laura gaynard, phd, ccls is the 2005 clc distinguished ......9. take involvement in clc to the next...

Laura Gaynard, PhD, CCLS is the 2005 CLC Distinguished Service Award Recipient

The Child Life Council Distinguished Service Award is presented by the CLC Board toan individual in the field of child life who has significantly contributed to the devel-opment of the profession. Emma Plank was the first awardee in 1988. The 2005

Distinguished Service Award will be presented to Laura Gaynard, PhD, CCLS onSaturday, June 11 during the CLC annual conference in Nashville, Tennessee, for her out-standing service to the child life profession, both academically and in clinical practice.

Laura earned her Doctoral degree in Interdisciplinary Studies of Human Developmentat the University of Pennsylvania, and two separate Master’s degrees, one in Child Lifeat Wheelock College, and one in Family and Human Development at Utah StateUniversity.

Laura currently serves as Director of Child Life, Children’s Education and LanguageServices, at Primary Children’s Medical Center, in Salt Lake City, Utah. Her title wasDirector of Child Life at Primary Children’s from 1995-2004. Prior to that time,Laura was Coordinator of Child Life Services at Utah Health Sciences Center, andChild Life Director at Phoenix Children’s Hospital in Arizona.

Laura was instrumental in early child life research for the Association for the Care ofChildren’s Health (ACCH), from 1985-1987. She served as child life specialist for the Child LifeResearch Project, the purpose of which was to assess the effects of preparation, education andpsychosocial support on hospitalized children and families. This project provided the researchfoundation for one of the key publications on child life today: Psychosocial Care of Children inHospitals: A Clinical Practice Manual. For this project, she served as part of a 5-person team pro-viding child life services, participated in design and implementation of the child life program,

INSIDE

2 President’s S.O.A.P. Box

3 From the Executive Director

5 Ethical Practicein Child Life

7 Crossing NorthAmerican Borders

VOLUME 23 • NUMBER 2 SPRING 2005

The Relation Between Nonessential Touch andChildren’s Distress During Lumbar PunctureVannorsdall,T., Dahlquist, L., Shroff Pendley, J., and Power, T. (2004)Children’s Health Care, 33 (4), 299-315.

Reviewed by Rose ReslerDirector of Child Life Specialist ProgramThe University of Akron, Ohio

Studies have focused on the use of distrac-tion as an effective way to decrease chil-dren’s distress during invasive procedures.

This study focused on the assessment of theeffectiveness of touch provided by a parent ornurse, not related to the provision of the med-ical procedure, as a way to decrease children’s

distress during an invasive medical procedure.The psychosocial literature on addressing children’s distress during invasive procedureshas focused on distraction, relaxation, deepbreathing, imagery and reinforcement, whichare forms of cognitive-behavioral interven-tions. Touch-based techniques such as holding, massaging, hugs, placing a hand on a child’s shoulder, and providing physicalcomfort can help the child cope with stressfulprocedures. The use of touch by parents andstaff can have a positive effect on children inmedical situations. Few studies have been

continued on page 3

continued on page 4

It’s a new year. Personally, it is a milestoneyear as I turn “the big 5-0” in ’05! As Iage, vision becomes a demanding issue.

My eyes need more help to do their job. Irecently made the change from using bifocalsto using contact lenses and reading glasses. Iwas given the option of trying one lens thatcorrects for distance and one lens that cor-rects for close up. As I was considering thispossibility, I got varying advice. I finallysettled on correcting for distance with thecontacts and using the magnifiers for closework. As always, there are different ways toget to a solution to any problem. Some solu-tions work better for some while others pre-fer a different approach.

This whole process started me thinking aboutother issues of vision. I am now acutelyaware of how much I desire to see clearly in all situations! When I apply this thoughtto my role as president of CLC, I feel theresponsibility to see and understand our past,our present and our future clearly too.

THE PASTAs an organization, our past is relatively

short. We will celebrate our 25th Anniversaryin 2007. Although I was not a part of thecreation of CLC, I did move into the childlife world in 1985 and I have had the honorto know many of the early pioneers in ourfield. Our History Committee is hard atwork to keep, organize and continue torecord our history. All of us can help by giving the histories of local and regionalchild life programs to the committee to addto the archives. The Child Life Archives atUtica College is on its way to being a modelcollection that charts the growth and devel-opment of a vital professional, nonprofitorganization. We can be proud of this work. It would also be helpful to record thework of child life specialists in nontraditionalsettings. If it were not for the vision of ourfounders and past leadership, CLC wouldnot be here today.

THE PRESENTWhen I look at CLC today, I see a healthyorganization of wonderful people who dogreat work! As good as that sounds, there ismuch yet to be done. We are now in theearly stages of implementing our Strategic

Plan. We still endeavor to become known bythe general public, to develop a greater bodyof research that supports our work, toenhance our professional standing, and todevelop partnerships with other organiza-tions and groups with parallel interests andgoals. These are all aspects of our StrategicPlan. As we make progress on all thesefronts, we will be guiding our developmentin a very positive way. I think we are defi-nitely on the right course.

THE FUTUREWe have created an organization that is well-positioned to grow and flourish in the nearterm, and if we do a good job of teachingand nurturing successive generations of childlife professionals, there is no reason why we cannot continue to achieve our greatestaspirations. Child life has so much to offerinside and out of hospitals. I feel that wehave set the groundwork for unparalleledgrowth into areas beyond the traditional hos-pital setting. We can grow into the widercommunities and beyond the seas. Childrenand families under stress around the globeare suffering. If we can learn to functionwithin the many cultures and traditions tobe found out there and apply our knowledgeof child development and family-centeredcare, respecting diversity, then we will surelyfind success even beyond my limited vision.

My vision, I am all too aware, is limited. Myexperience and energy will only take me sofar. Others will take my place and continueto move CLC forward. Talented and skilledchild life professionals are moving up andvolunteering their resources to do their part.For now I will be content to do what I canto keep us moving in the right direction forall the right reasons. I hope you too willfind ways in this new year to contribute tothe shared vision of the CLC. With yourhelp we can create a strong and dynamicforce for the benefit of all children and thefamilies who support them.

Seeing the Big PictureRandall McKeeman, M.S. Ed., CCLS

2 A PUBLICATION OF THE CHILD LIFE COUNCIL

BULLETIN SPRING 2005

PRESIDENT’S S.O.A.P. BOX

Child Life Council11820 Parklawn Drive, Suite 240

Rockville, MD 20852-2529(800) CLC-4515 • (301) 881-7090 • Fax (301) 881-7092

www.childlife.org • Email: [email protected]

President Executive Editor Executive Director Managing EditorRandall McKeeman Karin Dugan Susan Krug Amy Jackson

Published quarterly, mailed the 18th of January, March, June and September. Articles should be typed,double-spaced and submitted by the 15th of January, April, July and October.

Advertisements: Ad orders must be received by the 15th of January, April, July and October, or earlier.

Classified Ads: Typeset by CLC (e.g., program or conference announcements), max. 50 words, size may varydepending on space restrictions: $40 member / $60 nonmember.

Camera-ready, black & white display ads: 4.5” H x 2.5”W $1754.5” H x 4.75”W $3504.5” H x 7.5”W $500

and the development of psychosocial practicetheory.

For the past 15 years, she has also served as Adjunct Instructor for the Family andConsumer Studies Department at theUniversity of Utah, where she created andimplemented the Child Life Focus in thedepartment. She manages the program func-tion of the Child Life Focus for graduate andundergraduate students, and supervises childlife practicum students. She has been aninstructor in some capacity for 27 years, andheld a joint position as Research Associate atthe Early Intervention Institute and Instructorat Utah State University for two years in themid-1980s.

Laura has worked on eleven differentresearch projects since 1977, including oneshe is working on now with M. Tiedeman,Impact of Child Life Care on Same DaySurgery Patients and Parents. She has writtenor co-written 16 publications and 13 train-ing/educational materials, and has made 37presentations. She is the 1989 recipient ofWheelock College’s Centennial Award for

outstanding contributions to one’s profes-sion, in addition to other honors and awardsshe has been rewarded with since 1978.

