Mary - 10/26/2020 👍

Through June I was able to meet one of her colleagues from Boston's Children's Hospital.  Mary works in the inpatient cardiology unit and interestingly, enough gave me yet another perspective on Child Life.  It was obvious from the start of the interview that Mary really knew her craft!  When asked the very first question about her definition of Child Life, she was able to provide a whole range of information about Child Life in her answer, she was a wealth of information and knowledge.  Talking to her was very interesting as I got to learn some more of the ins and outs of child life specialists and their work.

After going back and watching the four interviews I can honestly say that my interview with Mary made me very uncomfortable.  When I interviewed Rachel, June, and Shayla, I had a very strong connection with them - a connection that made it very easy to share information and stories about the field of child life.  However I felt as though Mary was more about the information and facts rather than telling me stories and the personal emotions felt by a child life worker.  

I am married to a math man - a guy who can spit out facts, numbers, and information at the drop of a hat.  However I am the complete opposite - I prefer listening, talking, and connecting with people.  It was another preconceived notion of mine that child life specialists would easily connect to just about anyone and use words and stories to make children and families feel more at ease.  It was very interesting that she did not provide the stories that my other interviews did, she, like my husband kept to just the facts.

After looking over my notes and listening to the interview one more time I realized that although I felt very uncomfortable in my interview with Mary, I got a lot of information for her.  However, while relistening to our conversation I kept thinking how different my own hospital stay was to the work that she does with her patients.  I wonder if that is a part of why I was so uncomfortable, maybe I was not able to connect because that is not how it was for me.  

Mary talks about "Preparing the patient before the procedure, letting them know what to expect, what the procedure it going to feel like, what they are going to see, what its going to smell like even." And I cannot remember this ever happening for me, I don't remember a whole heck of a lot of my hospital stay besides what has been told to me, so maybe it did happen but I do not remember it.

I would have enjoyed this interview more if Mary had given me some examples of how she and her team prepare the patients for procedures.  Do they just talk to the patient and families or do they bring them into the operating rooms before hand and show them the medical equipment they are going to have around them?  Do they work with the doctors and nurses to introduce them to the children ahead of the procedure so they become familiar?  What tools or techniques does she like to use most when preparing the patients?  In reality as I look back I wish I had asked more clarifying questions during the interview to get some of those questions answered.   Personally, I am a talker and when asked about something I am passional about I tend to just talk and talk, even in circles - so it may be my bias but I assume most people are the same way.  So if I have to pull information out of someone on a subject I assume they are passionate about, I tend to back off thinking they might not be enjoying it.  Maybe in retrospect this is why I found my interview with Mary so disheartening because I wasn't able to get them same personal information and insight as I did my other interviews.  

Death Doulas 👍

 Death Doulas:

What are death doulas?  To answer that question we must first ask, what is a doula?  A doula is typically connected with births... they assist mothers on the journey of bringing a baby into the world.  Why is there no one to assist those leaving the world?  Thus the idea of the death doulas was created.  For years and across cultures, death and dying is often a very taboo topic for people to talk about.  However, many people in hospice or in the terrible situation of having a terminal illness have to face their own mortality.  Death Doulas help with this process.  They are not only working to normalize the death and grieving process but at the same time working to create lasting connections during a patients final days.  

Unfortunately, I haven't been able to find many numbers for Doulas and Death Doulas within the United States but in terms of Child Life Specialists, there are 53,500 within the United States as of 2016.  According to the Bureau of Labor Statistics, their annual salaries has a median of $60,000 - but is dependent on the demographics and hospital.  

For me personally, I am both intrigued and concerned when I see only 53,500 Child Life Specialists in the United States.  There are 250 dedicated Children's Hospitals in the United States - if Child Life Specialists were only in the hospital this would mean that there were 214 Specialists per hospital.  However, because they can also be found in private practices, out-patient clinics, and other locations this is not the case.  According to Jane, she has 70 Child Life Specialists at Boston Children's Hospital, including music and pet therapy - no where near the 214 that I calculated.  There is no data to find where these other Child Life Specialists can be located.  Does this mean that we as a society do not value the work of Child Life Specialists?  I would agree and disagree with that statement - I would say that we do value it with the justification that every Child Life Specialist that I have spoken to had interactions and experience with them in some capacity in their youth.  In my thinking - those interactions must have been extremely valuable and memorable for them to grow up to chase that dream job.  But does that mean Child Life Specialists are only valuable to those who have been affected?  I would say yes that they are not valued outside of the walls of a Children's Hospital because they are not "advertised".  

References:

https://college.mayo.edu/academics/explore-health-care-careers/careers-a-z/child-life-specialist/#:~:text=Today%2C%20the%20special%20emotional%20and,specialists%20in%20the%20United%20States.

Missing in the Literature 👍

After my interview with Shayla on Tuesday October 20th, I started thinking about what she had said and what is missing in the Child Life Therapy literature.  Shayla talked the concept that often when people think about Child Life it is all "sunshine and rainbows" and helping children in the perfect way, but it is not always that simple.  She told me a story about the night before our meeting that she was called onto a regular floor to meet with a family who's daughter was dying and they wanted an end of life conversation with the family and her two brothers.  This type of interaction with child life is not talked about in the literature as much, or as Shayla explained in any of her courses.  Not only was she there to comfort the patient in her final hour but she also had to comfort the family in the best way possible.  As mom held onto one brother on one side of the hospital bed, the best intervention that Shayla could come up with was to kneel down and hug the second brother.  She explained that it probably wasn't the protocol or best practice but it was what the family needed at that time.  The reality is not everything can be "taught" in the classroom or found in the readings - it just comes in the moment while you are working to best support the families.  

Why is this not talked about?  It is obvious that there are going to be children in the hospital are are going to die.  So shouldn't it be a more prominent discussion?  Especially when they are terminally ill?!?  What is holding us back?  Do we not want to scare them?  Are we afraid that families will not able to comprehend the reality of death?  Maybe, it is just that we don't know exactly how to talk about death.

One of my favorite courses that I took at Rhode Island College was a nursing course with the focus on Death and Dying.  It was early on in my education at RIC but rereading some of my essays, I still have the same opinion on death and dying as I do now.  I am not and have not been afraid of dying for as long as I can remember.  I have faced my own morality on numerous occasions and my doctors have repeatedly said that I am a medical miracle.  This course showed me that my thoughts on death are not typical for many people.  Most people my age have not had to face death or think about it at all, and many of the people who have had to face death are apprehensive about it.  I am not.  I wrote in one of my essays for NURS 312:

"It has interesting that the people I have talk to about death who have chronic medical illnesses, are the ones who have accepted their death and are no longer afraid.  It is when people are not confronted with their own mortality throughout their lives that they do not have a chance to understand that death does not have to be as scary as they make it out to be.  I have said my goodbyes and if something were to ever happen, I would be more ready to die than an average person my age.  It is unnerving for me to say that to most people, if they don’t know my history and story but to me it is very normal."  

I read two of my all time favorite books while in that course, Tuesdays with Morrie and The Last Lecture.  Both have the prevailing theme of dying throughout the entire story and yet I still hold them both close to my heart.  When talking about both to almost anyone, they say they have watched Tuesdays with Morrie on film but not read the book and many haven't even heard of The Last Lecture.  As a society are we more ok with watching and hearing about death on the big screen than we are with reading about it or being around it in real life?  Hundreds of people died in the Titanic, and yet it is one of blockbusters biggest hits.  Why?  In talking to Corinne, it made me think that as a society we are filled with death and dying and yet we have become desensitized to it on a global scale but not in an individual and personal way.  There have been more school shootings and mass killings in my life than ever before.  And yet, our society keeps going on each and every day.  Even in this pandemic, thousands are dying but we keep trying to continue our daily routines.  Is that because we don't like to face the idea of death?  We don't like to think about it, it makes us uncomfortable and thus it isn't a big deal?  It won't happen to me so why bother?  

