The first three days of my project were spent in the Children’s Hospital at Montefiore, in the Bronx. This is a large Children’s hospital with a 26 bedded PICU with a cardiac/ECMO program.
View from the PICU window!
I was predominately here to explore the Child Life Specialist (CLS) program after I was put in contact with the team by the Child Life Council. I have been interested in the CLS role as on researching American hospitals it is clear that they play a strong role within the PICU environment so I was keen to learn how they differ from our hospital play specialists and what we could learn from them. My wonderful host Katie had set me up with a comprehensive itinerary, spending time with not only the CLS team and associated therapists but also social workers, the nurse manager and the palliative care doctor.
On learning more about the CLS team from their director, I was surprised to learn that all CLS’s will soon require a masters degree in Child Life plus a 600 hour internship to be able to practice. The aim for the profession as a whole is to embrace the international community to improve standards. They are keen to not be considered as just a nice amenity for families but as a therapeutic necessity instead and they are looking towards an evidence base that shows improvement and good results from their practice.
I was particularly interested in the PCCU Caregivers Support Group that they have set up, which is a group led by the CLS or the social worker for one hour every week for the parents or caregivers to come away from the bedside and sit together in a relaxing atmosphere, drink some tea and coffee, do a craft activity and are encouraged to chat to each other for support and ask any questions or air any grievances with the group leader. This is a fairly new program but has had some very positive feedback from the caregivers who have participated.
The CLS team do a lot of in depth procedural play, with real medical equipment (including needles!) where possible where they can help normalise the child with the procedure, reveal and deal with any misconceptions the child might have and give them some choice in how they want it carrying out.
Montefiore has very strict rules for siblings visiting however for those who do come, a strong sibling support program was in place, with the CLS meeting the sibling away from the bedside and doing a preparation session with them to explore what they might see and hear and help with activities to help them create positive memories and feel closer to their sibling such as artwork and legacy making.
One of the long standing CLS told me a wonderful story that really seemed to sum up the work they do (and what I hope for with my project to an extent!). A few months ago, she was walking down the street by the hospital when a young woman she didn’t recognise ran up to her and gave her a hug. After the CLS had to apologise for not knowing her, the young woman explained that 12 years ago, she had been in PICU for 6 weeks and had nearly died. However, despite everything she’d been through, her overwhelming memories of that time were not traumatic but of this CLS coming in and spending time with her nearly every day of her admission. This was then reinforced when I went with a different CLS to visit an old patient of hers who had had a very long and rocky PICU stay before going to rehab and had come back for a clinic. They were telling me some of the stuff they’d done whilst he’d been in hospital when the child turned to the CLS and said ‘We had fun didn’t we’. The mum agreed, ‘Yes we do have some happy memories’.