She has also contributed significantly to thework of the Child Life Council for the past17 years, as a CLC Board Member-At-Large,from 2002-04 and from 1990-92, a memberand Chair of the Research Committee, and

serving on the Certifying and EducationCommittees

As you can see, Laura has made and is mak-ing extraordinary efforts for the developmentof the child life profession. For this reason,she is receiving the 2005 CLC DistinguishedService Award. We hope you will join CLCin recognizing Dr. Gaynard for her manycontributions to child life!

As a CLC member, you can remain confident that we are dedicated to delivering the best return for your

membership investment by providing qualityeducation and networking opportunities.Are you taking advantage of all CLC has tooffer? We hope that members take time toreflect on their professional development andhow CLC can help them achieve their goals.

The following list offers ideas on how to“recommit” to professional development, by being more strategic, thoughtful andresponsive to the opportunities that areoffered by CLC:

1. Prepare a professional development plan for yourself and set goals.

2. Attend programs that meet your professional development goals.

3. Challenge yourself by attending sessions on topics different from thoseyou would normally attend.

4. Let others know about your professionaldevelopment goals and needs.

5. Participate in CLC surveys. We use the results to tailor programs to member needs.

6. At conference, gain new perspectives by meeting and interacting with new colleagues.

7. Reflect on what you learn at conferenceand apply lessons learned in your daily work.

8. Share what you have learned with other colleagues.

9. Take involvement in CLC to the next level by volunteering to serve on a committee.

10. Offer sensitive feedback to nurture ormentor new leaders in the profession.

The CLC Web site offers information aboutthe 2005 CLC Annual Conference onProfessional Issues, June 10-12 in Nashville,Tennessee, as well as other continuing education opportunities. Check out our new Information Central section as well – we update it constantly with resources you’ll find helpful in your daily work.

Thank you again for your support … 2005will be our best year yet!

Top Ten List for Creating a Professional Development PlanBy Susan Krug, CMP, CAE

A PUBLICATION OF THE CHILD LIFE COUNCIL 3


FROM THE EXECUTIVE DIRECTOR

Award Recipientcontinued from page 1

Child Life CouncilEXECUTIVE BOARD 2004-2005President Randy McKeeman [email protected] Erin Munn [email protected] Barbara Gursky [email protected] Kelly Gleason [email protected] Bindy Sweett [email protected] Linda Skinner [email protected] Senior Chair Beth Daniel [email protected] President Nora Ullyott [email protected]

For phone numbers for the above call the CLC office: 800-CLC-4515 or email [email protected].

previously done to examine the use of touchduring procedures.

This study examined the relation betweenchildren’s distress behaviors and adult use ofnonessential touch (NET) during a lumbarpuncture procedure. Thirty-two children,whose ages ranged from five to fifteen yearsand who had the primary diagnosis ofleukemia, participated in this study to deter-mine the effectiveness of a cognitive-behav-ioral intervention to assist in their distressreduction during invasive medical procedures.The investigators examined baseline lumbarpuncture data before the child received psy-chosocial intervention. The average length oftime since diagnosis was 7 months, andbefore participating in the study the childrenhad experienced an average of 5.8 lumbarpunctures. In 72% of the procedures themother was present, 4% of the time fatherswere present, and in 24% of the cases bothparents were present. One nurse was presentduring 92% of the procedures and two nurseswere present in 8% of the cases.

The children were videotaped upon enteringthe treatment room until two minutes afterthe lumbar puncture ended. The children’sbehavior was coded according to the criteriafor the Observational Scale of BehavioralDistress (OSBD) at fifteen second intervals.The total distress scores of the OSBD corre-late significantly with the child’s self reportof fear and anticipatory anxiety, nurse reportof the child’s anxiety, and physiological meas-ures of distress. Distress scores were used forthe 3 phases of the procedure — the antici-patory phase prior to preparing the skin forthe procedure, the procedural phase which isthe actual performance of the procedure, andthe recovery phase occurring after the needlewas removed. Distress was recorded whenone or more of the five verbal OSBD distressbehaviors were observed; verbal resistance,verbal sign of fear and/or pain, seeking emo-tional support, and screaming.

The adult nonessential touch/child distressrelations were measured at fifteen minuteintervals and were coded as being present orabsent and were described as any kind ofphysical contact initiated by an adult duringthe procedure to reassure or provide comfort,and was not related to the execution of the

procedure. The three variables used to meas-ure NET included soothing physical touch,child sitting or laying on adult’s lap, andadult guiding or holding the child withoutresistance from the child.

The results of the study determined thatnurse use of NET during the proceduralphase lowered children’s distress scores dur-ing the LP. Children with low anticipatorydistress benefited from the NET of nurses.Children who experienced high distress dur-ing the anticipatory phase and received moreNET during the procedure displayed lessprocedural distress than did children withhigh anticipatory distress who received littlenurse NET during procedures. Children whowere very distressed before the LP andyounger children gained the most benefitfrom the nurse nonessential touch.

Surprisingly, no relation was determinedbetween children’s distress during any of theprocedural phases and to their parent’s use ofnonessential touch. However, children’s dis-tress was lowered when a nurse providednonessential touch. An explanation for theseresults could be that a child perceives thenurse as an authority over the situation incomparison to the parent and reassures thechild that the staff is being careful not tohurt him. The nurse’s touch could be viewedas a cue by the child to behave in a particularway during the procedure. Also, the noveltyof the nurse’s presence compared to the par-ent may increase the child’s tendency to payattention to the nurse.

This study offers some insight to the effec-tiveness of the use of nonessential touch withchildren during invasive procedures. Becausea child’s distress can be reduced throughnonessential touch, medical staff and parentsshould be taught how to apply these sup-portive techniques during medical proce-dures. Child life specialists can champion theuse of nonessential touch by encouragingand influencing clinical practices to supportthis strategy of emotional care during inva-sive procedures, as well as use the techniquewhile providing support to a child during theactual procedure. Parents can be taughtnonessential touch techniques in conjunctionwith their current manner of comfortingtheir child, to reduce their child’s distressduring procedures as well.

Nonessential Touchcontinued from page 1



Compiled and Edited by: Barbara J. White and Edward J. Madara; 2002; ISBN# 1-930683-00-6; Published by: Saint Clares Health Services, Denville, New Jersey; 410 pages; $15.00 (from Amazon.com)

Reviewed by Carla Ingle, BS, CCLSChildren’s Hospital of Alabama

The Self Help Group Sourcebook provides aresource for support groups around theworld. The American and New Jersey

Clearinghouses have organized the book toassist in many different aspects of findingand organizing self help groups in yourcommunity. The groups are compiled ofmembers of the community who have hadsimilar experiences. After a brief overviewof what self help groups are and what theydo, the book gives steps to start groups inyour community. The step by step instruc-

tions – from finding a meeting space torecruiting leaders and members and organ-izing discussions – are very helpful. Thebook also lists and reviews self help groupsfor the following categories: abuse, addic-tion, bereavement, disabilities, family/par-enting, health and mental health. Each selfhelp category has a short explanation of itspurpose, lists dues or fees for starter kits andprovides contact information includingaddress, phone number, email and Web sitewhen available.

This book is a great source for professionalsto assist families in crisis. The AmericanSelf Help Group Clearinghouse also offerstheir services through their Web site,www.selfhelpgroups.org or by calling 973-326-6789.

The Self Help Group Sourcebook: Your Guide to Community and Online Support Groups

PUBLIC RELATIONS

CASE developed by Richard Thompson, PhD, CCLS

With reductions in the “hard” budget for thedepartment, there has been an increasingdependence on the Mega-Wish Network tofund staff in child life. The local representa-tive has been especially interested in one ofyour group’s “pet projects,” which wouldextend child life services to the Hospital’sGeneral Pediatrics Clinic – a unit that serveschildren and families, mostly lower income,from the neighboring community. The rep-resentative has arranged for her organizationto sponsor a puppet show in the playroom –an event that will be attended by severalinfluential members of the Mega-Wish Boardof Directors. It’s a moderately quiet day onthe inpatient units. Nevertheless, there are anumber of children who might be able toattend the show. However, despite your invi-tations they seem more than content toremain in their rooms. Concerned about thesparse crowd, the Mega-Wish representativeapproaches you and says, “This won’t lookgood. Can’t you get more kids in here?”

THE ANALYSIS

RESPONSE by Marusia Heney, BA, CCLS

Bloorview MacMillan Children’s Centre, Toronto, Ontario

A challenge to be sure! How do you weighthe power of funding your scarce programagainst the needs of the children on your unit?