My husband lost his father to a brain tumor when he was only ten and we lost his mother to uterine cancer when he was 24ish.  While his mother Carole was dying, we went to the hospice center on multiple occasions.  However Matt was always very noticeably uncomfortable.  To this day, I remember the day we got the phone call from the doctors saying she probably would not last the night and Matt refused to go up to see her.  I argued with him that it was not about us, the people who were living but about Carole and that she needed someone there but he was adamant about not going.  To him, he did not want to watch another parent die and who was I to push him?  His brother had up and left for another state with everything that he wanted of his moms leaving Matt to deal the house, the finances, the funeral planning, and the inevitable loss of their mother all while finishing his semester at URI.  To this day, Matt does not like to talk about either one of his parents, which to me is very sad because I like to remember them - I have pictures of them all over the dining room and would love to know about them to tell our children one day.  I have had my fair share of loss throughout my years, nothing compared to Matt but I feel as though my thinking on death and dying is so different than most.  I like to remember those who have passed, through pictures, videos, even celebrating their lives, however for Matt he is still very uncomfortable about the whole idea of death.  It in interesting that none of my other interviews talked about death really at all - which is very concerning - do they themselves not like to talk about it or have they not had to deal with it as much in their positions?  Is that because Shayla is in a more urban part of the country where death and dying of children is more of a regular occurrence?  

Shayla - 10/20/2020 👍

When I was looking for people to interview about Child Life Therapy, I put a post on a facebook Child Life group that I am involved with.  Thankfully a woman Shayla reached out to me saying that she would be more than willing to do an interview with me, and was I glad that she did.  Shayla is a Child Life Specialist at University of Maryland Pediatric Hospital in the Emergency Department (ED).  The community that she works most with is low income people of color, so it was very interesting talking to her about Child Life.  Shayla does not have the same resources and funding that my other interviewees have.  In addition, the population that Shayla works with does not have the same conception of understanding about Child Life workers, programs, and important role that my previous interviewees spoke about.  Shayla spoke about some families that are not able to stay with their child through the night because they have to go to work or have other children at home that need to be taken care of.  Because of that and so many other factors, the families that she worked with may need different approaches and interventions.  She explained that sometimes the best way to connect with the family is to get them what they need at that moment and sometimes that is just a glass of water and a blanket.  This interview was very eye opening to me.  Shayla talked about the "dark side" of child life that no one ever talks about.  

https://ri-college.zoom.us/rec/share/ZUABvjVfpzalHHDJgtNBb6j5IjG3TsDJixlUbvG4Zn1sCdCSZKra1DIHOhDzPlIs.3f9c27az3JzA-SjM?startTime=1603226411000

Transcript of Interview:

All right, step in your own words, can you talk to me a little bit how you would define a child life specialist and what they do, what their job is?

 
A:  Yeah, so.  I my personal philosophy on child life is that we meet in families where they're at typically within a health care setting and we address their psychosocial needs in that moment. And by doing that, we assess what is needed and then provide appropriate interventions based off that assessment. And so that can look like a lot of different things for a lot of different families.
But I think one of the key elements of a child life specialist is the ability to assess and then provide whatever intervention is appropriate for that family, because there are so many wonderful child life interventions that you can use in various different practices and in various different environments. But not all families and not all patients and children are going to benefit from every type of child life intervention.

And so it's really about assessing and addressing those psychosocial needs and that moment and then also creating like a long term plan of care and ways to help families and children cope throughout their health care journey.

All right. Can you talk to me a little bit about because like everyone who I've interviewed has used the phrase meet a child where they're at. What does that mean to you? 

A:  I think it's for me it's going in to a room and trying not to have preconceived notions about what I think that child's going to need based off of like what I hear from nursing or what I hear from doctors.

It's and at times. Also kind of not, you know.

Having preconceived notions based on what parents think they're going to need to, because sometimes parents also go into stressful situations and think their kids are going to react certain ways and interpret things in certain ways, but taking that and listening to that, but also really tuning in with the kid and meeting that child where they're at and doing your own assessment in that moment while also taking the input of parents and families and doctors and nurses.

But. You know, addressing what that kid needs in the moment, but also knowing that meeting that child where they're at is going to change throughout your time with them.

And so that could be right within that 15 minute time span here with them, especially for me in an emergency room or like a long term care that can change day to day. Yeah, and so trying to not have a plan of care in mind before you meet the family and it's important to go into a room and have some sense of how you're going to intervene and options of what you're going to offer.

But knowing that that can all go out the window just depending upon what is appropriate for the child.

And thirty two seconds. Yeah. Gotcha. 

The above question with Shayla was a really interesting one for me.  It wasn't part of my original interview questions so it was nice to just have a conversation about what "meeting the child where they are at" meant to her because it was not the first time I had heard that during my interviews.

OK, how did you get involved with child life? 

A:  So when I was about like four four, I had some like bladder and kidney problems and I needed several because I don't know if you're familiar with that procedure. And those are very traumatizing for adults even. Right.  

And so I had I was being seen at a community hospital and then my dad works at Johns Hopkins. And so my parents ended up taking me there. And my mom just being kind of the overprotective, wanting to really help her child through. It was like, we need more help. This isn't working.

And Hopkins obviously had child life. And I work with a child life specialist. I ended up needing surgery as well. Nothing nowadays the surgery is very minor, but this is still traumatizing. Twenty years ago, this happened, so. Yeah, I was in the hospital for several days and work with child life, and so that's how I kind of found out about them. But I didn't really want to become a child life specialist until the beginning of college.

Like, I didn't anticipate going. Yeah, I didn't anticipate going into child life throughout high school or anything like that. And it wasn't until I started working at a rehab hospital like a pediatric rehabilitation hospital in Baltimore, and they had child life two that I kind of was like, oh, I kind of revisited what child life was and realized from a professional setting.

I really enjoyed it and wanted to pursue it professionally. Why were you in nursing? No, actually, I grew up. Like, I was pretty much like professionally trained in dance, and so I went to college originally for dance, so I went to a very small liberal arts college and ended up transferring to a bigger college for child life.

But yeah, so I kind of changed completely. And it happened. Yeah. So you were originally this kind of leads into my next one. 

I have found that most of the people who are child life specialists only know about them because they have had interactions with them.  It is not a "typical" job that is advertised unlike a social worker, or guidance counselor which makes it a pretty uncommon field consequently a difficult field to get into because there aren't many opportunities for internships and education.

What was the process that you went through either professionally or educationally to get to where you are?

A:  Yeah, so I pretty much knew my friends like my first semester, freshman year was kind of when I was having a lot of doubts. And so thankfully I transferred I don't even last year at this college. So I transferred to Towson University that has a Child Life Master's program, and I met with the program director of the grad program who ended up being my advisor. And she just was like, OK, you really need to start volunteering and just kind of getting a sense of if this is really what you want to do and just kind of get those hours.

And so I started volunteering at Hopkins and then I still continue to work at this pediatric rehab hospital. Right. And then Charleston has an accelerated graduate program. So you can do their undergrad program with a concentration in child life and do their master's program in five years. Wow.

So I applied for that the same time I was applying for a child like practicum. And then I got into the grad program, I got a practicum. And then right when I was finishing my practicum, a child life assistant position opened up at Hopkins where I'd been volunteering. So I applied for that and was fortunate enough to get that. And then I just kind of maintain being an assistant, finishing grad school that applying to internship and then setting for certification and then getting a job.

And here we are seeing. 

What are your strengths as a child life specialist like?

A:  Like for me personally or I think you personally talk to me about you.

One thing I think I've gotten a lot of feedback from various supervisors and colleagues is that I have and something I try to bring to my personal life, too, is that I tend to be like the go to person in a crisis. I can be very calm and levelheaded. And those moments, which has really shown to be helpful in the emergency room, I can imagine. And so I think that's.

Which is really interesting because as a person, I, you know, have lots of anxiety, I have my own mental health issues. And so it's always really funny when people are like, oh, you're so calm and you're so you have such a calming presence. And I like that I'm able to give it off because, you know, sometimes inside I'm like, well, I'm dying inside.

I'm glad I'm glad you think I'm coming back. I just try to be. Relaxing, honestly, I had a student with me a couple of months ago, and she was with me just for probably three days or so, and we were wrapping up kind of the end of her week.

And she was like, just like you kids like really differently than I've seen a lot of people prep kids. She's like, you prep them in a way that's like you don't make things seem like a big deal. And she's like not like you're undermining their feelings, but you're so casual with the way that you talk about it and you're so calm about the way that you talk about it, that it's like she's like it made me feel like, oh, like this is just an I've just got to do it. We got to get it done. But like, here's how to make it better. And that's just kind of the approach I have.

With most things and I think that works for the emergency room environment, who's to say I don't know if my style would change if I did it worked on a different unit, but I tend to take things as they come and address things as they are needed. And I think being able to stay calm and have patience is.

I'd like to think it's one of my strengths. It sounds like it. 

