Child Life Specialists: What Role Can They Play in Pediatric Clinics?


By Charles Archer, MNAAP writer…

Affirmed as “an essential component of quality pediatric care” by AAP, child life specialists have become standard in most pediatric hospitals, providing non-medical preparation and support for children undergoing tests, surgeries and other medical procedures.

But they are also finding a role in some pediatric clinics. Using play and psychological preparation as primary tools, they can offer extra support both to the family and the physician team.

Since hiring its first child life specialist in 2005, Essentia Health in Duluth, for example, has hired two more to work with children in its hospitals and clinic system. Armed with bags of toys and iPads, they calm children before routine immunizations, distract them during lab procedures and help them prepare for impending surgeries.

JoHannah Orman, one of Essentia’s child life specialists, recalls helping a physician obtain a throat swab from a very sick girl several months ago. “The child refused the test multiple times and the provider was frustrated,” she said. “After helping her verbalize her fears, we learned she was afraid it would get stuck in her throat. So I reassured her and helped her practice deep breathing. Twenty minutes later, she did the test.

“We know providers can be busy and time isn’t always on their side. We have more time in certain situations to talk with a child and try to get to the heart of the problem, and can bring some of the very specific play or distraction methods to the situation, which can help a provider get the work done.”

Lori DeFrance, MD, a pediatrician at Essentia Health, said she can’t imagine working in clinic without Orman and the other child life specialists. She calls on them an average of three times per week, mainly for pre-op exams, but sometimes for other procedures. “They make themselves accessible to us and are willing to jump in wherever they’re needed,” DeFrance said. “They’re a key part of our team and our health care home.”

At the University of Minnesota Amplatz Children’s Hospital, there are seven child life specialists on staff on the inpatient units and nine in other treatment areas, including radiology, surgery, the conscious sedation procedure area, and the emergency department. In addition, there are another seven who staff its pediatrics specialty clinics.

“We’ve added more to the clinic side recently due to increased volumes,” said Tim Knaeble, program manager of Child Family Life Services. “Their presence in pediatric clinics helps serve the whole family. Children with continuing medical needs benefit from developing coping and adaptation strategies and have a better understanding of their medical experiences.”

Because the pediatric clinics are physically connected to the hospital, child life specialists can also help identify support groups, classes and resources through handoffs to different service areas, further enhancing the patient and family medical experience.

Though child life specialists don’t necessarily generate revenue and aren’t always paid by insurance, there is some evidence that child life services may help to contain costs by reducing hospital length of stay and decreasing the need for analgesics. In the clinic and in the hospital, they may also improve patient and family satisfaction.

The Association for the Care of Children’s Health (ACCH) embarked on a large study in the 1980s, for example, showing that children who saw a child life specialist did better on many different levels. They got out of bed faster after surgery, required less pain medication, voided earlier than other kids, and were less psychologically upset than other kids.

Child life specialists are required to have a four-year degree in either child life, child development or a related field; complete an internship with a minimum of 480 hours under an experienced certified child life specialist; and pass a national certification exam. Many go on to earn a Master’s Degree.

“We’re here to help the child have a good, positive experience, and assist health care providers in getting their job done and have a good exam,” Orman said. “Our role is to first support the child and, secondarily, to support the provider so they can do their jobs effectively and provide the best care possible.”

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