„Child Life Specialist“-Interventionen in der klinischen pädiatrischen Versorgung: Ein systematischer Review zu Effekten auf psychische Gesundheitsparameter von Kindern und Jugendlichen

Zusammenfassung Ziel der Studie Krankenhausaufenthalte können bei Kindern zu psychischen Belastungen führen, die in der Regelversorgung häufig nicht ausreichend adressiert werden. Ein neuer Ansatz ist es, spezialisierte psychosoziale Fachkräfte, sog. Child Life Specialists (CLS), in die klinische Versorgung einzubinden. CLS begleiten Kinder durch den Klinikalltag und können Belastungen durch gezielte Interventionen auffangen und das Wohlbefinden der PatientInnen fördern. Ziel dieser Arbeit ist es, die Effekte von CLS-Interventionen auf Angst, Schmerz und Stress von Kindern im klinischen Kontext zu analysieren. Methodik Es wurde eine systematische Literatursuche in den Datenbanken Medline, Embase und PsycINFO durchgeführt. Die Ergebnisse wurden in tabellarischer und graphischer Form dargestellt. Ergebnisse Es wurden vier randomisierte kontrollierte Studien (RCTs) eingeschlossen, die die Effekte von CLS-Interventionen bei 459 Kindern im Alter von 0–15 Jahren untersuchten. Eine signifikante Verbesserung der Zielkriterien wurde jeweils in mindestens einer Studie berichtet. Bei allen Studien ist von einem mittleren bis hohen Verzerrungsrisiko auszugehen. Schlussfolgerung In den eingeschlossenen RCTs werden positive Effekte von CLS-Interventionen auf Ergebnisvariablen psychischer Gesundheit von Kindern im klinischen Setting berichtet. Aufgrund der geringen Anzahl von Studien sowie deren Heterogenität und Qualität ist weitere Forschung notwendig.

Feasibility of a child life specialist program for oncology patients with minor children at home: Qualitative analysis.

30 Background: Up to 24% of adult oncology patients have minor children at home, who may experience negative short- and long-term health outcomes as a result. Typical support networks often fail to meet the needs of these families. To address this, an innovative Child Life Specialist (CLS) program was embedded within the psychosocial support team at a tertiary oncology center. The program provided direct consultation to families (adults and children) including guidance on talking with children, provision of resources, diagnostic teaching, end-of-life support, grief support, and emotional expression. Methods: To understand the feasibility of this program (including acceptability, demand, implementation, practicality, adaptation, integration, expansion, and preliminary measures of impact), we collected 360-degree feedback from impacted stakeholders. At least two months following an encounter with the CLS, families were offered participation in a semi-structured interview (via purposive selection to capture multiple perspectives, including patients, non-patient parents/family members, and children aged 10-17). At the end of the pilot, two focus groups were held consisting of clinicians who engaged with the program. A thematic analysis was completed from the interview/focus group discussion transcripts. Results: 15 interviews were completed with adults (ten with patients, five with non-patient parents/other family members). Emergent themes were: Establishing comfort, Allaying parent apprehension, Coaching and reassurance, Value added, Integration, Impact of Covid-19, and Areas for development. In three interviews with children, the emergent themes were: Building rapport, Developmentally appropriate approaches, Understanding and managing emotions, Improving communication, and Areas for development. The first focus group included the CLS and two clinical leads of the psychosocial support team. Emergent themes from this discussion were: Promotion of the program, Accessibility, Role of social work, Impact of Covid-19, and Adopting a virtual approach. The second focus group consisted of three inpatient social workers, and the emergent themes were: Expertise, Accessibility, Allaying parent apprehension, Value added, Impact of Covid-19, and Areas for development. Synthesis of data identified five overall key themes: Awareness, Integration, Value added, Family-centered care, and Impact of Covid-19. Conclusions: This study conducted qualitative analysis of 360-degree feedback on the CLS pilot program. The analysis demonstrated that program was felt to add value, integrate well with current systems, and represent high-quality, family-centered care. This pilot occurred during the Covid-19 pandemic, the impacts of which were represented in this study.