A good beginning is the Child Life Council’sCode of Ethical Responsibility. The Codestates that as child life specialists we are ethi-cally responsible first to our patients andtheir families. We need to “hold paramountthe welfare of the children and families,”which in this case would mean respecting thechoice they made to not attend the specialevent (see also ethical principles of Autonomy,and Respect for Persons, Klein, 2000).

However, the Code also states in Principle 5that we “shall promote the development of[our] profession by continuous efforts toimprove the professional services and prac-tices which [we] provide in the health caresetting and in the community-at-large.” That

would include educating the public and,indeed, possible funders about the needs ofhospitalized children as well as the role, valueand benefits of child life. Extending servicesto a new area of a hospital or clinic wouldenable many more children to reap the bene-fits of child life, and could also be an excel-lent opportunity for hospital public relationsto highlight the profession. The difficulty liesin adhering to the ethical principles ofVeracity and Fidelity (Klein, 2000), in respectto being honest with the funders, and keep-ing any inferred promises made about thenumber of patients likely to attend theirevent. When funding is coming from a “soft”money source, is it then more important tocater to the needs of the funding group,rather than risk losing vital resources?

In simple terms, this seems to be a conflictbetween advocacy for your program versusadvocacy for your patients. But does it reallyneed to be a conflict? Is there a way to han-dle the situation that enables you to respectthe value of the work Mega-Wish has doneand is willing to do, while also advocatingfor patient needs?

POSSIBLE COURSES OF ACTIONOne approach is to consider looking at theMega-Wish representatives as a volunteer vis-iting group or entertainers. According toThompson & Stanford (1981), the effectivehandling of groups and entertainment is askill all child life specialists need to hone. Ifwe view the funders as a “visiting group,” itmay be easier for us to provide them withinformation as we would any other visitinggroup: educating them about hospital anddevelopmental considerations that mayimpact a child’s active involvement in anevent, selecting appropriate children for theevent, and limiting access to patients basedon patient-choice.

To address the Mega-Wish representative’sconcerns, you could:

• Speak about the needs of hospitalized children: “Unfortunately the children are unwell today, and as the goal of theiradmission is to become well, we need tolet them indicate to us when they areable/unable to participate in events.”

• Offer to speak to the Mega-Wish Board ofDirectors about the above.

• Offer to provide a formal introduction tothe special event that would address theconcerns of the Mega-Wish Directors andhighlight the value of the nature and scopeof their contributions and efforts (Smith,2003).

• Recommend using a smaller, moreenclosed section of the playroom so it“looks” as though you have more children.

A second approach places the needs of theMega-Wish funders higher in your decision-making. As a corporation, Mega-Wish needsto look as though it is practicing corporatesocial responsibility and to feel as though thework it does makes a difference (Smith,2003). A large turnout at its event reinforcesthat it has made the right choice in backing aspecific charity. Corporations supportevents/causes to give back to the communityand to improve their image.

You could:

• Begin to assuage the Mega-Wish represen-tative by educating them about the needsof the hospitalized children.

• Suggest inviting children from a nearbyunit who would(a) also benefit from the socialization of the puppet show and the normal lifeexperience.(b) increase the numbers in attendance,even though they are not the exact targetaudience for the funding.

Ethical Practice in Child LifeColumn Facilitator, Chantal LeBlanc, B.Ps., CCLS; IWK Health Centre, Halifax, Nova Scotia



MILESTONES• The Canadian Association of

Child Life Leaders (CACLL) has just launched their new Web site at www.cacll.org. It can also befound on the CLC Web site under“Information Central/Local &Regional Child Life roups/Canada.”

• Patricia Weiner, MS, CCLS, is now amember of the faculty at Bank StreetCollege of Education in New York.

Please send any suggestions for individualand program Milestones to Amy Jacksonat [email protected].

continued on page 6

• Look into including visiting siblings, chil-dren attending day-clinics, or patients on aunit that doesn’t typically receive the samelevel of funder support, and highlight thebenefits of including that group for theMega-Wish representative.

A best approach ethically might include avariety of the suggestions listed above, com-bined in a unique way that best reflects theneeds of your patients, families and funders.

FUTURE STEPSThe dependence on “soft” money for child lifeservices raises a concern. As discussed in theGuidelines for the Development of Child LifePrograms (CLC, 1997), child life programsshould “not rely too heavily on soft money forongoing operation,”as this type of funding is“sometimes viewed as less secure” (p 75). Animportant next step to help you avoid havingto balance the needs of public relations andfunders with the health and developmentalneeds of your patients, would be to advocatewithin your hospital to augment the child lifebudget. There are suggestions in both the

Guidelines for the Development of Child LifePrograms and in Child Life in Hospitals to helpyou with an appropriate approach.

Another possible way to avoid facing the eth-ical challenges of veracity and fidelity is tocreate guidelines for visitors and specialevents. This may provide you and your col-leagues with a handy and valuable resourceto make decisions about future visitors andfunders (Thompson & Stanford, 1981).Other suggestions include:

• Creating guidelines/policies that address spe-cific issues related to your hospital, programor patients (Thompson & Stanford, 1981).

• Sharing the recommendations with childlife staff to prepare them with the infor-mation and skills to handle similar situa-tions.

• Conducting an initial assessment of thegroup to ensure they are a good fit withyour program objectives and patientneeds, and to provide information aboutyour facilities and the number of childrenlikely to attend an event (Thompson &Stanford, 1981).

• Sending a copy of your guidelines/policiesto future visitors with confirmation infor-

mation about their visit (Thompson &Stanford, 1981).

• Discussing the recommendations withpotential visitors to ensure they under-stand the restrictions and appropriateactions to take while in the hospital.

Discussing your hospital or departmentalguidelines with visitors creates a way to beclear about their and your expectations froman event and a means to work out details in away that satisfies the needs of everyone –patients, funders and child life specialists alike.

REFERENCES(1994). Official Documents of the Child Life Council,Child Life Council, Rockville, MD.

(1997). Guidelines for the Development of Child LifePrograms, Child Life Council, Rockville, MD.

Klein, Doris (2000). Making Ethical Decisions in ChildLife Practice. Rockville, MD: Child Life Council.

Smith, N. C. (2003). Corporate Social Responsibility:Whether or How?, California Management Review,Berkeley, California.

Thompson R. &. Stanford, G. (1981). Child Life inHospitals: Theory and Practice. Springfield, IL:Charles C.Thomas

Ethical Practicecontinued from page 5



Romesberg, T.L. (2004). Understanding Grief: A Component of Neonatal Palliative Care. Journal of Hospice and Palliative Nursing 6(3): 161-170.

The death of an infant is devastating, and the grief that surrounds the loss is ajourney. Healthcare professionals often

struggle to accept that death is inevitable andfamilies often struggle to maintain hopeagainst all odds. Understanding and offeringbereavement support are key components toproviding beneficial neonatal palliative care.

This article provides a review of the literaturediscussing perceptions of death, the dyingneonate, and the experience of grief follow-ing neonatal loss. This article also definespalliative care. Implications for clinical prac-tice are also discussed briefly as well as sug-gestions for helping families once the deci-sion to discontinue life support to the criti-cally ill infant is made. The author suggeststhat regardless of religious preference, ourindividual values systems shape our own

journey with grief. Healthcare professionalsdo impact families who are suffering by theirpresence and humanity. Providing culturallysensitive care such as effective communica-tion is recommended. The author also high-lights the need for education of nursing andother healthcare professionals to becomeskilled and knowledgeable about end of lifecare. Community support and the need forgrief support follow-up are also discussedand examples of resources are included.Topics for further research include whetherthe experience of grief is less daunting forfamilies who do receive grief follow-up, wheninterventions are aimed at preventing theeffects of complicated grieving. Is care fordying neonates and their families improvedwhen bereavement support is offered as acomponent of palliative care?

This article could be used as a resource forsomeone who is new to working in a pallia-tive care environment, or for educating stu-dents about the complexities of palliativecare. This article was a recommendedresource on the Child Life Forum.

