Child Life in Action

in a Child Advocacy Center with Annie Drehkoff, MS, CCLS

by Bea Wikander | June 12, 2018

Annie 2

Annie Drehkoff, MS, CCLS, is the Child Life Supervisor at Chicago Children’s Advocacy Center, where she oversees a team of four. Child Advocacy Centers (CACs) are multidisciplinary centers that provide services to children who have experienced sexual abuse. More than 950 CACs in 33 countries provide valuable services to the most vulnerable members of our society. 

"I am grateful for our Child Life team as they contribute significantly to the continuum of care we are able to provide children who come to ChicagoCAC.”

These services include medical exams, forensic interviews, family advocacy, and mental health therapy. Law enforcement, child protective services, legal defense, and medical and mental health teams work collaboratively to reduce trauma and support the healing process for children and families. At the Chicago Children’s Advocacy Center—whose motto is Battling Abuse, Restoring Lives—all services are free.

Annie had never heard of child life when she was an undergraduate. She majored in anthropology and sociology and began working in sales and marketing after college. Feeling unfulfilled professionally, Annie researched and explored other career options. After shadowing a child life specialist at Children’s Memorial Hospital (now the Anne & Robert H. Lurie Children’s Hospital of Chicago), Annie felt “a connection to that type of work” and knew that she had found her ideal career. Her next step was going back to school for a master’s in child development with a concentration in child life from Erikson Institute and completing her child life internship. In 2012, she became certified at the Child Life Annual Conference in Washington, D.C.

After earning her CCLS certification, Annie began work in the NICU at Cincinnati Children’s Hospital. She loved the work but returned to the Chicago area for personal reasons. Unable to find a child life position in Chicago, she worked as a preschool teacher for two years. She never gave up on her goal to use her child life skills in an official capacity, and her perseverance paid off when she was offered a position at the Chicago Children’s Advocacy Center.

The first Child Advocacy Center was founded in Huntsville, Alabama in 1985, and the Chicago Children’s Advocacy Center opened in 2001. Before CACs, a child who had experienced sexual abuse had to retell his or her story to law enforcement, healthcare professionals, social workers, child protective services, and perhaps others. The act of retelling is potentially traumatic and triggering, particularly for a child. Child Advocacy Centers offer a better way to collect information about alleged abuse and protect and advocate for victims. At CACs, forensic interviewers trained in the National Children’s Advocacy Center Forensic Interview model conduct interviews in a supportive, non-leading manner. The purpose of the forensic interview is to gain information about the sexual abuse allegations. The child's family advocate assesses the need for medical and psychological care.

At the Chicago Children’s Advocacy Center, employees work with the Illinois Department of Children and Family Services, the Chicago Police Department, Illinois State’s Attorneys’ Office, and healthcare staff at Cook County Health & Hospital System. Funding for the Chicago Children’s Advocacy Center comes from a combination of federal, state, and city funding; private foundations; and fundraising efforts. It is mandated by law to provide funding to support children who are victims of sex abuse. Annie’s center received a Victims of Crime Act (VOCA) grant, which helped fund one full-time child life specialist.

Within the advocacy center, child life is present in the medical clinic and in the two play areas/waiting rooms for children and families awaiting therapy and forensic interviews. A full-time CCLS works in the center’s medical clinic, where she preps patients for procedures, uses normalizing play and distraction techniques, and provides support during exams and blood draws. She also supports and advocates for caregivers, as she would in a hospital setting. Another full-time CCLS works in the play rooms and Family Hope Center, where caregivers wait while a child receives therapy or completes a forensic interview. Informal support is provided for caregivers in these areas. A healthcare crisis or other traumatic experience affects the entire family, and child life professionals are trained in and attuned to family dynamics. In addition, Annie has two child life assistants—one part time and one full time. The child life assistants are bilingual in English and Spanish, which is important because many of the families are Latino and may speak only Spanish. According to the center’s most recent quarterly data, their clientele is 51% African American, 38% Latino, 8% Caucasian, and 3% other.

The Chicago Children’s Advocacy Center conducts two thousand forensic interviews a year, which is about seven to eight per day. Child life staff interacts with five thousand children a year since siblings often visit as well. To support the needs of families with children doing forensic interviews, the play room is open from 9am until 8pm and is staffed the entire time. Child life staff does not leave until the last family has completed their visit. Although play is the most obvious activity in the play rooms, preparation is an important component. Caregivers often struggle to explain the concept of a forensic interview, and some children arrive at the center with little to no knowledge of what to expect.

