Child life services can provide competitive edge

Boost satisfaction with modest investment

If your ED handles 15,000 to 20,000 pediatric patients a year, it might be time to consider adding a child life specialist to your staff.

These specialists, say observers, can increase cooperation and compliance with medical staff, can prove invaluable in pain management, significantly improve patient and family satisfaction, and set you apart from the competition.

"In those cities where EDs are competing, and there are lots of kids with options on where to go, this tremendously differentiates one ED from the others in the community," says Emory Petrack, MD, FAAP, FACEP, of Petrack Consulting in Shaker Heights, OH.

Prior to becoming a consultant, Petrack served for 10 years as the director of pediatric emergency medicine at Rainbows Baby’s and Children’s Hospital in Cleveland.

"We save the docs time, and we make an emergent health care experience a more positive experience for everyone; that’s the intended purpose," adds Shannon Chapman, CCLS, child life specialist in the ED at Children’s Healthcare of Atlanta, Eggleston Campus.

The primary goal of child life specialists, who are employed not only in pediatric hospitals but also in medical centers with pediatric units, is to reduce the impact of stressful or traumatic events for children and families, says Chapman. She is one of 40 such specialists at Children’s Healthcare, but she is the only one assigned to the ED.

The services she provides include:

  • Procedure support: Acting as a coach for coping techniques — deep breathing, guided imagery, or telling a story.
  • Distraction techniques: Using something familiar to the child that empowers them to gain a sense of control during painful procedures. These age-appropriate techniques can involve blowing bubbles, using toys from home or in the ED, music, or video games. "This also involves talking to parents beforehand," Chapman explains.
  • Medical play: Familiarizing the patients with unfamiliar procedures. This process can involve a toy suture kit, a stethoscope, or little dolls (called "Shadow Buddies" at Children’s Healthcare) on which the child can actually start a real intravenous (IV) line or perform some other procedure. (For ordering information, see the resources, below.)

Children’s Healthcare of Atlanta also uses "Hospital Buddies," which are not condition-specific and are empty of features and clothes, so the children can individualize the dolls by drawing their own faces, hair, and clothes if they so desire. These blank dolls are made and donated by community volunteers.

These techniques decrease the anxiety of parents, too, Chapman says, noting that she often sees parents nod in understanding as she explains a procedure to their child.

"If children need anything from IVs to blood draws to lumbar punctures, child life services can help prepare both child and family," Petrack adds.

Petrack and Chapman agree that perhaps the single greatest benefit of child life services is in the area of pain management.

"One of the great things about distraction techniques is that sometimes they can even obviate the need for pharmacological intervention, where otherwise the child would have needed to get sedated," Petrack explains.

Chapman has had similar experiences. "Kids come in for stitches, and if you give them something to focus on, they can lay there and be still," she says. "It’s huge in pain control."

There are different ways to structure the role of the child life specialist; having them report directly to the ED manager is the best option, but flexibility is important Petrack adds.

Chapman’s role demonstrates that flexibility. "I have a supervisor for child life, and I also report to the ED manager," she says. Nurses or doctors will refer patients to her who are very anxious or scared, but she also has direct access to patients, who she will help after conducting an emotional triage.

"I do an initial clinical assessment upon introducing child life services to patients and families," Chapman explains. "This involves conversation with both patients and parents to determine their level of coping with the current situation and stress potential." This initial assessment is a way of prioritizing and planning appropriate care.

A child life specialist also may be used as a greeter, going from room to room when staff are busy to connect with children and families and ease their anxiety, suggests Petrack. "There used to be lots of guest liaison people, but there are less and less of them since budgets have come under pressure," he explains.

When should an ED hire a child life specialist? "Unless the department sees enough kids, this is not likely to be cost-effective," says Petrack, noting that 15,000 to 20,000 patients a year may justify the salary, which he estimates at about $20,000 a year.

"If you are seeing fewer children than that, your nursing staff can be trained in these techniques," he notes, adding that his firm provides such training.

An ED with child life services gains a distinct advantage over the competition, he says. "Families come in, they feel this different environment, they sense something much more child-friendly and family-centered in this ED, they see people helping their kids when they are scared, and their whole sense of experience is changed," he notes. "Word gets out, and potentially — though the data are hard to get — you could even have an impact on your adult emergency care."

Sources and Resources

For information on using a child life specialist, contact:

  • Shannon Chapman, CCLS, Child Life Specialist, Children’s Healthcare of Atlanta, Eggleston Campus. Phone: (404) 785-6127. E-mail: Shannon.chapman@ choa.org.
  • Emory Petrack, MD, FAAP, FACEP, Petrack Consulting, 16781 Chagrin Blvd., No. 249, Shaker Heights, OH 44120. Phone: (216) 371-8755. Fax: (216) 928-9400. E-mail: epetrack@petrackconsulting.com. Web site: www.petrackconsulting.com.
  • Child Life Council is a national organization for child life specialists that provides certification programs and other member services. The web site, www.childlife.org, includes listings of state and regional chapters in the United States and Canada, as well as membership information.
  • Shadow Buddies are condition-specific and anatomically show the physical results of treating a particular condition. Pricing and ordering information can be obtained by visiting www.shadowbuddies.com, or by calling (913) 642-4646.