Featured Journal Article: Understanding GriefBy Jane L. Darch, CCLS, The Hospital for Sick Children, Toronto, ON

SEND JOURNAL REFERENCES AND ABSTRACTS TO CLCCLC has heard from members in the 2003 and 2004 member surveys that you would like to be kept abreast of currenttrends across clinical disciplines as they relate to child life. We are working in several ways to bring this information toyou. One way is for us to feature journal abstracts in each issue of the Bulletin and are soliciting our members’ help tomake this happen. Do you have a journal article you want to share for the readers of the Bulletin? Send us the journalreference and the abstract. Include the complete citation and try to choose journals that would be easily accessible toother child life professionals. You also might want to consider starting a journal club in your child life program. If youwant to share journal club tips, or have read a journal article you want to share, follow the format in this article andemail your submission to Amy Jackson at [email protected].

INTRODUCTIONThe Beanstalk Program is a developmen-tally focused model of care that has recent-ly been created in an effort to address thelimitations of the hospital setting withrespect to early childhood developmentand quality of life. A developmental careteam was formed on the PaediatricAcademic Multi Organ Transplant,Nephrology, Gastroenterology andRheumatology Unit at the Hospital forSick Children in Toronto, Ontario,Canada. The team is comprised of repre-sentatives from physiotherapy, occupation-al therapy, social work, nursing and childlife services. This multidisciplinary teamdeveloped a unique approach to care tar-geting children under 3 years of age, whoremain in the hospital for three weeks orlonger. These children are often awaitingsolid organ multivisceral transplant, andgenerally have complex nutritional needsthat cannot be managed at home.

This article will summarize some of thedeleterious effects of long-term hospitaliza-tion on the developing child, look atdevelopmentally supportive care withinthe hospital setting, and outline the com-ponents of the Beanstalk Program as ameans to address the development of thisunique group of children.

As the program is currently in the earlystages of implementation, the developershave begun to take steps in preparation forthe evaluation of the program’s impact.

A program logic model was created inorder to present a diagrammatic represen-tation of the components of the program.This was further expanded to includeexpectations of the program and plans for data collection for evaluation.

DEVELOPMENTALLYFOCUSED CAREThere is extensive research about developmentally supportive care in theNeonatal Intensive Care settings.9,12,13,14

The term developmental care emerged in theliterature approximately 15 years ago and is“a philosophical approach to NICU care inwhich the goal is to support each infant tobe stable, well-organized, and competent aspossible.”13 In addition to care procedures,developmental care incorporates the physical

and social aspects of the NICU, with anemphasis on family-centered care.9 The liter-ature regarding developmentally focusedcare beyond the NICU remains sparse.12

The Beanstalk Program is based on the gen-eral philosophy of providing developmentalcare, which is a multidisciplinary approach,incorporating environmental and caregivingmodifications with parent and staff educa-tion to enhance infant and family outcomes.

It has been shown that in providing a“developmentally supportive milieu, wecan better meet the infant’s physiologicaland neurobehavioral needs, support theinfant’s emerging organization, and fostergrowth and development.”10 Healthcareprofessionals can decrease the harmfuleffects of long-term hospitalization on parents by helping them to recognize theirfeelings, encouraging participation intreatment sessions, and empowering theircapabilities as a parent despite their child’sillness.1 It has been shown that educationspecific to growth and development canbenefit healthcare professionals workingwith infants.1, 11 Particularly, “educationplays a key role in moving managementand staff toward the philosophic changenecessary for long-term commitment andprogress in developmentally supportivecare for infants and their families.”12

LONG-TERM HOSPITALIZATIONChildren from birth to three years of ageaccount for more than half of the totalpediatric in-patient population.3 For many


THE BEANSTALK PROGRAM: A DEVELOPMENTALLY FOCUSED CARE PROGRAM FOR INFANTS AND YOUNG CHILDRENEXPERIENCING LONG-TERM HOSPITALIZATIONCatherine Patterson, BSc.P.T.; Stephanie So, BScP.T.; Sarah Patterson, MScHospital for Sick Children, Toronto, Ontario, Canada

continued on FOCUS page 2

The term developmental care

emerged in the literature

approximately 15 years ago

and is “a philosophical approach

to NICU care in which the goal

is to support each infant to

be stable, well-organized,

and competent as possible.”

chronically ill children, the hospital environ-ment can be the first and only home envi-ronment they experience. The sterile natureof this environment does not typically fosterthe important experiences and interactionsthat promote normal child development.Medical stability becomes the focus and maynot adequately prioritize the developmentalneeds of these children. The hospital envi-ronment has been referred to as “chaotic”and “non-supportive” and many of the socialinteractions are intrusive.4 Due to the factthat the Hospital for Sick Children is ateaching hospital, there are multiple care-givers and the environment may also be over-stim-ulating, inconsistent, and full of pain anddiscomfort. Children become confused withlack of consistent schedules, alteredday/night patterns and constant sleep inter-

ruptions, as the sounds of machinery andcontinuously playing televisions become the norm. Exploratoryplay becomes limited as children are confined to beds or chairs.5

The relationship between parent and childalso suffers during hospitalization, whichaffects normal infant development.Separation from parents has been determinedas a “factor contributing to both immediateand post-hospital disruption.”6, 7 Life-savingapparatus and frequent medical interventionsare two of the many factors that increase thedistance between parents and their children.8

Parents may be become overly cautious ofmedical equipment which may decrease thehandling of their infant.3

There are certain behavioral qualities that aredemonstrated by infants and toddlers whoexperience lengthy hospitalizations, namely:social and exploratory passivity, inhibitedperception of ability to move, narrow rangeof affective expression, distractibility, disin-terest in fine motor tasks requiring hand-eye coordination, and minimal vocalizations.4

These behavioral qualities can have signifi-cant impact on normal motor development.

THE BEANSTALK PROGRAMThe goal of the Beanstalk Program is to pro-vide an optimal care environment, facilitatepositive experiences, and promote ongoingeducation to enhance the overall develop-mental experiences of chronically-ill, long-term hospitalized (>3 weeks) children (0-3yrs) and their families on Unit 6A at theHospital for Sick Children. The overallobjectives of the Beanstalk Program are outlined below and address needs in threespecific areas related to: environment, experience and education.

1. To optimize the environment on 6A in order to improve developmentaloutcomes of children experiencing prolonged illness and hospitalization.

A. Create a “normal” environment withinthe hospital setting by:

• Establishing regular day/night patterns

• Posting daily schedules for each child

• Using radios, CD/tape players, andage-appropriate music for settlinginfants and children to sleep.

B. Create a “home-like” environment in thechild’s room to encourage and developplaytime and treatment sessions by:

• Providing and utilizing development-ally appropriate toys and equipment,i.e., mats, benches, mirrors, toys,infant seating, strollers and mobiles.

C. Create a secure environment as a separateinfant/child play area within the 6A playroom to facilitate developmental play and treatment sessions:

• Utilizing mats, benches, boundaryblocks, mirrors and developmentallyappropriate toys

• Promoting the use of the play-room infant/child area to families, volunteers, PT, OT, and child lifetogether with the child.

D. Ensure safe and appropriate equipment isavailable by:

• Providing supportive seating (tumble-forms, strollers, high chairs, and infantseats), mats, toys, benches and balls.

2. To foster positive family experiencesthat promote optimal developmentalinteractions.

A. Provide families with information regard-ing the Beanstalk Program upon transfer-ring from the NICU or other hospitals.

B. Encourage parental attachment and aninfant/child sense of belonging by:

• Celebrating milestones and “normal”life experiences and accomplishments

• Using cameras, personal albums,scrapbooks and plaster material formolds so that parents have tangiblekeepsakes of developmental milestonesand accomplishments

• Encourage increased involvement offamilies in the daily care of their child.

3. To provide ongoing education for par-ents and multidisciplinary team members


About the ViewsExpressed in FocusIt is the expressed intention of Focus toprovide a venue for professional sharingon clinical issues, programs and interven-tions. The views presented in any articleare those of the author. All submissionsare reviewed for content, relevance andaccuracy prior to publication.

REVIEW BOARDEllen Good, MS Ed, CCLS

Yale-New Haven Children’s Hospital

Peggy O. Jessee, PhD, CCLSUniversity of Alabama

Toni Millar, MS, CCLSRainbow Babies and Children’s Hospital- Cleveland

Kathleen H. Murphey, MS, CCLSChildren’s Hospital of Philadelphia

Suzanne Reeves, MS, CCLSChildren’s Health System - Alabama

Cathy Robinson-Learn, MA, CCLSMattel Children’s Hospital at UCLA

Michael Towne, MS, CCLSUCSF Children’s Hospital - San Francisco

FOCUS SPRING 2005

continued from FOCUS page 1

Create a “home-like” environment

in the child’s room to encourage

and develop playtime and

treatment sessions …

related to normal development and age-appropriate interactions/play strategies.