So if I had to ask you for, like, a situation that kind of played off that strength and was in the end a good outcome for a patient, what would that look like?

A:  Well, last night, I. Work until eleven thirty, but I didn't end up leaving work until almost one a.m..

There is a death in the Picayune and after a certain time the specialist covers the whole hospital. And so I got paged just they were withdrawing care from a teenage patient. And it wasn't I had never met this family and. So I got the page and I always I'm very attached to my team and my staff, I work really well with them. It's always very different, like going to another unit. And I go to their unit plenty.

But it's just there's nothing like your own staff. Yeah. Yeah.

And so I always get like, oh, God, I don't feel like dealing with this, but, you know, you've got to do what you got to do and you gotta, you know, be professional and move on. So I went up there and the mom was just at a loss with whether or not to have the three younger brothers come up to visit. And just looking for me to just tell her what was appropriate. And I was just like, you know, I there's no right or wrong answer to this.

And we kind of talked through what she thought, the pros and cons of both. And she ended up deciding to let them come up. And lots of family came up.

And I was just kind of lingering outside of the room because we had made a plan that, like brothers, we're going to come up, we would let them see sister. And then we were going to do like handprints and molds and whatnot. And I was just kind of lingering outside the room waiting for siblings to come. And mom came down the hallway with the two oldest ones who were like school aged kids, older, maybe like older adolescents, and then like a school age kid.

And when they entered the room, they just like completely lost it emotionally, like complete hysterics. And I just go into very much like crisis mode. And so I just like went into the room and like Mom went on one side of the bed with one brother and I while on the other side about the other brother. And I just like crouched down next to him.

And I tend to be and I don't know if this is always the best approach or the most appropriate approach, but I tend to be more hands on with families in this situation. I'm very physically affectionate and with covid I know that's not always great, but in this moment, that's what this kid needed, like my other brother. And so I just wrapped my arms around one of the other brothers and we just kind of talked through what they're feeling in that moment.

And I was able to talk to mom beforehand a little bit about like their perceptions on death and like faith. And I could incorporate their thoughts and feelings on that in our conversation. But when I came out of the room by myself, the nursing staff was like, I don't understand how you're holding it together.

And I'm like, oh, like know. And I was such and just work mode at that moment. And I was like, oh, well, I mean, I have to. And they're like, that was one of the worst reactions we've seen. Like it was horrible. And I don't even really remember it that much because I just went into like I just yeah.

Yeah, you just have to make it not it's not about you and not that it's wrong to shed a tear or to show your own empathy and sympathy, but I just go into. Fight or flight, and my fight is support right now.

I think that's more. Most recently last night, just something that's been on my mind, that's been something that I was able to do. And I feel like I felt honestly a little bit useless up until siblings came. And I was like, OK, this is what I'm here for and this is how I can support. And so who knows what you know, when they look back on this day, what they'll remember, but I hope they at least can know that they did have people there to support them, to support them and are there for them.

So and this is just me listening to what you're saying.

This is a story that really stuck with me, so much so that I shared it in my presentation with YDEV.  It is interesting that she was so honest in saying it probably wasn't best practice but in the moment, it was.  So even with all the training in the world, it is the situation that dictates and drives the techniques that are implemented in the moment.  

Would you say that you were not only there for the patient, but you were there for the family, whereas like the doctors and the nurses were more so there for the family? 

A:  For the patient, I'm sorry. Yeah, I think. Yeah, from like a child like textbook situation, like, of course, we look at doctors and nurses are there to help the medical aspects of this patient, and that is why child life is important, because we're there to support families.

But this patient had been in the picture for not quite a week and. The You staff had formed a really great relationship with mom and dad, siblings had not yet been to visit or anything. It was just mom and dad that had been around. And so I'd be lying if I said I was the only person supporting family because I definitely wasn't.

But I think. What's helpful about child life in those moments is that even though we know that this child is not going to make it, she's neurologically devastated. We're going to have to withdraw care at some point, like there are still changes happening, happening physically. There are still alarms going off. Nurses still have to do different medical aspects of it.

Doctor, still to talk to family about organ donation, I'm just that one person that doesn't have to do any of that. Like I'm not here to be like, oh, just so you know, like we have to remove this or that thing from that medical. Yeah. And they handle the pick your team. They're experts and end of life stuff, unfortunately, but they are and they're great about doing it, but they have to be that person that's like, oh hey mom, I need to talk to you about we talk to you about organ donation.

Can I pull you aside and have those hard conversations where.

They like when mom would and I spent four hours up in the pic, you like helping family back and forth to bedside, but I think for the mom at least, she knew that whenever she saw me and was interacting with me, like I wasn't going to break any more news to her. I wasn't going to have any more additional like, oh, make this decision. Now, we need to talk about this now. Which I think is helpful for families to know that at least like when they're sitting with me and when I'm supporting them, I'm not going to be like, oh yeah, that's what are we going to take out the intubation to or what are we going to remove this stuff?

Yeah, and from a nursing standpoint, you know, that wasn't that nurses only patient that night, and so she has changed a dying patient in one room and then another dying patient in another room. And she still has to continue on with medical care and so with everybody else. Yeah. And so my focus was definitely more on the emotional aspect of family. That. I think it's interesting, the two different worlds coming together.

Yeah, I know that you have talked about interventions when you're having a difficult situation and like the one last night, what are some like what are your I don't want to say favorite interventions, but how do you what do you use? 

A:  I think it depends on the situation again, like last night was very was a very serious, heartbreaking situation.  But my day to day is and death, I do deal death in the setting. But my day to day is IVs and sutures and broken bones. And so. I would say my main intervention is building a relationship with the kid before any other physical thing that I provide.

I'm really fortunate that in the end, I have a really good relationship with all my nursing staff and all my attendings residents obviously come and go, so. I do my best to educate residents and form relationships with them, but ultimately it's my attendings and my nurses that I work with day in and day out.

And we have a big team approach when it comes to creating care plans for kids, when it comes to what type of pain management are we going to do, what type of farm, even pathological pain management. I'm very present for all those conversations. And so I think. At times, it can be easy to say, like, oh, my favorite entrenchments, like I'd be lying if I said my iPad wasn't my go to, you know, it's there.

I have it. It's great for distraction. But I would say, like my biggest and most valuable intervention is being able to collaborate with my team and knowing that we can adjust and reassess the plan at any point that I feel like it's not going well. And in order to have the best outcome, I need a relationship with that kid, so being able to go and make a quick assessment, can this kid tolerate it with minimal medication? Will this kid need distraction? If so, what type of distraction?

And then communicating that with my nursing staff and my doctors of, hey, this is the plan. Which isn't the most like best cookie cutter child by fans are like, oh, my white wand, but I mean, that's the truth, right?

And that's what I'm looking for.

Have you found that your either your interventions or the way that you're connecting with kids or any of that have changed in our covid times? 

A:  I wouldn't say it's changed with covid, I think it's changed a lot as I've grown more. I've been practicing now for a year and a half and I definitely think that it's changed a lot since starting out as a child life specialist.  I've learned to adapt my introduction of services quite a bit, especially in an environment. It's fast paced, there's a lot of moving parts, sometimes I don't introduce services until the entire medical workup is done because I go in, we're replacing a line, we're drawing labs.

We could be straight carrying a baby. We could be doing a lumbar puncture and. I got to go, I got to make stuff to do out what's best. Yeah, and not to say that I'm going into rooms and not saying like, oh, I'm Sarah, but not really going into tons of detail of what I am until afterwards, just because sometimes there's not the time and. That was a weird transition going from an intern, because I did not intern. I didn't do my internship in the ED, so.

Moving into the ED, where the environment is very different than like an inpatient setting and then also learning to adapt. How I interview services based off what that kid's there for, you know, if it's a newly diagnosed diabetic that's going to be admitted, my introduction of services is going to look really different for them than the kid that we're placing a cast on. And they're going home right now. Yeah.

And so just trying to you what is best for myself, like what are my goals?

One of my main key points that I want this family to understand about child life before I go into the room that's going to best serve them on a more long term basis if they need life on a more long term basis. 

Right. So. Talking about figuring out what services work best, have you have you noticed that your services towards one? I don't want to say minority, but one group is different than another. Do you think?

Or at least in the way that you interact with different groups. 

A:  No, I, I mean, I work.  In Baltimore City, my the majority of my population is children of color, and then with that, Baltimore is one of the poorest cities in our country. So I would say I work with the main population I work with tends to be lower income African-American children.

