Child Life in Action

in a One-Person Program with Nicole Perez, MA, CCLS

by Yvonne Kassimatis | June 15, 2020

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Nicole Perez, MA, CCLS, works in a one-person child life program at Elmhurst Hospital, in one of the most densely populated and diverse neighborhoods in the borough of Queens in New York City. There are as many as 800 languages spoken in New York City, and nowhere in the world has more than Queens, according to the Endangered Language Alliance (ELA).

Elmhurst was also the epicenter of the epicenter at the height of the coronavirus pandemic in New York. Nicole rose to the challenge, as did so many other first responders.

"There is so much which can be lost in translation and we constantly have to remind ourselves of the effects body language can have on communicating with patients and families."

The diversity in the neighborhood, in both language and cultural traditions, can pose challenges when providing patient care. "There is so much which can be lost in translation and we constantly have to remind ourselves of the effects body language can have on communicating with patients and families." Though there are some on-site translators, the staff relies heavily on translation via telephone or video calls.

As a native Spanish speaker, Nicole can easily establish a connection with the predominantly Hispanic/Latino demographic. But, there are still challenges when it comes to religious or cultural practices due to the vast variety within the Latino community. She experiences even greater challenges with patients of Asian descent, the second most common patient population. There are numerous languages spoken, compounded with multiple dialects, and many religious affiliations. It can be hard to communicate with parents in conversation, trying to provide development information or asking about different milestones the child may/may not have mastered.

"Let's face it, the term 'Child Life Specialist' doesn't really translate well into any language (even with Spanish you could get puzzled looks), but luckily play is universal and at least that initial rapport can be built before bringing in any additional translation services." Nicole tries to simplify phrases, using tangible examples, picture demonstrations, and repeating herself to clarify that parents are understanding. In-person interactions are now kept to a minimum (if any at all) due to the coronavirus and Nicole is adapting to provide care for patients remotely.

"Let's face it, the term 'Child Life Specialist' doesn't really translate well into any language, but luckily play is universal. "

As a result of the pandemic, there has been a decrease in the pediatric census and a greater need for child life services on the adult side. Many families, particularly those with children, are dealing with grief and loss due to the illness/death of a loved one diagnosed with COVID-19. Caregivers are faced with issues of insecurity, job loss, homeschooling, and on top of all that, are grieving. Child life has been providing psychosocial care and bereavement support to these families and their children, identified and referred by palliative care, medical and/or social work staff. Child life has also been involved in encouraging staff self-care and wellness, helping those fighting hard on the front line.

While bereavement support is a service child life normally provides, it is done a bit differently now. Despite being a small program, child life here has always taken the 'extra mile' approach with compassionate interactions often ending in hugs and heartfelt exchanges with patients and staff alike. Due to the infectious nature of the pandemic, patients and families are communicating with child life remotely and resources are being provided by phone, mail and/or email. Normally child life at Elmhurst is very hands-on and unfortunately, there isn’t a space for that right now. 

Typically, child life along with other psychosocial care staff, assist families in creating precious mementos to cherish memories of the loved one. Now, parents are being encouraged to engage children in legacy making activities at home, which may or may not have that same long-lasting effect as when it is done alongside hospital staff. While the work continues to be individualized and focused on family-centered care, it has changed in nature, because of the ongoing situation.

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"Each day, I am grateful for another opportunity to work for and support my community."

When COVID-19 first started overpowering Elmhurst Hospital, Nicole noticed medical personnel in the hallway outside the adult emergency room (an area previously left empty). She would see them standing with their heads bowed down, eyes shut, some sitting on the floor with their heads tucked into their knees, and more often than not, in tears. It started out as 1 or 2 staff members and then as days went on, the numbers started to increase. Eventually, she would see up to 6 or 7 staff members scattered down that long hallway, taking turns seeking respite. It was then that Nicole realized they were all in search of a safe space to take a break from the painful reality they were living and have a quiet moment to breathe and decompress. It was heart wrenching to see their exhausted, overwhelmed faces, day in and day out.

One of Nicole's most memorable moments was the first time staff was applauded at 7:00 p.m. by the FDNY. 'New York’s Bravest' were clapping and cheering for the staff at Elmhurst Hospital, blaring the sirens on their fire trucks, and holding their signs of appreciation and gratitude for all to see. The experience was truly uplifting and brought tears to many people’s eyes. There was so much love and it was directed towards 'Elmhurst’s bravest'. Each night after that, Nicole heard the community’s support and couldn't help but smile. Along with millions of other New Yorkers, she would clap and cheer for the incredible work healthcare professionals were doing. The 7:00 p.m. tribute expanded as NYC came together in song as well, belting out Frank Sinatra’s ‘New York, New York’ in unison, conveying a message of hope, resilience, and strength. It became Nicole's favorite time of the evening.

While serving others, Nicole became ill with the coronavirus. The quick progression of the illness coupled with Nicole's asthmatic condition was very frightening. She found strength in phone calls with friends, emails from colleagues, and virtual hugs from family members. Thankfully, Nicole recovered and is back at her one-person child life program at Elmhust Hospital. "Each day, I am grateful for another opportunity to work for and support my community." In the midst of all this, Nicole applied for and was selected as one of only two ACLP One-Person Child Life Program Conference Scholarship recipients this year, sponsored by enCourage Kids Foundation. To borrow a phrase from New York Governor Andrew Cuomo, Nicole is a shining example of New York Tough, Smart, United, Disciplined, and Loving.

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Child Life Profession