A. Provide parental education related to normal development and the impact of illness/ hospitalization on the achieve-ment of these milestones by:

• Assisting parents in understanding the contribution they make to theirchild’s quality of life and developmentthrough the application of develop-ment techniques and new skills

• Using educational materials and developmental posters related to theirchild’s unique developmental needsand their daily standards of care

• Providing opportunities to demon-strate hands-on treatment sessions by PT/OT

• Encouraging the family’s continuationof developmental therapy exercises

• Encouraging consistent parent visitation.

B. Provide nursing education related tonormal development and individualchild-specific developmental interven-tions by:

• Establishing developmental-friendlycharting and communications

• Holding educational in-services

• Utilization of teaching posters, written cues and signs on doors, cribs and walls

• Utilizing bedside white boards for communicating and posting individual developmental plans.

C. Provide educational opportunities for those volunteers who wish to learnadditional strategies and techniques for appropriate developmental/play interactions with infants/children by:

• Utilizing volunteer orientation to educate about the Beanstalk Programand normal development

• Orienting volunteers to teaching materials and individualized developmental treatment posters

• Providing opportunities to observePT/OT treatment sessions.

D. Provide education to the interdiscipli-nary team regarding the objectives and

specifics of the Beanstalk Programthrough rounds, staff meetings, brochures and posters.

HOW IS THE PROGRAM DELIVERED?• A program logic model and methods

worksheet were created identifyingthree main components:EnvironmentExperienceEducation

• Developmentally appropriate equipment and resources have beenpurchased and an infant area in theplayroom has been designated for therapy and parent interactions

• Eligible children are identified by the multidisciplinary team and parents/caregivers are provided withinformation about the program

• A “Beanstalk checklist” is utilized totrack delivery of the program compo-nents to individual children

• The “Methods worksheet” collects data pertaining to the delivery of theprogram and assists in identifyingareas needing further refinement

• Monthly case reviews are conductedby members of the BeanstalkCommittee.

ROLE OF THE CHILD LIFE SPECIALIST

• Promote and foster infants’ capacity for achieving social-emotionaland developmental milestones through play

• Use of playroom, toys and activities topromote development

• Strengthen parents’ ability to supportand guide their infant’s development

• Empowers parents by increasingknowledge, skills and confidence.

ROLE OF THE PHYSIOTHERAPIST

• Receives referral on initial transfer to unit

• Completes initial developmental assessment (use of Alberta InfantMotor Scale-AIMS)

• Plays role in multidisciplinaryapproach to introducing family to theobjectives of the Beanstalk Program

• Provides children with appropriateequipment

• Creates an individualized developmen-tal poster with ideas for positioningand specific developmental activitiesrelated primarily to gross motor skills

• Implements treatment and ongoingassessment on a regular basis

• Focus on parental, nursing and volun-teer education regarding developmentand positioning.

ROLE OF THE OCCUPATION THERAPIST

• Provides assessment of sensory, motor(with an emphasis on fine motor),cognitive and oral motor developmentas it impacts on daily functioning

• Develops an individualized treatmentplan to address delays and areas of difficulty (eg: fine motor delay, oralmotor stimulation, poor sensoryprocessing/organization etc.)

• Collaborates with parents, volunteers, andstaff to implement program objectives.

ROLE OF THE CLINICALNURSE SPECIALIST

• Initiates timely referrals to Beanstalkmultidisciplinary services

• Facilitates smooth transition fromreferring unit

• Clarifies family’s expectations of care

• Monitors family’s attachment, knowl-edge and competency in child’s care

• Provides continuity and consistency in communications for family and team(s)


FOCUS SPRING 2005

continued on FOCUS page 4

Role of the Child Life Specialist:

promote and foster infants’

capacity for achieving social-

emotional and developmental

milestones through play …

• Tracks immunizations and growthparameters.

ROLE OF THE STAFF NURSE

• Reinforce developmentally focusedplan of care over 24 hour period and 7 days/week

• Maintain/advocate importance of diur-nal cycles and meeting rest/sleep needs

• Educate parents, volunteers and staff about developmentally appropriate care

• Collaborate with parents in getting to know their chronically ill,hospitalized child.

ROLE OF THE SOCIAL WORKER

• Completes a family assessment

• Supports the family in caring for their hospitalized infant

• Is a consistent resource person to theteam and family

• Participates in program evaluation andadministration

• Refers family to supportive resources

• Goals of intervention:· Family experience on 6A is

more positive· Family distress is reduced· Attachment is strengthened

between the infant and family.

ROLE OF VOLUNTEERS

• Volunteers can increase knowledgebase and skills toward supporting emotional and developmental needs of families

• Long-term volunteers vs. regular volunteers

• Volunteers are supported and educatedwithin the multidisciplinary team.

FUTURE DIRECTIONSTo ensure the efficacy and feasibility of theprogram, the developers of the BeanstalkProgram, with the assistance of six physio-therapy students from the University ofToronto, have developed a plan for programevaluation.

One of the goals of this project was to produce a program logic model in order topresent a diagrammatic representation of itselements. This was to be accompanied bythe development of methods worksheets tooutline evaluative measures for each compo-nent of the program. The second goal was todevelop a measurement tool to evaluate theeffect of activities in one component of theprogram on a target group. For this pur-pose, a self-report questionnaire was selectedto measure the change in attitudes, andbehaviors of nursing staff with regards todevelopmentally focused care of children onthe unit, following the implementation ofthe Beanstalk Program.

Blank and completed examples of the logicflow model chart used by the BeanstalkProgram are available at the following link tothe CLC Web site:

http://www.childlife.org/Information_Central/resource_pages/administrative.htm

It is the hope of the Developmental CareTeam at the Hospital for Sick Children thatopportunities for the implementation ofdevelopmentally supportive programs similarto the framework of the Beanstalk Programwould reach into other hospital settings.

REFERENCES1 Association for the Care of Children’s Health.

(1987). Position Statement on the Care of Infantsin Health Care Settings, Children’s Environment’sQuarterly, 4(3):20-21.

2 Barba, LA; King, DJ; Walker, CL. (1992). InfantDefinitive Care Unit: Developmental Care for theHospitalized NICU Graduate. Neonatal Network,11(7): 35-41

3 Goldberger, J. (1988) Issue-Specific Play withInfants and Toddlers in Hospitals: Rationale andIntervention. CHC, 16(3): 134-141

4 Goldberger, J. (1988). Infants and Toddlers inHospital: Addressing Developmental Risks, NationalCentre for Clinical Infant Programs, 8(3): 1-6.

5 Wells, PW; DeBoard-Burns, MB; Cook, RC; Mitchell, J.(1994). Growing Up in the Hospital: Part 1, Let’sFocus on the Child. Journal of Pediatric Nursing,9:66-73.

6 Goldberger, J. (1989). Supportive Environments forInfants and Toddlers in Hospitals:What We Know,Where We are Heading, and Where We Should Aimto Be. Children’s Environment Quarterly, 18-24.

7 Yantzi, N; Rosenberg, MW; Burke, SO; Harriso, MB.(2001).The Impacts of Distance to Hospital onFamilies with Child with a Chronic Condition.Social Science and Medicine, 52(12); 1777-1791.

8 VandenBerg, KA. (1997). Basic Principles ofDevelopmental Caregiving. Neonatal Network16(7); 69-71.

9 Infant Handling in the NICU: Does DevelopmentalCare Make a Difference? An Evaluative Review ofthe Literature. Journal of Perinatal NeonatalNursing, 13(3): 83-109.

10 Kinneer, MD & Browne, JV. (1997). DevelopmentalCare in Advanced Practice Neonatal NursingEducation. Journal of Nursing Education,36(2): 79-82.

11 Goldberg, J; Simmons, Robert J. (1988) ChronicIllness and Early Development.The Parent’sPerspective. Pediatrician 15:13-20.

12 Carrier, CT.(2000). Instituting Developmental Care:One Unit’s Success Story. Neonatal Network,Journal of Neonatal Nursing, 19(2):75-78.