And so I wouldn't say like my intervention or my interruption of services changes from group to group because I typically don't interact with that many different groups.

All right. So now I would say no. I think, to be honest, I did my internship in Texas and Dallas, which is just so vastly different from Baltimore. Yes. And. I think something I've really learned to think about and reflect on is that.

Two families that I work with, child life services, often look like a luxury to families who don't have their basic needs met. Right. And so I've learned that sometimes the hostility or just the at times me perceiving that like, oh, they don't want to talk to me.

It's not about not wanting child life. It's that this mom has three other kids at home and she's trying to figure out who's going to pick them up. She has to go home and make dinner. She has to get herself to work. But her other kids here, who is going to pick her up from work, the kids getting admitted, who's going to stay with this kid? And she needs water. She just needs water. She just needs something to drink and she just needs food.

So I think that has changed a lot of what I do in terms of sometimes I'm literally just giving that mom water and giving them a blanket before I introduce all of what. Yeah, so I think from that aspect, it hasn't changed. It doesn't like the way I interact with families and patients, doesn't change change day to day today now. But I think it's changed quite a bit, kind of moving from one population to another and just different areas.

And I'm from Baltimore. I was born and raised in Baltimore. So that. You know, I'm familiar with it, but I think learning how to practice child life in Dallas. It was it's different, it's just very different.

I can see that, yeah, my brother lived in Texas, so, um, do you think that. And forgive me. Being a white woman, do you think that identity affects your work, especially in the populations that you work in? 

A:  Yeah, I mean.  Absolutely, I think I think it affects my relationships with family, with parents more than just kids, you know. Kids. Tend to be. More trusting, and they tend to judge you based off your actions in that moment of like, oh, hey, she told me the truth about this needle or she gave me these toys, you know, versus parents who have their own experiences in their world and the world in their own opinions on things. And so at times, I think it definitely does impact.

I work I work quite a bit with our psychiatric population, which tends to be more so like a behavioral health population, which it's a lot of kids that are up.

I don't know if you're familiar with emergency petition to. Police can emersion emergency petition anyone, really, if they feel that they're a threat to themselves or to other people, and typically they emergency petition adolescents for doing dangerous or illegal stuff when they bring them to us versus bringing them to juvie. Not to say that we get emergency protection for kids that are self harming.

And that is tough, too. But we do get a lot of emergency petitions for just a kid acting aggressive toward mom. And I've really had to learn to think about how I'm going into those rooms and what that adolescent is going to think of me right off the bat, because so many of the kids that I work with have experienced so much trauma, the loss that these kids have experienced, the violence that these kids have experienced. You know.

And on the outside, I am a privileged white woman. And so knowing that going into the room, I think.

It requires a lot of self reflection. Yeah, and the ability to not make it about you when a kid doesn't want to talk to you and doesn't have it isn't about having a relationship with you. And I haven't thankfully, I haven't really had experiences where kids weren't open to talking to me, but not to say that that's never going to happen.

But I just really try. To be mindful. Of how kids can perceive me and how families can perceive me, but, yeah, I definitely think I think and nowadays, too, and the culture that we're in and, you know, the social tensions that are happening, you know, I'd be delusional if I thought that the color of my skin didn't impact some of the families that I worked with. Especially parents.

I think there's such a stigma, especially for African-American women, that the health care systems don't take them seriously and they don't address their needs.

And so sometimes. What other people interpret as them being aggressive or loud, it's just them trying to get their voice heard and trying to get the needs of their child heard, and I think reminding myself and helping remind my staff that, you know, that this mom is escalating. This mom is talking loudly because she feels we're not listening to her finger. I think is more helpful just to have us all as a team reflect and better assess and address these families needs.

I like that, I like that you bring in the staff to your answer. Yeah, I really. I love my staff. It shows. 

What advice would you have for a brand new child life specialist just coming in or even an intern? 

A:  I think my advice for an intern and the child life specialists would be very different, I think as an intern, like I would just say, like take absorb everything you can and.  Ask all the questions that you feel are dumb and go through hypotheticals, if you don't get the chance to see certain things, talk through them, and then because if you don't, then you're going to be stuck by yourself one night doing it by yourself and not that. You can do it, you can get it done, but it's helpful to kind of talk through those things when you when things are it's low staff.

Yeah, you have somebody.

But for a new child life specialist, going back to my staff, I think, like when I started in the end, my number one priority was being on my unit 90 percent of my day because out of sight, out of mind. And I my big philosophy is that, like when I messed up procedure, it's 60 percent my fault and 40 percent of the nurses fault. And I mean that because a lot of specialists put it on their nurses like, oh, they didn't mean oh, they didn't call me.

And I tend to be more like, well, where was I? If I'm in my office, I need to be looking at the board. I need you watching orders. I need to see who's coming in and out. My job is patient care. My admin duties come second. And there will be times that you miss procedures, and that's just the way it is, but I think.

Being present on your unit and, you know, was. Probably the most helpful thing for me in the beginning. Nurses can be hard people to get in with their very goal oriented, and they're very they have their way and they like to do it certain ways. And so I think for some people that can be intimidating, especially emergency room nurses, but. I think showing them that you're a part of the team is really helpful.

I also think doing things that are not, quote unquote child life jobs is really helpful.

You know, I try to remind students that, like, we're never too good to get families water and get families blankets and to help clean up. Yeah, and that's the type of stuff that nurses appreciate, and so when they see like, oh, hey, she's helping out with this and she said, my family how to get to this place where people, if they like you as a person, that they're going to want you around for the Ivy and the other procedures.

And so I think I just really emphasized so much to students that, like, when you get your first job, you can't do your job without the nursing staff. If you don't know that a procedure is happening, that you can't be there for it and then you're not doing your job. Right. Right. And so just really focusing on trying to have a good relationship and you don't have to like everybody, but it's helpful when you like at least the majority of them and they like, you know.

Yeah, and just knowing that you can rely on them, and I think for me, partially, I'm so appreciative of my staff and I'm so reliant on them is because I work hours that I hardly ever see other child life stuff. I don't see child life stuff on the weekends. I see child stuff for a couple hours during the day and then I by myself.

And I know that I can go to them like I I'm off today and I talk to the Picchi specialist about the death that happened last night. So I have my job, my staff. But, you know, when it's nine o'clock at night. It's my nursing staff that I have, and that's all I rely on to kind of help get through the night and.

I think also it helps. When you have those good working relationships, that helps your job satisfaction. We judgmentally will help you burn out less quickly because we'll all burn out one point or the other, but, you know, helps to fill your cup at least a little bit. We'd like to think that's way far down the line.

Oh, gosh. Now, I think it's a revolving door. I mean, oh, no, you burn out and then you fill your cup and then you're back and then you're back. 

Are you the only one during the night shift?

Are you the only you are? How terrifying is that? It's so bad. I think I'm terrified for you now. And this is my first job to my first certified job. 

I no, it's not bad. I think just knowing how to prioritize is really helpful.

My position is funded by the ED, there's two of us and the need that we cut, we do seven day week coverage and so we only overlap like one day a week for a couple hours. So from a funding standpoint, like, my priority is to be embedded with the population because that is who is paying for my position.

But if there's a death in the picture, I'm not going to, you know, not do child life there, too, but when it comes down to it, my main priority is the dead and working with those patients and families and then assessing what comes in as need be, typically the other units, the impatient Jenkins units, the pick you.

Tend to be peculiar, but tend to be a little slightly more predictable than the 80, so I can get a report out from those specialists during the day of how this procedure might happen. This kid is getting this line removed. This kid going home, which can kind of help shape how I think my night is going to go. But of course, even the peculiar deaths happen. Emergency procedures need to happen.

And so. They sure know how to find me. They call the Ed begging for me to. Yeah, I just try to balance and I communicate as best I can with the team of like, hey, I'm going to be in Kikue, I will let you know how long I think I'll be up there when I get there, that sort of thing. But it's really not as scary as I think some people think it is.

It's like when you're in the moment, you just kind of got to go with that and you don't have time to be like, oh, crap, how am I supposed to do this? You just got to do it. Your adrenaline kicks in. Yeah. 

If you have the ability to go back to school and learn something to help better your career, what would what would you do? What would you learn?

A:  So many things, and I feel like I have a really great education and I think. Sometimes from an academic standpoint, we focus so much on developmental levels and what are the stressors for that developmental level? And so what are going to be the coinciding interventions and.

