We have the money, now what?

Expanding Child Life Services to New Departments

Presented by:Michelle Pennington, BS, CCLS

andKaren Frame, BA, CCLS

Attendees will have an understanding of how to: Identify the needs and set goals for a new

program. Introduce and implement program with

support of the interdisciplinary team. Continuously evaluate efficacy of the

program and make appropriate adjustments.

Presentation Goals

Needs Assessment

A tool for making better decisions

organizational leaders use needs assessments to define those areas where performance can be improved in the near term and long term.

Figure 1.1 Relating Needs to Discrepancies between What Is (Current Results) and What Should Be (Desired Results)

Need (gap)

Process to achieve desired result

Current result Desired result

Source: Based on Kaufman, Oakley-Brown, Watkins, and Leigh (2003) and Watkins (2007).

“ The goal for child life programming should contribute to the advancing the clinical excellence and quality of services offered to and for pediatric patients and their families across the healthcare system”

Concentrations of the most challenging procedures and age groups Relative severity of illness/ patient time spent in healthcare Degree to which illness/treatment is unexpected or unfamiliar

leading to likeliness of being overwhelmed to traumatized by experience

Identifying families who will be most helped by new coverage Family centered approach Inpatient vs. outpatient services Sibling support

Identifying the Needs for a New Program

List expected benefits of the program Translate benefits into monetary value List savings benefits (cost avoidance) of the program List return on investments List total cost of running program over a period of time

Formula for cost/ benefit ratio:Discount cost avoidance savings+ discounted return on

investmentsinitial investment + operating costs

* If ratio is greater that 1, this demonstrates the benefits exceed the cost

Cost Benefit Analysis

Example CBA Worksheet

Family cost avoidance savings:20 beds = 1500 admissions = 500 surgeries1% children will suffer long term = 5 childrenCost of therapy = $500 each; for 5 children = $2,500

Hospital cost avoidance savings:Because of cooperation, the equivalent of 1 FTE saved = 20,000

2,500 + 20,000 = 22,500 -10% discount = $20,250 (CA)

Cost Avoidance

Example CBA Worksheet 2

Family return on investment:Without prep., 2 of the 5 children will be impairedPotential lifetime income of each is $500,000Both will lose 25% of earning power$500,000 x 2 = $1,000,000 – 25% = $250,000 lost

Hospital return on investment:Good will and publicity of program hospital gains $2,000 in 1 yr

$ 250,000 + 2,000 = $252,000 – 10% discount = $226,800 (ROI)$20,250 + $226,800 = $247,050 total

Return on Investment

Initial Investment:Furniture and equipment 1st year = $1,500Operating costs salary, fringe, supplies etc. $24,500

$ 1,500 + 23,000 = $24,500

$ 247, 050 = greater than 10 = ratio benefit/ cost$ 24,500 1

10:1 is value of the investment

Example CBA Worksheet 3

Initial Investment

Look at the Mission Statement, Visions, Values and operation principles of the organization.

Look at the policies, procedures and program guidelines.

Look at the needs of the program. Be sure that all of the above align, then set

the goals accordingly.

Setting Goals for a New Program

Ground rounds Psychosocial rounds Informational letter to physicians Staff meetings Journal club Bulletin boards E-learning modules

Introducing a New Program tothe Interdisciplinary team

Getting Everyone on Board

Child Life Team

Meeting with fellow child life specialists to garner support and ideas for future growth should begin with presenting the idea at a department meeting in the very beginning.

Management

Presenting the plan for a new program to management at a steering committee meeting!Be sure to include all of the costs and benefits, including patient satisfaction.

Interdisciplinary Team

Staff meetings and interdisciplinary rounds are two good times to present the plan. Include Fellow Child Life Teamthe ways that the new program will assist the interdisciplinary team in caring for patients and provide support for families

Proposal for services to new area Operations report including all costs and

benefits Evidence based practice statements

supporting the new program Patient and family satisfaction reports from

other facilities Interdisciplinary staff support

Closing the Sale to Management

Hours:

M-F 6:30-3:00pm

Wednesday 8:00-4:30 tour 3:30-4:30

Pre-surgery tour:

Weekly on Wednesday from 3:30-4:30

See and touch medical items such as an

anesthesia mask, a syringe and an IV bag to help alleviate fears

on surgery day.