13 Blackburn, S. (1998). Environmental Impact of theNICU on Developmental Outcomes. Journal ofPediatric Nursing, 13(5): 279-288.

14 Mouradian, LE & Als, H. (1994). The Influence ofNeonatal Intensive Care Unit Caregiving Practiceson Motor Functioning of Preterm Infants.The American Journal of Occupational Therapy,48(6): 527-533.

15 Liakopoulou, M; Patterson, A; Samaraweera, S;Finnegan, L. (1983). Developmental Interventionsin Infancy During Lengthy Hospitalizations.Journal of Developmental & Behavioural Pediatrics,4(3); 213-217.

16 VandenBerg, KA. (1997). Basic Principles ofDevelopmental Caregiving. Neonatal Network16(7); 69-71.


FOCUS SPRING 2005

continued from FOCUS page 3

Child Life Council’s strategic plan andoperating principles include a track tofacilitate relationships between CLC and

like organizations regionally and worldwide.Our membership continues to express interestin reaching out to children, families and col-leagues beyond the North American conti-nent. This article is intended to help if youplan to do any level of child life work to advo-cate for the psychological well being of chil-dren in another country. I provide a fishbonediagram (Figure 1) to show a variety ofprocesses and the interrelationships betweendifferent parameters that can be attributed toachieving the development of a child life pro-gram in another country. For anyone consid-ering consultancy work for educating aboutchild life in another country, I recommend an exercise using a similar cause-and-effectdiagram specific to the situation early in theplanning process. This can assist in identify-ing successful resources, partners, and poten-tial barriers to the venture’s success. I alsohighlight some useful tips ininternational outreach and giveillustrations using the examplefrom my work in India.

BECOME FAMILIAR WITHAND GAIN A PERSPECTIVEOF THE COUNTRY’S DEMO-GRAPHIC AND ECONOMICPROFILE:India is the second most pop-ulous country in the worldwith a population of approxi-mately 1.03 billion. Thereare an estimated 400 millionchildren between the ages of 0and 18 years of age. The totalpopulation of USA is approxi-mately 294 million. (TheUnited Nations Children’sFund [UNICEF], 2004).There are more children inIndia than the entire popula-tion of USA. Increase in therate of economic growth hasmade India among the 10fastest growing developingcountries. Poverty continues

to be a considerable challenge.

THE HEALTHCARE PRIORITIES ANDTHE HEALTHCARE DELIVERY SYSTEMIN NORTH AMERICA MAY BE VERYDIFFERENT FROM THE SYSTEMS INTHE COUNTRY IN WHICH YOU PLANTO WORK:United Nations Children’s Fund(www.unicef.org) and World HealthOrganization (www.who.org) provide goodbasic resources to learn about any country’sdemographic, economic and health profile.Obtain the annual report from the ministryof health to get a health profile of the coun-try. A statistical report of admissions bydiagnoses for the hospital you plan to workin will be a useful tool.

BE PERCEPTIVE OF CULTURALSIMILARITIES AND DIFFERENCES:Space restrictions limit my expansion of thistopic.

BE SENSITIVE TO THE STATUS OFPSYCHOSOCIAL SERVICES ALREADYBEING PROVIDED; ASSESS BOTH THESTRENGTHS AND NEEDS. RESEARCHTHE HISTORY OF CHILD LIFE OR SIMILARSERVICES IN THE COUNTRY:An Indian child is hardly ever left alone inthe hospital, so there is almost always thecomforting presence of a familiar caregiver.There is an emerging focus on the psycho-logical needs of children in hospitals.Professor Muriel Hirt from WheelockCollege had initiated child life efforts inIndia during 1980s. Dr. Indira Mallya andDr. Jigisha Shastri at The Maharaja SayajiraoUniversity of Baroda (MSU) have also initi-ated child life efforts through student fieldwork placements. Collaborate with profes-sionals in the country who are alreadyengaged in similar work. Program statusranges from few psychosocially-focused serv-ices to a well developed profession such ashospital play programs in UK and elsewhere.

IDENTIFY AND BUILD TRUSTINGRELATIONSHIPS WITH PARTNERORGANIZATIONS WHICH WILL PROMOTESUSTAINABILITY OF YOUR EFFORTS:

Child Life Outreach: Crossing North American BordersBy Priti Desai, MSc, MPH, CCLS, Instructor/Child Life Program Coordinator, East Carolina University, Greenville, NC


MANPOWER MONEY

METHOD/PROCEDURES MATERIALS

CulturalExpectations

ChildcarePractices

HealthcareBeliefs

Religion

Child and Family

Cultural Factors

Personnel Attitudes

Purchasing Resources

Travel

Knowledge

Attitude

Practice

TrainingResources

Local Staff Initiative

Child Life History Identifying Country’s Strengths & Needs

Identifying Country’s Strengths & Needs

Staff Awareness & Training

Language Barrier

Data Collection

Storage

Play Area

Patient EducationMaterials

Supplies

ChildLifeorSim

ilar

Interpreters

Hiring Local Staff

Grants

Government

FoundationAwards

Developing aChild Life Program in another country

UniversityPrograms

HDFS/CDFR

Psychology

MedicalSchool

Other

Hospitals

Physicians

Policies

Administration

Other Staff

InternationalAgencies

OperationSmile

WHO

UNICEF

LocalAgencies

Churches

Other


continued on page 8

Critical to the success of your efforts is yourcollaboration and networking with key agen-cies and supportive individuals in an identi-fied location. The interest, understandingand support of in-country hospital adminis-trators, medical, nursing and child develop-ment (or similar) staff is vital. Engaging fac-ulty and students from universities with childdevelopment or psychology programs may beanother decisive factor in your long-termsuccess.

I work with colleagues and students at myalma mater in the Human Development andFamily Studies (HDFS) department at MSU.Over the past 15 years I have traveled fre-quently to India where I have conductedseminars for the HDFS department. Theuniversity attracts students from all overIndia, so I am able to introduce child lifeconcepts to a wide reaching audience. Thestudents have been receptive, and many wantto explore child life as a career. The chal-lenge remains to ensure that they receive ade-quate field-based training experiences.Opportunities emerge in unexpectedavenues. Operation Smile has initiated mis-sion sites in India, one of which is withinreasonable proximity of Baroda. I requestedthat the HDFS department send students to work with the child life specialist on themission team, and three Master’s studentswent to help the CCLS for the mission team.

I received a monetary award last year froman Indo-American group, which I dedicatedto KG Patel Children’s Hospital in Baroda,with the goal to use the funds to develop achild life program. I selected the hospitalcarefully because of the institution’s reputa-tion for providing quality services to theregion’s sick and poor children and families.

The head of Pediatrics and the board oftrustees at this hospital are visionary andhave pioneered other psychosocial services atthe hospital for children with special needs.I spent last summer in Baroda, and recruitedthe same three students to sign up as part-time project associates for the child life initiative. I provided 1-1 training to them,and gave seminars about child life to themedical and the mental health clinic staff atthis hospital, and to the members of theIndian Academy of Pediatrics of the Barodabranch. Our mutual commitment is todevelop a model CL program there.

GENERATING RESOURCES FOR SUSTAIN-ABLE CHILD LIFE SERVICES IN ANOTHERCOUNTRY:Depending on the economic status of thecountry in which you want to work, the priorities on allocating financial resourcesfocusing on psychosocial services may pose a challenge. You may have to obtain grantsfrom North America to start a pilot projectto prove the benefits of child life services.Child life directors, hospital foundation staff,nonprofit foundations, and universityresearch centers can provide guidance aboutpotential partners and funding sources.

DOCUMENTING AND EVALUATING THEEFFECTIVENESS OF YOUR GOALS ANDSTRATEGIES IS ESSENTIAL:Indigenous research is essential to measureand prove the value of child life services indifferent countries. It would also be helpfulto collect photographs that documentchange, and statements of support andappreciation from children, parents andmedical staff. A perceptive father of a criti-cally ill child admitted with dengue fever tothe ICU at KG Patel Hospital expressed hisappreciation for the child life initiatives, bystating that his son had a faster recoverybecause of play opportunities he received.

HOW CAN YOU HELP TO COLLABORATE,MAINTAIN AND PROMOTE THE CHILDLIFE PHILOSOPHY AND IDENTITY THAT ISACCEPTED ON AN INTERNATIONALLEVEL?Encourage international students to learnabout child life in your universities or hospi-tal internships. Participate in medical mis-sions to gain focused international experi-ence. Speak at international conferencesabout child life. When you travel to othercountries, try to arrange a lecture at a chil-dren’s hospital or on a university campus.Reach out to global partners who are doingsimilar work.