I feel like, you know, we don't put enough emphasis on how to work with interdisciplinary team. We don't learn like what do you do when you're in a room with the patient and we're doing sutures and the resident keeps telling McCan that they don't feel anything and the kids like. But I do feel it in the residents like, well, no, you don't you're not like what do you do in that moment? How do you talk to the resident after that?

That's the type of stuff that and I think those are the things in general that you just have to learn as it happens. Just think from an academic standpoint, we do students a slight disservice because we don't even. Broke at all of how do you deal with not even bad relationships, but like just difficult one?

Me and my co-worker, my co-worker had done lots of education, like team building stuff in the 80s. We did a lot of stuff for child life, mom and. We put a lot of emphasis on continuing to educate staff, even staff that know all about comfort zones, but like let's talk about why nurses hate. Let's just broach the uncomfortable subject. Most nurses hate them. Let's talk about why how can we make this better?

Yeah, and I just think from a student standpoint, like. We never talk about that kind of stuff, and so I think for me that was something I really had to kind of learn on the go. Like I always give the example to students like, you know, you learn in class all the great comfort holds and you were in the room with the family and you're prepping the family and you have this great idea for this positioning. But what do you do when the nurse is like, no, I don't want to do that. I'm not comfortable poking a kid in that position.

Right. You have that conversation and that's never talked about, at least for me. That was never talked about. Right. More. And so just kind of how to address my goals and nursing goals and doctor goals and how they can all work together to best serve the families, so.

Yeah, I'm very big on staff. I can see that and it really shows yeah, it's a good thing though, I promise. Yeah, yeah, yeah. 

What do you want to tell me that I haven't asked or I should keep in my mind or anything like that? What do you want to tell me? 

A:  Oh, gosh.  Do you plan on becoming a child life specialist someday when I grow up? I think. A lot of students and I mean myself and my friends and a lot of students look at my friend.

It's like magical to a lot of them and. You know, it's bubbles and light ones and these beautiful interventions, and you're the unsung, the unsung heroes of the hospital and you see all the amazing posts from the CLP and all the great interventions that we highlight. But 80 percent of my days are not bubbles and light ones and.

That sort of thing, and so I think. That is why we have had so many child life specialist burn out of this job and transition onto different jobs because we go in with a preconceived notion of how magical and wonderful it's going to be and. For some people, it ends up not being that and I think putting emphasis back on that, you're working in health care with really sick kids, but also you're working with families that are often at their lowest points on their worst days. And so just keeping that in mind, when you're going through schooling and you're going through internship and there are great days are great, perfect textbook child life interventions that happen. I'm like, wow, that kid beautiful with Ivy.

But last night when I got out of the Pigou, I walked down downstairs to the ED and my staff was getting ready to do three rape kits on three kids. And I deal with sexual assault all the time in the 80s. And that's just not something that we talk about from a student standpoint. And there's nothing magical fun at all about any of that.

Yeah, and so I think just knowing that there are really not that it's not because I do love what I do, but they're really, really hard aspects of child. Yeah.

And so I think sometimes when I have students, I've had a couple students shout at me for certain days and have had an intern for her like elective week, I think sometimes there's a disconnect between students and what it's like to actually be practicing. And I can only tell that by the questions they ask, not that they're inappropriate, but they sometimes tend to be off base.

And I have students ask me all the time, when do I do medical play? How often do I do medical play? What are your medical things? And it's like always so funny when I get asked that, because I'm like, it's a good month if I do one time. And I love my job, especially when I was a little kid, that's when we did, we did and I love it. But medical play is I have my IV catheter on my dad and I show the kid the catheter before we do the poke. And that's about for moment.

And that's what it is. And so. When you get ask questions like that, it's always kind of a bit of a hint of like that's not that's so far off of what I get to do every day and when especially does get to do it. It's it's a Facebook post and it's an article. And it's this amazing thing. It's not a every day.

Yeah. Yeah. And and maybe it maybe it is for an impatient specialist on a giant PEDs unit, I don't know, or an oncology specialist that has kids that she can form really good relationships with. But it's not that way for everybody. Yeah, so just knowing that job life looks so different, depending on the hospital you're at, city you're in. The unit you're on, if you got like Baltimore would be different than New England. Yeah, yeah, I, I 100 percent think it is, I think to.

I work at a hospital within an adult hospital. And I do my internship at a freestanding children's hospital, and there's just such a difference between a freestanding children's hospital and an adult house, a children's hospital and inside of an adult hospital. And. Comparatively, we're a poor hospital. From my standpoint, we do not we do not have a large budget.

You know, we don't have music therapy, we have one art therapist that works part time. We have one shot, one full time job, a life assistant. And my internship had nine full time childlike assistants.

They had 30 child specialists I work with. Five other child life specialists and so I think. Now, to say that it's easier, but I think there are aspects that are easier in child life when you have all the resources and all the funding and you can refer your patient to music therapy, art therapy, pet therapy.

And you have. The backing of the president and all the higher ups of the children's hospital, because everybody at that hospital is children focused, right? Nurses at an adult hospital, which is not the way it is first. And then, you know, we are not we do not bring in the money for this hospital.

Yeah, and so just being mindful of. Kind of where you want to work and the environment you want to work and not that you get tons of choices as a child life specialist, because there's not always tons of options out there. But just knowing that, like your internship experience will be different than your job experience, then you're 10 years from now job experience, but just like taking it as it comes and be willing to change and grow and adjust as need be. OK, I have one last question and.

It's not even on my list, it's just something that intrigued me from talking to you. So what are your play interventions? What are your favorite ones? What did you learn about them? Because I know you don't get to use them much, so.

A:  I would say my favorite when I in a perfect world. Is what I can do, medical play like very traditional medical play with a kid after an IV placement, I think sometimes like the full on child life prep with the doll and the supplies. And the step by step isn't always the most helpful for a kid whose anxiety is already up here. Right. And isn't always possible from the pace of the either. So.

You know, I get the kid through piece by piece information, get him through the I.V., he and then letting the kid return to baseline, calming down and then me coming back in later and being like, hey, I have this doll. Do you want to do medical play with me? How about you want to play I.V. with me in this doll and then letting them manipulate and work with those materials in a way less threatening way? You know, the nurse is outside the room getting stuff together, waiting for me. I'm done getting all the tubes for the blood.

And he's looking and seeing what she's doing. The scary part's over or done. And I feel like I've learned that sometimes the debriefing afterwards is way more important than the prep beforehand.

Because I can tell a kid I remember one time and this five year old who I was prepping him before his IV and right when they were tracked the needle and adjust the catheter stays. And I'm like, OK, like like just the straw parts in your skin is like, OK. And then I came back later to check on him and he was like really moving his hand. And I was like, is there a needle in your hand? He's like, yep, there's a needle there. And I was like, You missed everything that I talk to you about and prep because you were so fixated on what was happening that we need to backtrack now. We need to go through it again.

And so I was able to do, like, full on that with him, with the doll and all the teaching staff and show him hands on, you know, like there is no there is no need all that stays and.

Yeah, and so I think those those little like aha moments for kids when things have calmed down for them in the 80s and they can relax a little bit or some of my favorite. But I mean, I'd love to do regular play, too, I wish I could do it more. I think that's how covid has impacted me a little bit, because before I can pop in and out of rooms really easily, check out so and so I'm back to the other kid. But now it's slow me down a little bit when I have to be mindful of the PPE I'm wearing.

Be mindful of going in to just say hey to this kid is really. Not that I waste to do that, and just being a little bit more mindful of that has kind of slow me down, but hopefully one day we can go back to being a little bit more relaxed. I'm hopeful that sooner rather than later. Yeah, this is terrible. OK, that is all of my questions.

During my undergrad YDEV courses as well as many of my social work courses, we talked about race.  In particular, YDEV talked about how our race impacts our identity... While looking back at Shayla's interview I am reminded of my YDEV courses and my personal identity.  I am a white woman who grew up in a wealthy community with little diversity and a great school system.  I will have a masters degree and my husband and I own our own single family home.  I can remember growing up in a single parent household that I did go without the fanciest new sneakers and extra frills for my locker but I never went without food, shelter and the basic necessities.  Even while in the hospital, my mother was able to take time out of work to be with me; she still was paid.  The housework, yard work, and general upkeep of things was done by the generosity of neighbors and friends.  Family regularly sent warm food and gift cards to us to keep us fed without the struggle of gross hospital food.  And my very extensive and expensive hospital bills were fully covered through my double coverage.  I am extremely thankful and fortunate for the things I have, but in talking to Shayla it is crazy to me to think that some of her families are just thankful for the blankets and snacks that she can provide for them.  I keep saying it but the difference between Shayla talking about the basic needs of the population that she works with is so contrast to the work of the other three interviewees.  Previously my thinking of a child life specialist was very focused on making the children and families in the hospital happy and keeping their spirits up, as Shayla says, the sunshine and rainbows of child life.  While now I see that they are so much more, especially given their demographics.  A child life specialist has the power to make a child and family happy with a simple hug and a warm blanket.  

