reality is that mistakes happen. What we do afterwards is what allows us to grow and become better specialists and supervisors.
Provide a DEI In-service for new hires: along the lines mentions above, start the conversations early within the department. Discuss cultural humility, and how it is important to always be open to learning. We as child life specialists know that every patient and family has unique needs, and part of our job is to assess what those are. The same applies when it comes to diversity, equity, and inclusion. Not one single patient or family is the same, even if they come from cultures/backgrounds that one has worked with before
Internship Supervisors should engage in continuous learning opportunities to combat unconscious bias and promote stronger relationships with BIPOC students. If you didn’t read Part 1, below are a couple of resources from the ACLP to start:
ACLP Free PDU: Introduction to Intersectional Relationships in Child Life Practice
ACLP Bulletin, Summer 2023: Supporting Autistic Child Life Students by Mary Ann Gill
ACLP Bulletin, Winter 2023: DIVERSIFYING THE FIELD Supporting the Development of Child Life Academic Programs at Historically Black Colleges & Universities and Hispanic-Serving Institutions (Hammond et al., 2023)
Remember students are looking to preceptors to guide, but it is equally important for preceptors to recognize when different support is needed.
Offer a scholarship fund that is accessible, even if only partially, before internship starts to help lessen the financial burden that many minority student face when it comes to internship (ACLP, 2021). Or if you can’t offer a scholarship, eliminate other financial barriers and implement alternative accessible options including emailing applications to avoid mailing fees, asking for unofficial transcripts, and offering virtual interviews.