Child life staff provides photos of the interviewers and interview pods so children are informed about where they will go next and whom they will see. They also use first/then signs to explain to children that they will play first, talk with a family advocate, play again, and then go home. Explaining the purpose and process of the interview is important because this knowledge helps children feel safe, comfortable, and prepared and lessens any anxiety they may have about the appointment. Kids cope best through play, which is why returning to the play room after the interview is important. After the interview—a challenging experience despite the training and support of the center’s caring and professional staff—returning to a welcoming and friendly environment is an opportunity to play and process the experience. Shawntae Jones, Ph.D, Forensic Interviewer Supervisor at Chicago Children’s Advocacy Center, recognizes the contributions of the child life staff to the continuum of care:

“At the conclusion of their FIs, children have a safe, fun, neutral space to which they can return after talking about potentially difficult and scary topics. It is not uncommon for children to make reference to the Center being a “fun place,” or to note at the end of their forensic interviews that they are looking forward to returning to the “playroom” or the “hangout room.” I am grateful for our Child Life team as they contribute significantly to the continuum of care we are able to provide children who come to ChicagoCAC.”

One of Annie’s preparation tools is the result of collaboration with a child life specialist working in the emergency department of a local hospital. The hospital-based CCLS often sees children in the emergency department who will be referred to Annie’s center the following day, and she and Annie realized there was an unutilized opportunity to provide support and preparation for these children. They decided a coloring book about the advocacy center would be a valuable tool and found a graphic designer to create the book pro bono. The coloring book provides information about the center’s staff and services and provides children with a friendly, age-appropriate preview of what to expect at their appointment. The coloring book mentions, for example, that child life staff wears purple shirts and that the center sometimes has canine companionship and music magic programs.

Introducing the coloring book is one example of how Annie has thoughtfully expanded the role and effectiveness of child life at the center. When she began working at the center, child life was present in the play rooms but not the medical clinic. Thanks to Annie’s efforts, there is now a full-time CCLS in the clinic, and no patient has required sedation to complete an exam. (Although rare, referrals to the hospital for sedation occurred occasionally before the clinic acquired a full-time child life specialist.) When children understand what will happen during an exam and receive age-appropriate, individualized support during procedures, they are better able to cope.

Annie admits it is challenging to quantify the value of child life but believes because “We’re looking to support families in additional ways…it could theoretically improve their healing process.” Based on findings that show a correlation between child life services and increased patient- and family-satisfaction, Annie believes additional support from child life could make children more amenable to the interview process, empower them to provide more thorough information, and reduce the length of their therapy. Annie’s ambition is to pilot this type of expanded child life service and to get partner staff on board. Jan Waters, MS, L.C.P.C, Senior Director of Clinical Services, is a colleague who knows that child life plays an important role in the healing process:

“Positive, affirming relationships are a vital part of recovery from trauma and building resiliency against future trauma.  Our child life team provides just such positive, nurturing relationships to the children, as well as their families, when they come to attend therapy. Therapy is not always easy or fun, however, the child life team provides a supportive, positive environment where children feel safe to relax and play and sometimes learn and practice new social skills. Children and families highly value these relationships which are an important part of healing and providing therapy in a trauma informed environment.”

 Although simply having a play room staffed by people with experience working with children is better than nothing—many centers have only a basic waiting room—having a play room staffed by child life professionals is ideal. Annie is adamant that her team provides more than babysitting services. They know how to assess children for different needs, and they can “put that information to appropriate use.” Annie and her team provide specific activities and interventions to help a child express anger or build self-esteem, for example. They can also work with caregivers and siblings to heal family bonds.

Annie’s commitment to her work is inspired by Erin Merryn, the sexual abuse survivor and activist who inspired Erin’s Law and wrote a book about the abuse she experienced as a child. In the Stolen Innocence: Triumphing Over a Childhood Broken by Abuse, Erin mentions how she felt extremely nervous before a forensic interview and was comforted when an employee brought her a toy. Annie often reflects on the difference that even the smallest gestures make in the lives of the families and children they serve.

The director of Chicago Children’s Advocacy Center is a champion of child life, but not all advocacy centers directors employ child life specialists or are aware of the profession. With more than eight hundred advocacy centers nationwide, there is room for growth. Annie hopes one day all advocacy centers will employ one or more child life specialists and value the role of child life in the healing process. The key to realizing this goal is education and outreach. The National Children’s Alliance is the national association and accrediting body for Children’s Advocacy Centers. One of Annie’s professional goals is to present on the role and importance of child life in CACs at the NCA conference.

Annie also sees room for improvement at CACs that currently employ child life staff. Family advocates do not currently offer the type of preparation that child life specialists would—partly because of time constraints, their responsibility of conducting family assessments, and their lack of capacity for individual child prep. After speaking with another CAC-based child life specialist at the 2018 Child Life Annual Conference, Annie learned of additional ways to use child life in the healing process. She would also like to see therapists at her center refer clients or siblings for one-on-one intervention with the child life department.

As far as the child life profession in general, Annie would like to see ACLP do more to promote child life as a career option for high school and college students, particularly with an eye to cultural and linguistic diversity. She hopes that one day child life will “be recognized and respected across the board,” and the average person will know what she does if she says, “I’m a child life specialist.”

Annie is eager to collaborate with other child life professionals working in advocacy centers. At the 2018 Child Life Annual Conference, she met two other CCLSs working in CACs and learned new ways to apply child life skills in an advocacy center environment. If you have experience at an advocacy center and are interested in networking, please contact Annie at ADrehkoff@ChicagoCAC.org

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