Engage in an age appropriate discussion

of what will happen before, during, and

after surgery.

Get age-appropriate answers to his/her

questions and clear up misconceptions.

Become familiar with the hospital/surgery

environment. 

Meet with patients during PACE visit to introduce services

Day-of Surgery

Preparation

The Child Life Specialist will help

with surgery preparation utilizing

education and medical play materials

allowing for mastery of equipment and

expression of feelings regarding procedure.

Procedural support:

Iv starts

Medication administration

Vital signs

Separating from parents

Induction support

Procedural support and distraction

Coaching deep breathing and

comforting presence

Diversion activities

Provide daily activities for play for each age

group

Maintain art and craft materials

Offer diversion during recovery process

Proposal for Child Life Services in Perioperative Services

Working with the interdisciplinary team building support and trust is essential

Showing the team that what you do is important and helps the patients as well as fellow employees

Being there consistently Working hand in hand with others in the

department or unit Being part of the team

Garnering Support from the Interdisciplinary Team

Discussions at staff meetings Responsibilities Coverage Hours Working within the department framework

Working Out the Kinks within the Child Life Department

Website: http://wolfsonchildrens.org/your-visit/pops/Pages/tours.as

px

* Printed materials:* Physician offices* Hospital magazine or communication* E-mail notice to employees

* Public Relations:* Media coverage* News releases

Advertising the New Services to the Community

800 Prudential DriveJacksonville, Florida 32207Phone: 904.202.8548Fax: 904.202.8187wolfsonchildrens.orgThursday, April 23, 2014

Michelle Pennington, BS, CCLSChild Life Specialist Family Support Services

Dr. Loveless,  This letter is to inform you of a new “POPS” (pre-operative preparation session) surgical tour being offered at Wolfson Children’s Hospital for pediatric patients ages 3-18 and their parents. This session will allow patients to tour the pre/post surgical areas and have a hands-on medical play session to help them understand what they will experience on the day of surgery. The tour will be scheduled on an individual patient basis provided by a Certified Child Life Specialist, and will enhance the pediatric patients experience allowing them to better cope with a surgical experience. Parents or staff members should call 904-202-8247 to schedule a tour. If you have any questions or would like more information, please feel free to contact me at any time.   Sincerely,   Michelle Pennington BS, CCLSCertified Child Life Specialist904-202-8247

Apply for grants Fundraising opportunities ie: movie sale,

bake sale, toy drive Donations from stores and community

groups Addressing health needs through

collaborative agencies ex. Safekids coalition

Building the Program

Working with the Community

Volunteers

• Kitted caps• Cloth dolls• Blankets• Providing normalization for

patients• Helping with special events

Community Groups

• Renovation donations • Activities/ parties• Celebrity room visits • Supply donation

Patient surveys Anecdotal reports Staff opinion Statistical Data Patient behavior ratings scales Quarterly Operations report

Child Life Budget Staffing New Resources Child life hospital wide Committees Goals Plan of action

Evaluating the Program

Getting the staff on board Nursing Physicians Ancillary departments

• Adequate coverage (spread too thin)• Maintaining boundaries• Family centered care

Challenges

DRMC one-person program PICU/ Progressive Care CVICU Peri-anesthesia

Success Stories

Adult patients Advocacy Hospice Peds Care

Possible Growth and Community Coverage

Questions? and

Comments!

Discussion

Michelle Pennington, BS, CCLS Perioperative Services Child Life Specialist Wolfson Children’s Hospital office: 904-202-8247 michelle.pennington@bmcjax.com

Karen Frame, BA, CCLS Intensive Care Child Life Specialist Wolfson Children’s Hospital office: 904-202-8548 karen.frame@bmcjax.com

Contact Information

References:

Kaufman, R., H. Oakley-Brown, R. Watkins, and D. Leigh. 2003. Strategic Planning for Success: Aligning People, Performance, and Payoffs. San Francisco: Jossey-Bass.

Thompson, R. (2009). The handbook of child life a guide for pediatric psychosocial care. Springfield, Ill.: Charles C. Thomas.

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

Watkins, R., & Meiers, M. (2012). A guide to assessing needs essential tools for collecting information, making decisions, and achieving development results. Washington, D.C.: World Bank.