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Child life programs in the pediatric emergency department
M S Krebel1, C Clayton, C Graham
1Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, USA.
Insights
Child life (CL) programs are underutilized in pediatric emergency departments (EDs). Child life specialists (CLS) offer vital support, including procedure preparation and developmental activities, but are scarce in most EDs.
Area of Science:
- Pediatric Emergency Medicine
- Child Psychology
- Healthcare Services Research
Background:
- Child life (CL) programs are established in inpatient settings to mitigate hospitalization-related stress and anxiety.
- The role and availability of CL programs in pediatric emergency departments (EDs) remain less understood.
Purpose of the Study:
- To assess the current availability of child life specialists (CLS) in pediatric EDs.
- To identify the types of interventions provided by CLS in a pediatric ED setting.
Main Methods:
- A telephone survey was conducted with 44 large children's hospitals in the United States regarding CLS utilization in EDs.
- A retrospective review analyzed CL interventions over a two-year period at one large pediatric ED.
Main Results:
- Only 14% of surveyed EDs had full-time CLS; another 14% offered CL services via consult, while 72% had no CLS.
- Higher ED census correlated with increased likelihood of having a full-time CLS (P = 0.02).
- Interventions included invasive procedure teaching (32%), developmental stimulation (22%), and family support (21.5%).
Conclusions:
- Child life programs are significantly underutilized in most pediatric EDs compared to inpatient settings.
- CLS provide essential services in the ED, including procedural preparation, developmental support, and family assistance.
- Further integration of CLS into pediatric EDs is warranted to enhance patient and family coping during emergency care.
Abstract:
Child life (CL) programs have long been utilized in the inpatient setting to help in relieving the stress and anxiety associated with hospitalization. The objective of this study was to determine the current availability of such programs in pediatric emergency departments (ED) and what interventions were provided in one ED with a CL program. We conducted a telephone survey of EDs in 44 large children's hospitals in the United States as to their use of child life specialists (CLS). Also, a retrospective review was performed of the CL intervention in one large pediatric ED over a two-year period. Only 6/44 EDs (14%) had at least one full-time CLS, with three of those having two full-time workers. In these EDs the CLS prepared children for painful or anxiety-provoking procedures and provided developmentally appropriate activities in the ED. Another 6/44 (14%) had CL services available by consult. There were no CLS available in 32/44 (72%) EDs, where nursing staff prepared children for painful procedures. EDs with a higher census were more likely to have a full-time CLS (P = 0.02). Hospitals with certified pediatric trauma centers were less likely to have any CL services available in the ED (P = 0.04). A review of the records of the ED at Arkansas Children's Hospital revealed that 32% of patient contacts by the CLS were for invasive procedure teaching and support. Another 22% of interventions were for developmental stimulation. Family support (21.5%) and therapeutic intervention (17.5%) were the next most common contacts. Admission teaching accounted for 4%, while preoperative teaching and support accounted for only 3% of the total. There were more patient contacts made by the worker on evening shift. CL programs, while common in the inpatient setting, are currently underutilized in most pediatric EDs. CLS can provide a variety of services in the pediatric ED.