Child Play Specialist e Child Life Specialist: ruolo, evoluzione storica e benefici per il paziente pediatrico. Una rassegna della letteratura

Il gioco rappresenta un diritto fondamentale del bambino ed assume un ruolo cruciale du-rante l'esperienza dell'ospedalizzazione. Le figure del Child Play Specialist e del Child Life Specialist (riconosciute rispettivamente nel sistema sanitario del Regno Unito e degli Stati Uni-ti) forniscono programmi di gioco che normalizzino l'esperienza di ricovero del bambino e aiutino la familiarizzazione con il contesto medico. La presente rassegna persegue tre principali obiettivi: i. definire il ruolo dello specialista del gioco, la sua formazione, le tecniche implemen-tate, le aree di similitudine e differenza tra CPS e CLS; ii. esaminare l'evoluzione storica di questa professione; iii. indagare gli effetti dell'intervento dello specialista del gioco sulla salute bio-psico-sociale del paziente pediatrico. Di 613 fonti complessive (n=193 da Scopus, n=403 da Pubmed, n=17 da PsycInfo), 17 pubblicazioni sono state incluse, avendo applicato criteri inerenti lingua, tipologia di pubblicazione e pertinenza dei contenuti. Dalle fonti esaminate ri-sulta che: I. CLS e CPS presentano percorsi di training e tecniche simili. Emergono peculiarità di approccio diverse per CPS e CLS; II. Le esperienze pionieristiche di programmi di gioco in ospedale risalgono agli anni '20 con contributi significativi di Plank, Bergmann e Brooks; III. I principali effetti sulla salute infantile documentati sono il potenziamento del coping e la ridu-zione del ricorso a terapie farmacologiche per la gestione del dolore. Si evidenzia la necessità di un consenso internazionale sulla definizione del ruolo dello specialista del gioco, al fine di accrescere la ricerca empirica rispetto a tali professionisti della salute.

Feasibility of a child life specialist program for oncology patients with minor children at home: Demand and implementation.

28 Background: Up to 24% of adult oncology patients have minor children at home. Children may experience emotional problems, somatic complaints, social isolation, depression, and post-traumatic stress as a result. Typical support networks often fail to meet the needs of these families. To address this gap, an innovative Child Life Specialist (CLS) program for patients with minor children at home was offered at a tertiary oncology center. Methods: To understand the feasibility of this program, we examined the demand for and implementation of the CLS program over its initial 10 months. Demand was characterized using administrative data (referred patient/family demographics, referral details, and disease/treatment characteristics). Implementation was described through encounter data (audience, type of visit, interventions provided, time for preparation, and time of direct interaction for each encounter). Results: The program received 100 referrals, 93 of whom accessed the program. Patients were most often female (66%) with a median age of 45 years (range: 19 to 72). 81% were parents of minor children, 10% grandparents, and 9% other. Families predominantly had multiple children (98%), most commonly school-aged (ages 5-9, 39%; 10-14, 37%). 53% of families had two birth parents co-parenting in the same household; the remainder had alternate parent/living scenarios. Most referrals came from social work (57%). Median time from diagnosis to referral was 79 days (range: 9d-6.5y). Breast cancer (26%) was the most common diagnosis, followed by gastrointestinal (19%) and hematologic (16%). Cancer phase at referral was defined as at new diagnosis (within 30d, 18%), undergoing treatment with curative intent (20%), undergoing treatment with palliative intent (39%), at end of life (within 30d, 16%) and after death/bereavement (5%). 1 patient (1%) did not have cancer. The CLS recorded 257 unique encounters. 55% of encounters included patients, 40% non-patient parents, 21% children, and 21% others. 75% were individual encounters, while 25% were group encounters. 95% of encounters that included children also included an adult. Phone calls were the most frequent encounter type (43%), but hospital visits consumed the largest proportion of recorded CLS time (38%). Mean encounter time (all visit types) included 20min for preparation and 51min of direct interaction. CLS interventions included: guidance on talking with children (67% of encounters), providing resources (37%), diagnostic teaching (21%), end-of-life support (18%), discussing change in status (10%), grief (8%), and emotional expression (4%). Conclusions: This study characterized the demand for this program and described its implementation over the pilot period. This period occurred during the Covid-19 pandemic, which dramatically altered healthcare and family visitation, likely influencing the results of this study.