Shayla's interview also made me think back to my time in my social work internship at Metcalf Elementary School and the volunteer work I did at Chester Barrows Elementary School.  Chester Barrows is one of the lowest income schools in Cranston Public Schools, while my mom was principal there 90% of the kiddos had free or reduced lunch and at least 65% were of color.  Myself and my mom, both white women loved working with this population.  While I volunteered there I spent a lot of my time in a first grade classroom working with a particular boy who just needed some extra support.  He had a very complicated and upsetting family home life and that often showed during his time at school - thus my mom requested that I work one-on-one with him while I was there.  I often spent my entire day sitting with him and working on not only how to cope with his aggression, but also working to inspire his creativity.  He loved to draw - and I would make sure that he and I got to do so as much as possible.  No one else in his life showed interest in his work or gave him time and space to be creative because his parents were always working.  This simple gesture really helped him out of his shell and created a bond that I still cherish.  While at Metcalf I worked heavily with the Alternative Learning Program where most of the children were brought in from a group home and had significant behavioral problems.  About half of the students I worked with were of color even though most of the building as a whole was predominantly white.  I remember sitting in an IEP meeting about a student who was of color and his grandmother was his legal guardian.  She expressed right in front of me and my supervisor that she did not feel as though I was a good fit to be working with her grandson because I could not relate to him in any way.  And she was right, I was a white woman who appeared to have no learning disabilities or any other issues of any kind medical or physical.  Her grandson a biracial student had outstanding delays in his learning, had been hospitalized multiple times at Bradley for emotional and behavioral issues, and had hearing aides.  Grandma was only seeing my external identity and was shocked to find that I was able to connect with the student - not because of my identity but because of my age.  Unlike the other adults around us, I was able to talk to him and relate to him because I was much younger.  I feel as though this is a very interesting aspect for Child Life - are child life specialists more effective the younger they are?  

June - 10/8/2020 👍

Thursday October 8th was a very exciting day for me.  I interviewed someone whom I have admired for a while.  June went to Rhode Island College and got her undergrad in Youth Development, then was able to go to Wheelock College for her masters in Child Life Therapy.  Now she works at Boston Children/s Hospital.  Although she just had a baby and is currently on maternity leave, she was able to give me plenty of insight and information on how Child Life has adapted to the pandemic and what that means for children in the hospitals.

https://emailric-my.sharepoint.com/:v:/g/personal/npatenaude_0387_email_ric_edu/EVK_SGOtg4NOoly2y-C9qp0Bb67kQWLo0EqfUpkHUeWZHw?e=wL4HEY

It was interesting seeing the difference between my interview with Rachel and then this one with June.  June was such a great resource for me because I was able to really talk to her about specific techniques and the effects that COVID has had on child life specialists during this pandemic.

   Interview Transcript:

In your own words, how would you describe child life therapy in child life specialists? 

A:  So today, say what we do is we are there to normalise the environment for patients and families. The hospital can be a really scary place for kids. It can be a scary place for adults as well.
So our job is to kind of come in and meet the child where they're at and help them still be a kid while they're there, helping them understand what's happening to them procedures and just kind of being that support person in that safe person for them while they're in the hospital. A lot of studies have shown that kids who are prepared and know what's happening to them before it happens or have an idea and a developmentally appropriate way do much better.
So that is that is our job. And a lot of what we do is doing that through play, because that's what kids understand. That's their language. So we meet them where they're at through play and hopefully make a difference while they're with us. I love that answer. I love it because a lot of the interviews I've done, it's always meet them where they're at. So I love how that huge.

How did you become interested in child life, so I became interested. 

A:  My older brother was a cancer patient at Hasbro Children's Hospital in Boston Children's Hospital when I was very young. I was his bone marrow donor twice, two and a half and three and a half. And then he unfortunately passed away when I was five. But I still have memories from our time in the hospital and we have pictures with our child life specialists. So I kind of always had in the back of my mind growing up and, you know, I ended up going down that path and I love it.
So it's really cool. And it's especially cool to be back at I'm at Children's right now, Boston Children's. So it's really interesting to be back at the place that we spent a lot of time at when I was a kid. And now kind of being on the other side is is really cool.

Do you think that that your experience has helped you? 

A:  I think so.I think I have a little bit of a different understanding than maybe some people coming into it, just because I've kind of been on both sides of the side helping patients and families. But I've also been on the side of having a sick sibling and seeing what my parents kind of understanding now more as I'm older, but what my parents had to go through. So I think it definitely gives me a little bit of a different perspective when I'm working with patients and families for sure.

What's interesting, so after you got interested in everything, how what was your path like educationally, professionally? How did you get to where you are? 

A:  Absolutely.  So I started I didn't I wasn't fully set on child life through high school and so forth that I kind of always wanted to be. I didn't always but I kind of had teaching in the back of my mind as well. So I started at Rick. I did my undergrad at Rick, and I started an education, but kind of knew it wasn't it wasn't really for me once I started getting into it. I loved working with kids, but I didn't want to be in the classroom, really. And then I think youth development kind of became the thing like a major kind of when we were in it. And I knew I kind of had in the back of my mind at that point that I wanted to go for child life.
But I knew I needed a a undergrad degree of related field. Yeah. So if I had to go through teaching, I would have done it. But I figured youth development kind of would have been kind of the best, best path excuse me. That way you kind of get a little bit of everything.
So I did that with the idea that after I graduated I would apply to grad school and try to get my child life degree, which I ended up doing. So I went to I took a year off, actually. I went to Beilock for for grad school, their program. I think they're the first child life program in the country and they have a really good job life program. But the only problem is they get hundreds of applicants and only accept like nine or ten people. So the first year after undergrad, I applied and I got waitlisted.

So I was the second I think there was one girl ahead of me there waiting for her decision. If she had said no, I would have gone in. But she said yes, she went in. So it kind of derailed me a little bit. And I was like, I didn't really know where I was if I was going to try again. Or maybe it wasn't the path for me. But I actually met with Leslie and Karen a lot and they kind of helped me through it, which is awesome. So I applied the next year and I got in and the rest is history.

It was it was a good a good stepping stone because it did get me in for those internships kind of to make connections within the child life world. And that's ultimately how I ended up getting him both jobs, both the two child left jobs I worked, which I know that you work at Boston now, Children's.

I started my final internship because you do two in the Child Life program at Wheelock. My final internship was in the emergency room at St. Luke's Hospital in New Bedford. So I was there for my final semester. It's a very small program, one person program, the woman who runs it was the one who started it and she hired me after my internship. So it was just me and her kind of running the inpatient unit in the ed.

But I was working per diem, so I didn't have benefits. I was getting pretty much close to full time hours, but they weren't giving me benefits. So I was there for seven months and then a job at Children's kind of opened up. And I had connections through Wheelock and new people there and was able to kind of get in. Oh yeah. And now I that's where I've been for two years now. So that's awesome. Yeah.

What strengths you think that you have for child life? 

A:  I think part of what we said earlier, I think I have a unique perspective just because I've kind of been on both sides. I love, love working with siblings. Just, again, kind of that unique perspective.

And I kind of can understand where they're coming from. But I think the biggest strength is I feel like I'm able to kind of, again, as I said earlier, kind of get down and meet the child where they're at. And I feel like it's gotten especially with experience. I've gotten better at it and the environment in which I've worked kind of the high.

It's a very fast paced settings to be able to kind of go in a room, assess them pretty quickly, and then it's kind of a challenge to try to see what you can do to kind of make a connection with somebody, whether it's a teenager or a four year old, whether it's the family that's incredibly nervous because they're waiting for results for their child.

I feel like I've gotten pretty good at going in and trying to kind of feeling out the room and hopefully connecting with them in whatever way works best for them, whether it be talking about something, a blanket that the child has proper or maybe dad has like a sports hat on or something, just finding like little ways to connect with them, to make them feel more comfortable and hopefully open up a little bit more to me.