The ideas to create humanitarian bridgesbeyond North American borders throughour child life philosophy are endless. Youmust be the change you wish to see in theworld. - Gandhi

REFERENCESThe United Nations Children’s Fund. (2004). The Stateof the World’s Children: 2005. New York.

Fishbone Charts: basic information about developingfishbone charts is available through resources formanagement studies.

Child Life Outreachcontinued from page 7


RESEARCH-BASED CHILDREN AND TEENRELAXATION PROGRAM

Old Me New Me is a 3 CD series that teaches relaxation, uses soothing soundeffects, positive self-talk, and imagery imbedded in a story line to decrease anxietyand tension. For more information, address and research see www.oldmenewme.com.$84 plus $5.00 shipping


CALL FOR VOLUNTEERCOMMITTEE MEMBERSLooking to make a difference in the child lifecommunity? CLC is seeking volunteers for its2005-2006 committees, for new committeemember terms of 1-2 years beginning at the June annual conference. CLC committeesare recognized vehicles for identifying theopportunities and challenges facing CLC andthe child life profession. They bring togetherCLC members from all levels of the child lifecommunity to explore the many facets of theprofession and help move the association forward. If you are looking for a rewarding andfulfilling volunteer opportunity, please call CLCat 1-800-CLC-4515 to request a Volunteer Dataand Interest Form, or download it from theMembers Only section of the CLC Web site at:

http://www.childlife.org/Membership

Please fax or mail your completed form to CLC by April 29.

For a list of CLC committees, go to:http://www.childlife.org/about/committees.htm

If you are an Active, Associate or LifetimeCLC member, it’s time to begin deciding forwhom you would like to vote in the 2005CLC Executive Board election. A list ofcandidates is provided in this article, and the full 2005 Candidate Profiles can bedownloaded in the Members Only section at the following link:

http://www.childlife.org/Membership/

You can either vote at this year’s annual con-ference in Nashville, TN, or you can vote byabsentee ballot. If you are attending annualconference, you will receive a ballot and2005 Candidate Profiles in your tote bag.For Active, Associate and Lifetime CLCmembers who will not be voting at annualconference, the deadline for requestingabsentee ballots (by phone, fax or email) isMonday, April 25. Those who requestabsentee ballots will receive a ballot and the2005 Candidate Profiles via email or mail(please indicate preference in your request).

The following CLC members are candidatesfor the Executive Board:

TREASURER

Eugene Johnson, MA, CCLS, Child Life Specialist, Children’s MedicalCenter of Dallas, Texas; Instructor, Baylor University, Waco, Texas

Kathy Payette, MA, ECE.C., CCLS, Mobile Crisis Response, Lutherwood –CODA, Kitchener, Ontario, Canada

CLCCToni Crowell, MS, CCLS,

Child Life Specialist, Children’s HospitalBoston, Massachusetts

Sharon McLeod, MS, CCLS, CTRS, Senior Clinical Director, Child Life andRecreational Therapy Division, Cincinnati Children’s Hospital MedicalCenter, Cincinnati, Ohio; AdjunctProfessor, Psychosocial Care of Childrenand Families in Healthcare Settings,College of Mount Saint Joseph,Cincinnati, Ohio

MEMBER-AT-LARGE - OUTREACH

Kelly Gleason, CCLS, Child Life Specialist II, Cincinnati Children’sHospital Medical Center, Cincinnati, Ohio

Gloria Mattera, MS, M Ed., CCLS, Child Life Director, Bellevue HospitalCenter, New York, New York

MEMBER-AT-LARGE -PROFESSIONALISM

Steven Fletcher, CCLS, Child Life Director,Dr. Everett Chalmers Regional Hospital,Frederick, New Brunswick, Canada

Toni Millar, MS, CCLS, Director, Child Life Department, Rainbow Babiesand Children’s Hospital, Cleveland, Ohio

MEMBER-AT-LARGE - MEMBER CARE

Civita Brown, MS, CCLS, Coordinator ofInternships, Psychology-Child Life, Utica College of Syracuse University,Utica, New York

Suzanne Graca, MS, CCLS, Child LifeSpecialist II, Children’s Hospital Boston,Boston, Massachusetts; Instructor in Child Life, Wheelock College, Boston,Massachusetts; Adjunct Instructor, Eliot Pearson Department of ChildDevelopment, Tufts University, Medford, Massachusetts

CERTIFICATION DEADLINES ANDDATES TO REMEMBERThe next certification examination will be held duringthe 23rd Annual CLC Conference on ProfessionalIssues on June 10, 2005 in Nashville,Tennessee.Completed applications must be received by the CLCoffice on or before March 31, 2005. There are current-ly three cities scheduled for the November 12, 2005exam: Las Vegas, NV;Toronto, ON; and Houston,TX.Additional sites may be requested by completing theapplication found on the Web site in the Certificationsection. (http://www.childlife.org/Certification/dead-lines_loc_exam_dates.htm)

For those whose certification expires in 2005, youmust recertify this year by either submitting 50Professional Development Hours or by taking andpassing the CLC Certification Exam. PDHs are due by June 30, 2005, and must be submitted along withthe Application for Recertification by ProfessionalDevelopment Hours, and a completed PDH form(found on the front of the PDH folder and also available for download from the Web site athttp://www.childlife.org/Certification/index.htm).Also located on the Web site is a 2005 Events Calendar(http://www.childlife.org/Conferences/Annual_Conference/other_conferences_meet.htm) listingpotential activities you can participate in to fulfill the 50-hour requirement.



2005 Elections: Executive Board Candidates

LESS IS MORE

One of the tips that came in this month(courtesy of Deb Vilas of Bank StreetCollege) was that “less is more.” That seemsa very good place to start with this edition’s“Tips and Lifesavers,” the Bulletin’s place forus to share those little hints we have alllearned that help us do our jobs just a littlebetter. Deb warns against “too many ques-tions, too much feedback and too manycompliments” directed at kids. “Quietobservation and empathic reflection and nar-ration . . . are more likely to empower chil-dren and form paths of communication.”

KEEP IT FRESH

A quick tip came from Jennifer Tudor at TheChildren’s Hospital of Philadelphia- “Findnew and exciting activities . . . if you’re gettingbored then your patient is too! Use the inter-net or colleagues to build a new bag of tricks.”

STOPPING AN ITCH FROM A CAST

Another quick tip came in from JessicaCummings of University of ChicagoChildren’s Hospital. She writes “My favoritetip is for my ortho clinic kids to stop an itchunder their cast by using a hair dryer set oncool. This takes away the itch and allowstheir cast (and the skin underneath) toremain in good condition.”

MAKING EYE DROPS EASIER

• The CLC Forum (another excellent sourceof ideas) had some very helpful ideas earlythis year regarding the sometimes difficultprocedure of giving eye drops to youngchildren. Kristin Glentz of DeVosChildren’s Hospital suggests several impor-tant steps, all in keeping with the centralphilosophies of the child life profession.These include: preparing the child for theprocedure (including a time when it willoccur); providing real answers as to why thedrops are being given; validating the child’sfeelings; providing options where availableas to position (in Mommy or Daddy’s lap,on bed, etc.,) and assistance (would you liketo hold the tissue?) and rewarding the child(sometimes a paper reward or praise is as

meaningful as a material one).

• Carmel Mahan of Baltimore County PublicSchools and Amy Wynia of Children’sHospitals and Clinics - St. Paul offer somepractical suggestions to address this issue.Carmel suggests that, after preparation,“you pull the lower eyelid down and slight-ly towards the nose. This makes a little‘pocket’ that you put the drops in. Put thedrops in this space, and you’re done.” Amysuggests “if the patient is able to tip his/herhead back or lay back in parents’ arms, theeyes can remain closed as the drops aredropped into the inside corner of the eye.Then the caregiver can gently pull downthe bottom lid and the drops will run intothe eye. This helps when it is hard for thechild to keep his/her eye open as the drop is dropped into the eye.”

So those are the “Tips and Lifesavers” for this edition. Thanks to everyone who hassent in tips for the column so far. Pleasekeep them coming — as a matter of fact, if you think of one right now as you arereading this article please email it to me rightaway at [email protected]. You mightjust see your words in print!