A child life specialist szakemberek helye a magyarországi egészségügyi ellátási rendszerben

Bevezetés: A gyermekek kórházi kezelése során nyújtott pszichés támogatás és gyermekbarát ellátás mind a hazai, mind a nemzetközi kutatásokban kiemelt jelentőséggel bír. Külföldi kórházak gyermekgyógyászati osztályán és ambulanciáján child life specialist szakember segít a gyermekeknek és családoknak megbirkózni a kórházi ellátás, a betegség és a fogyatékosság kihívásaival. Célkitűzés: A vizsgálat során a magyarországi gyermekellátás során nyújtott pszichés felkészítést és támogatást vizsgáltuk szülői vélemények alapján. Célunk volt továbbá, hogy megismerjük a gyermekápolók véleményét és tevékenységeit a gyermekek pszichés felkészítésével és támogatásával kapcsolatban. További célunk volt a kutatás eredményeinek tükrében, hogy bizonyítsuk a már nemzetközileg elterjedt és bizonyítottan pozitív hatású ellátási rendszer magyarországi adaptációjának szükségességét. Módszer: A Magyar Egészségügyi Szakdolgozói Kamara gyermekápolási tagozatának tagjai, és kórházban kezelt gyermekek szüleinek körében végzett online, kvantitatív, kérdőíves felmérés eredményeinek deskriptív és többváltozós elemzése. Eredmények: A kérdőíveket 566 szülő és 361 gyermekápoló töltötte ki. Az ápolói és szülői vélemények a gyermekek pszichés felkészítéséről és támogatásáról eltérőek, az ápolók sokkal jobbra értékelték ezen tevékenységek megvalósulását. A szülői vélemények szerint a gyermekek felkészítése kevés esetben történik meg, a gyermekbarát ellátásra vonatkozó értékelésüket nagyban befolyásolta a felkészítés gyakorisága. Következtetés: A child life specialist szakemberek munkájára a magyarországi gyermekellátási rendszerben is szükség van, ezért fontos lenne ezen szakma magyarországi adaptációjának kidolgozása, mely magában foglalja az ellátási struktúrába való elhelyezést, illetve a kapcsolódó kompetenciák megszerzésének oktatási szintjeit.

Development and implementation of a novel child life protocol to enhance psychosocial support for pediatric awake craniotomies: technical note

Awake craniotomies are a crucial tool for identifying eloquent cortex, but significant limitations frequently related to patient tolerance have limited their applicability in pediatric cases. The authors describe a comprehensive, longitudinal protocol developed in collaboration with a certified child life specialist (CCLS) in order to enhance patient experiences and develop resiliency related to the intraoperative portion of cases. This protocol includes preoperative conditioning, intraoperative support, and postoperative positive reinforcement and debriefing. A unique coping plan is developed for each prospective patient. With appropriate support, awake craniotomy may be applicable in a wider array of preadolescent and adolescent patients than has previously been possible. Future prospective studies are needed to validate this approach.

Child Life Services in an Epilepsy Monitoring Unit

The goal of this study was to determine the value of a certified child life specialist (CCLS) on the patient and staff experiences in an epilepsy monitoring unit (EMU). We integrated a CCLS into the EMU for all children as well as adults with intellectual disability. We surveyed families to determine the impact of child life services on their stay. EMU staff completed questionnaires to determine perceived impact to their job performance from the integration of the CCLS. All of the families (pediatric and adult patients) who responded to the survey reported the presence of the CCLS improved their hospital experience. Staff reported that the CCLS improved their daily work by allowing them to focus on their assigned medical duties. This preliminary pilot study suggests that CCLS can have a strong impact on the experience of patients and staff in an EMU.