Do you think that has anything to do with your age, the like connecting with with the children? 

A:  I do actually.  I have we do have there's I think in our department children's there's 70 of us, not all child like specialist that we count like music therapy in there. And we do have some people that have been there for years. The two women I work with on my team, my drug team, they've been there for twenty five years and they're phenomenal. They're amazing at what they do. But I think sometimes when young people come in the room, for whatever reasons, kids are a little bit more depending on the age, too, I think, especially for teenagers or maybe that like pre-teen. I don't know if it's because they can relate better, which is my guests.

And just being younger and knowing kind of what like teenagers are into and hearing that, I think it does, they feel a little bit more likely to open up. And I think it does help them open up as well. OK, so you talked about play as one of your big techniques. Yeah. Do you have a specific. Interaction or play technique or something like that that you felt really successful with? Yeah, it's very dependent on the patient. It's also dependent on where you work.

Like I'm an MRI. That's the unit, like radiology, MRI, mostly an MRI. But I do float around to other units in radiology. So our kids are you have to be careful and MRI one because it's all MRI safe. And I have certain things with like magnets or any of that. The biggest thing, again, it depends on the child. And because we're fast paced as an anesthesia unit mostly.

So they're coming in. They have any and they're usually pretty cranky, you know, and they're kind of moving things along. They're getting an IV started and they're kind of going under. So I don't have I'm also there's also five rooms running at once. So I don't have the kind of leisure time to just sit and kind of sit and play with them. So it's mostly procedural based play. I've.

The biggest thing kids love is an iPad. We have four iPads that float through our unit and we use it very big for like distraction kind of kids getting an IV started. Know, we always tell them if they want to look, they certainly can look. Some kids do really well watching some kids. You kind of have to divert their attention. And the iPad is huge. And to be able to one, if you want to block kind of what they're seeing, that's kind of a nice way to do it.

Or sometimes they like to like, look over, but they're so kind of into the game they're playing that they're going to like, OK, well, this is happening. But this really cool game on the iPad, that's a big one. That's what we use. And a lot of the times I'll always start off and I'll be like, let me show you my favorite game, which is like it actually I do have a favorite game is the silly haircut game I love. So all the kids, then I'll show them and they usually get pretty into it with me. So it's kind of like that.

And sometimes it's even if the child doesn't want to play but they want to watch, it's me playing for them, which can be big in our field sometimes with kids too sick to play or they have stuff on their hands or they can't play and kind of watching someone else play or helping them play can be big. So those are the two main things we ought to do is buy books. A lot of our kids like I buy books. So like I said, a lot of the play I'm doing is play for distraction and diversion to kind of ease any anxiety.

And over those five starts, which is basically pretty much how most of our kids go under anesthesia therapy. Have you had any difficulties, were there any difficult situations with not doing well? 

A:  No, absolutely. We see a lot a lot of patients with behavioral plans, which we have a whole behavioral response team that kind of helps out with child life as well. So a lot of difficult kids coming in who they either don't tolerate.

Some of them are children who have a lot of sensory needs. We have a very high population of children with autism coming in. So those visits can be hard on. Our unit is very overstimulating.

They meet five, six, seven, eight people coming in and out of their rooms within a couple hours. They're getting a lot of things done to them. The IVs sometimes are taking a premed. Sometimes it's the mask over their face. And a lot of the times a lot of their triggers are not eating and waiting. And our kids come in again, not eating. And they sometimes have to wait. Like if there's a delay in anesthesia, there's sometimes there's an emergency and cases get pushed back.

They're sitting in this tiny little room, sometimes for hours, which can be really hard for them. So we've definitely had kids come in who either sometimes are just having a bad day, but kids who have a lot of needs. And you kind of have to plan around how can we make this environment as comfortable as possible for them while they're here with us for two hours. And a lot of the times it's working with the families.

We always say the parent knows the child best and kind of having them give us what they think is going to work best. And sometimes it can be even worse leaving the kid alone.

Sometimes they don't want to be distracted. They don't want it. Just sometimes you're another person in the room. So the best therapeutic approach sometimes is like check and see if anything, but kind of understanding when it's OK to step back and just kind of let the parents handle it, which is can sometimes be hard in our fields because I think a lot of staff often misunderstand what our role is.

And they hear a child crying and they automatically are like, OK, go work your magic. But sometimes crying is coping. So sometimes kids just need to cry. And that's OK. It doesn't need to always be fixed. So that can be kind of a great challenge. But I think the biggest is definitely our behavioral patients who, like I said, they have sometimes a tough time waiting and they're hungry. I get it. I'm hungry. I get angry too. So I don't blame you.

Yeah, well, it can be tough. 

Do you have kids from group homes that might not have a parent bringing them in? 

A:  We do, yeah. We see that a lot to a lot of a lot of group homes they're coming in with just like whatever workers with the Monday times.  It's a worker they have a relationship with. Sometimes it's not that can be tough, especially if they don't have a relationship with them, because, like I said, in our our environment can be very overstimulating and very scary for kids. So, you know, mom or dad's not there. That just makes it even worse. That's hard. Mm hmm. Um.

So I know that you've been pregnant throughout a covid, but before you left, did you see changes in how you were working with kids? 

A:  Absolutely, yeah, I worked. I actually worked all throughout the pregnancy. I was off for about six weeks, kind of when things started, because they weren't they weren't really sure what to pregnant women. So they're like, yeah, you can stay over for a little bit. But then after they're like, you know, it's time you got to come back. So I worked from out all of April. I went back in May and then I worked all through up until I delivered. I delivered two weeks early, actually.

So I was there. And it definitely everything was harder. It's the biggest thing starting as we all started wearing masks so kids couldn't see our faces, which is awful nervous and absolutely. So it was just so forth, like you can't even it's hard. They couldn't even see us smiling. So it's like someone's coming in. I would always try to do with my eyes like, oh, so they knew. But I mean, it's scary.

Another big thing we blow bubbles a lot in our unit is super distraction tool for toddlers, even like three, four. Even school age kids sometimes love it. We were no longer allowed to use bubbles or pinwheels for helping them through their breathing. Yeah, because we couldn't we couldn't take our masks off and it couldn't be anything that we were blowing.

The kids were encouraged to keep their masks on, which is hard for a lot of kids. And their parents came home and he absolutely so under two they didn't have to but two and over, we had asked that they do. A lot of our kids didn't.

And then the biggest thing was when our kids fall asleep under anesthesia, they go to an induction room and one parent is allowed to go with them. And some of our anesthesiologists decided, well, I think the department decided that parents could no longer go back into that room because it was too many people because of covid, which caused.

A huge I mean, for I think I saw it more than anybody else, but it really it's hard it's hard to tell a kid that they can't have their parent, especially for our kids who had maybe a little bit higher needs coming in. Some anaesthesiologist were very flexible and they would kind of let it happen.

Some of our older kids, they would kind of give up premed in their ivy before they took them so that they didn't really know what was going on. But for our young kids are like toddlers and infants, it was sometimes taking the kids away from their parents screaming. And it's hard to explain to a two year old why we're doing that. So that, I think, was the most difficult thing for me to navigate and for our kids and families, too. I mean, no parent wants to do what they're done, nervous to begin with and then to kind of like watch their kid be ripped away from them as they're screaming down the hall.

That was the biggest thing, social distancing, trying to stay away from people. And a lot of what we do like getting down on kids levels and like kind of getting close to them. And we had to be a little bit more mindful of that. So it was just a little it's harder to connect when you have a mask on and you can't get super close and you can't use the things that kids. You know, that help kids like bubbles or pinwheels.

So it was tough. It was really tough.

Do you think that you were still able to play as effectively? I think we made it work. I think I made it work.

A:  A lot of our time and everybody on our team, really the whole we kind of it's crazy how we were able to just kind of be very creative and we got like bubble guns that would spit bubbles out on their own and finding ways to connect the kids as best we could.

But I think it I think for me, there were times especially vary depending on the patient and their needs. But there were times where I was not able to, I think, as effectively do what I would have had normally would have done had we not had those precautions. We did our best and I think it worked for some kids, but for some kids, I think it definitely, I think made a difference for sure.