Tips and LifesaversCompiled by Gavin Ross, BCR, CCLSThe Children’s Hospital of Philadelphia


CALL FOR BULLETIN ARTICLES

Do you have an idea for an article forthe Bulletin or FOCUS? Have you justread a great book or journal article, orfound a method, tool or resource thatyou believe would be helpful to otherchild life professionals? Submissionguidelines can now be downloadedfrom the Members Only section of theCLC Web site at:

http://www.childlife.org/Membership

Just follow the guidelines and sendyour submissions to Amy Jackson [email protected] by the fol-lowing deadlines: 1/15, 4/15, 7/15,10/15.

CLC welcomes your submissions!


MASTER SUPERVISION INTENSIVE AT ANNUAL CONFERENCECLC is offering a unique live-supervision opportunity for intermediate to advanced child life supervisors onthe afternoon of Thursday, June 9, 2005 during the Annual Conference on Professional Issues in Nashville.

Facilitators Diane Rode, MPS, ATR, CCLS, Director, Child Life and Creative Arts Therapy Department, KravisChildren’s Hospital at Mount Sinai, New York City, and Erika Leeuwenburgh, MPS, ATR-BC, LPC, CCLS, Chief,Section of Child Life/Creative Arts Therapy, JMS Children’s Hospital Hackensack University Medical Center,New Jersey will provide an in-depth exploration of the importance and value of clinical supervision in childlife practice.

A related goal for participants will be to begin developing their own supervision groups through the information and experience gathered from this course.

The three-hour workshop will begin with a brief overview of the theory and practice of clinical supervisionin related professions. Then, two case presentations will involve participants in observing and experiencinga professional, clinical supervision group focusing on the therapeutic use of self, and of creative arts processes in child life practice.

Registration is strongly recommend by May 1st and participation will be limited to the first 30 registered.Recommended reading will be forwarded to participants who register by May 1st. Participants interestedin presenting one of the two cases must email Diane Rode [email protected] and ErikaLeeuwenburgh [email protected] by May 20th for consideration.

In order to attend, you must register for this session. The fee for attending this afternoon session is$50 US, or $100 for a full day with a choice of a morning session and lunch. To register for annualconference, go to the CLC Web site:http://www.childlife.org/Conferences/Annual_Conference/2005AnnualConference-NashvilleTN.htm

Kara Llewellyn runs a one-person programat The Hospital for Sick ChildrenPediatric Center, a nonprofit hospital in

Washington, DC, that provides rehabilita-tion and transitional care and services forchildren with special needs. Kara provideschild life services to the 130- bed hospital,the only one of its kind in the Washington,DC metropolitan area. Child Life currentlyprovides services up to 60 patients at thistime. She has begun the first internship pro-gram for the child life program since it wasreinstated two and a half years ago, and ishopeful that the program will one dayexpand. Kara also serves as a member of theCLC Evidence-Based Practice Committee.

As an example of Kara’s work on behalf ofchildren she helps care for, she was called into help with a newborn who has a rare skindisease, Epidermolysis Bullosa (EB). Thedisease causes the skin to blister and tearwith any type of friction. This child had towear dressings over most of his body, whichneed to be changed a minimum of threetimes a week. During the dressing changeprocess, the child was bathed, all blisterswere lanced, and any immunizations orblood work also would be done. This processwas an excruciating experience that took sev-eral hours. It was one of the only times this

infant was able to explore his hands and feeldifferent textures on his skin.

Sweetease was used in the beginning, but Kara remembered that it eventually wouldstop being effective. Kara worked with thecharge nurse to research Sweetease, to find outhow much time she had to find an alternative.She then created a pain management pro-gram, pairing black and white images withSweetease, in the hopes that the Sweateasecould be weaned and the black and white

images would produce the same relaxationresponse. The plan was successful and theinfant would actually start looking for imageswhen he was distressed. When the image wasprovided, he would begin to calm. As he gotolder, other techniques were adapted, until helearned to distract himself from the pain andallow the dressing changes.

The Dystrophic Epidermolysis BullosaResearch Association of America (DEBRA),was so excited about the pain managementprogram that they asked Kara to write anarticle describing it for their newsletter. ThatKara was able to develop such a successfulintervention for this unique situation is laud-able, but that she was able to do this in addi-tion to running a one-person program isinnovative for the profession.

CLC spotlights Kara Llewellyn, in additionto child life specialists who are running oneperson child life programs, providing the solesource of child life services at a moment’snotice for their entire facility, AND manag-ing the administrative side of their programs.CLC staff is working with committee mem-bers to follow up on Kara’s recommendationsfor how we can help support one-person pro-grams. If you have suggestions, please [email protected].

Kara Llewellyn, CCLS


BulletinFeedback SurveyCLC would like to know what youthink about each Bulletin so that wecan provide what you need most inthis format. If you would like to giveus your feedback, please visit the fol-lowing online survey link by April 30:

http://www.zoomerang.com/survey.zgi?p=WEB224784RYPPV


CHILD LIFE INNOVATOR

Special Offer from CLC Corporate Member,Discount School Supply

A Special Offer for Child Life Council Members: Take 10% Off Your Next Order & Get FREE Freight on all orders of $97 or more*! Use source code CLC when ordering. Order as often as you like between now and 12/31/05.

* Items that have a in the catalog are shipped direct from manufacturerand do not qualify for Free Freight Offer, and cannot be used to reach the $97 level.This offer is not valid with any other promotions or discounts. Offer expires12/31/05 and is not valid on orders shipping outside the Continental U.S.Valid on phone, fax, mail and Web orders.

New Change ofAddress FormCLC has a new change of address form.Go to the CLC Web site at:http://www.childlife.org/membership.

Please let us know if you are receivingduplicate mailings. If you have troublereceiving the Bulletin, email AmyJackson at [email protected].


CLC is happy to announce that registrationfor the 23rd Annual CLC Conference onProfessional Issues in Nashville, Tennesseehas officially begun! The conference pro-gram, along with the registration form andsession descriptions, have been posted onthe Web site for your convenience. Toensure you receive the best rate, register onor before May 1st.

To make hotel reservations at the Opryland,go to the following Web site link:

http://reservations.oprylandhotels.com/cgibin/LANSAWEB?procfun+rn+resnet+nsh+funcparms+UP(A2560):;CLC05;?

You will need to use the password CHILD(it is case sensitive) to access the site.

To receive the lowest rate ($135 plus tax)select the Traditional View room.

This year we are celebrating the 50thAnniversary of the founding of the firstChild Life and Education Program byEmma Plank at the Cleveland MetropolitanGeneral Hospital, now known asMetroHealth Medical Center in Cleveland,Ohio. Our conference program will featurea video presentation of interviews withEmma Plank, a poster presentation and asession presentation focusing on her workand accomplishments.

We have a fantastic conference planned for Nashville, full of exciting professionaldevelopment and networking opportunities.A unique event offered this year is an educa-tional concert by singer/songwriter JanaStanfield on Thursday, June 9 at 8:00 pm.

Jana has also been a professional speaker forthe past 10 years with quite an extensiveand impressive list of clients. She has sharedstages with fellow performers ranging fromKenny Loggins to The Dixie Chicks. Jana’smusic has been heard on programs such as20/20, Entertainment Tonight, Oprah, andis featured in the movie 8 Seconds as well ason radio stations nationwide. We hope youwill join us for this inspiring and education-al opportunity focusing on the therapeuticuse of song, and how others are successfullyusing songs therapeutically. You can readmore about Jana on her Web site,www.janastanfield.com.

This year you can earn 11 ProfessionalDevelopment Hours for basic conferenceattendance and there are always other oppor-tunities to obtain more. Always keep copiesof the documentation you receive in caseyou are audited, and you should bring yourconference receipt with you to conference.

For additional conference information,check out the CLC Web site at:

http://www.childlife.org/Conferences/Annual_Conference/2005AnnualConference-NashvilleTN.htm

See you in Nashville!

11820 Parklawn Drive, Suite 240Rockville, MD 20852-2529

PRESORTED FIRST CLASS

U.S. POSTAGE

PAIDSUBURBAN MD

PERMIT #2460

The Stage is Set for CLC’s 23rd Annual Conference!

Jana Stanfield