I didn't in my unit, just because we were outpatient, a lot of a lot of us actually ended up working from home like a day or two a week just because the hospital wanted us. They didn't want a ton of people in the hospital. We cut down to like, I think 20 percent of employees. So we would do like administrative stuff that we had to do, but we would just do it from home. And a lot of our child life specialists on the inpatient units would do like virtual visits from home with the kids that well.

And then our our pet therapy program, pawprints, they and I think our clowned to they went completely virtual because the dogs were not allowed in the hospital. They're still not at this time. And the clowns kind of weren't allowed either. So they set up a bunch of virtual things to kind of keep patients connected so they could still see the dogs and the clowns kind of did shows in our secret studios, which is run by Ryan Seacrest.

Did you guys do any virtual stuff? 

A:  We did.  They kind of did all kinds of virtual things. So the kids get it on their TVs in their room to find ways, like I said, to keep kids involved and assess their needs. But doing it in a safe and virtual way, that's awesome. Yeah. So, OK, so this one's a little funky, but.

Did you personally or in the hospital or anything like that find that covid was it affecting specifically low income minorities? Because I guess that's what the research is showing. But what is your take on that in terms of. Like this, the sickness, like if they're getting, like, asking if they're we're seeing more of that. 

A:  Yeah, like I didn't.  So the way my unit worked is because there's anesthesia. We did not the the patient trial tested twenty four hours before they came in to us. So they had to be they couldn't go under anesthesia unless we knew they were positive or not. We did have kids from the floor who were positive. That did come down for like emergency things. But we didn't have a ton of our senses for covid wasn't very large.

I think it's the most we had like seven in patients with it. So I it's hard to say if it was if we saw, like, more lower income families getting sick. What I can say is, I think made it a little bit harder for our lower income families coming in because they had to arrange twenty four hours beforehand. They had to drive to the hospital to get tested. So they had to arrange for transportation, transportation, which can be a problem for a lot of our lower income families.

And a lot of the times they had we have a one visitor rule or one parent, two parents really for anesthesia. We're allowed to come in. But siblings were not and are still not. And we found a lot of families were having trouble finding child care for the other children. So it was really hard to come to the hospital twenty four hours before with one kid, but have to find arrangements for their other kids and get transportation, which they couldn't afford. Or it was hard to get transportation because they were scared to get in a car with somebody, someone that they don't know.

So in that I saw in that way affect them, I can't totally speak on whether or not we saw more patients who are lower socioeconomic sic. The data kind of has shown that it was kind of affecting those populations more. So I would assume it may have, but I didn't really see those those patients, so I'm not sure.

So. Forgive my frankness, but how does your identity as a white woman affect how you're working in the populations that you're working with and, you know, having families identify with you and connect with you? 

A:  Absolutely. I think about this a lot, especially now in kind of what we're dealing with right now with all this all these awful things happening in the world. It was interesting because we and we hadn't talked about it kind of with some of my colleagues.

I think the majority of us are white, were white women. I think we have one nurse who is black.

And I often thought about that when I was going in to patient rooms and trying to connect. And, you know, one, they don't know me. Who am I? But two, it's like if we have young girls and I say young girls especially this because I feel like there but I guess young males to coming in. Wouldn't it be nice for them to see more people who look like them, you know, who they can probably identify with more, who understand probably the struggles that they're going through families way more than I can as a white woman.

So it's something in the back of my head. I always try to be kind of with families to, like you say, with kids, to relate to them as best I can. But there are I think some of it is just having understanding that there are ways that I can't relate to them and I probably never will be able to relate to them in that way again because of the white privilege I have.

So, again, trying to be as understanding as possible, letting them be open and hopefully making it a comfortable space for them to kind of express anything that they feel they want to express to me as we're talking. But I do think and we have a lot of things that we've done kind of in our department with everything going on, kind of talking about being more open.

And a lot of the things we're talking about is that we don't have a lot of nurses or even some doctors. We do, but even doctors who are black. So I think it I think it's definitely a conversation. And I think we should have people who everyone, all different cultures and races can relate to, because I think I think it would be so much more helpful for their care. And I think there's almost like a different level of trust there, just like, you know, when someone comes in and, you know, like they understand they understand me that.

Right. So I try my best to, like I said, try my best to. You know, be supportive, and I think sometimes it's just saying, listen, I, I don't I don't I can't understand what you're going through. I am with you. But, you know, I support you 100 percent. But and so I think that's sometimes comforting for people. Not that I've ever had the direct conversation with someone about it. Family. No one's ever said anything to me.

But, you know, just kind of having that understanding. 

What advice would you give to a brand new child life specialist or an intern working with kids and family? 

A:  I would say I think the biggest thing is to be flexible and be flexible. A lot of the times you kind of come up with a plan for someone or a patient or family and you go in the room and within 10 seconds that plan is out the window.

You kind of have to be able to think quick and and be flexible and know that things don't always work out perfectly when you're creating a coping plan or when you're working with patients and families.

Sometimes you think one thing is going to work and you end up, you know, it ends up being the thing that was like the worst. So you go in with a lot of options and I think really take the time to to to assess the room and get to know the patient, but also be flexible so that I think especially with with staff, I mean, sometimes because there's still a lot of there's a lot of misconceptions about what we do.

Even in a hospital like Boston Children's Hospital where we're huge, there are still staff that have literally no idea what we're doing. We think we're going in to just entertain kids. So. Kind of you have to be pretty, you have to be pretty strong and be able to kind of advocate for the profession yourself and be flexible with patients and families and also staff, because if not, it can get pretty frustrating for sure.

Yeah. So if you were to give advice for an intern or a new specialist in the realm of covid-19. Yeah. Would that advice change at all? 

A:  I don't think so, I think. I would say I would add be flexible and be creative, be creative, because what you've been trained to do isn't always going to work with these covid guidelines.  But we still have to we still have a job to do and we still are seeing patients. We don't our job doesn't stop for covid. So we have to figure out how we can connect with families in whatever way we possibly can. And it's takes a lot. Out of creativity, a lot of creativity. All right.

You kind of talked about your educational background and all that. Is there anything either in the field of child life therapy or just in general that you would like to learn more about? 

A:  Absolutely. We have a strong background in child development, which is huge. And I would I would tell anybody that's it's like the most important part of our job is knowing child development and knowing ages and stages and kind of understanding that. But I think also.

For me personally, I would like to do more with bereavement.

It is a huge part of our job, not my specific role, just because I don't see that a ton more in the unit I am where outpatient. A lot of our girls upstairs suffer sometimes a ton of what they do is like bereavement support for families and siblings. I don't I don't have a ton of experience in that. So for me personally, I would love to get better at that and to know more and to be more effective and efficient in working with families who are kind of navigating end of life situations where.

How did what was the best things that you learned about play? 

A:  The best things I learned. I think what's up, whether it's a technique or just in general, I think the biggest thing is they're they're kind of like two types of play. There's like very. Child directed play where you just kind of let them. Do their thing, lead the way and let them do their thing, which I find is really helpful because a lot of the time is watching a child play.

You're learning about them and you're learning kind of how what's the way they're thinking and misconceptions.

There's very like you can there's also a very structured play that you kind of come in with a goal and you're trying to either, like, get a child to express themselves or something. But my favorite is this child directed play and just letting them.

Do do what comes naturally to them, and you really do learn a lot about them, whether they're playing with action figures or blocks, sometimes even during the play, they're talking and saying things. So I think the biggest thing we learned is just letting just letting giving the kid an outlet, a safe place to play and be a kid and kind of picking up on details of what they're saying or what they're doing to to help you learn about them.

And the more you know about them, it's easier for you to help them, whether it's coping or distraction or diversion or even their family situation. It's it's a huge rise.

OK, is there anything that I didn't ask that you want to tell me? 

A:  I don't think so. You got some good questions. You covered all the bases, play covid, schooling, internships, I think that's you covered a lot of this with the I'm just checking the boxes. You did good. You got them all. You did good. All right.

Is there anybody that you would like to refer me to that would be willing to talk to me? 

A:  I do, yeah. I spoke with one of my good friends actually at the hospital, Megan. She had mentioned that she would be down to to talk with you. So I can actually I don't have her information ahead of me. I should have gotten it for you. I will email you or I can message you her info, her work, email. She works in cardiology at Children's. She's child life. She's awesome. She's so good at what she does.
So, yeah, she had she had said she would be willing so I can check in with her again, see if she's still able to do it, which I don't, I don't see why she wouldn't be. I think she will be. I'm going to consider your info. I would probably tonight or tomorrow, if that works for you.