Completeness of Care: Child Life Specialists

Operation Smile volunteer child life specialist Kelly Raymond works with a young patient during a mission to Honduras. Photo: Rohanna Mertens.

Editor’s Note: With more than three decades of experience performing safe surgery in resource-limited environments, Operation Smile knows that a single surgical procedure is a small part of a larger process that’s focussed on the entire well-being of the patient. Our “Completeness of Care” series highlights each of our volunteer medical specialties and the critical roles these dedicated, selfless volunteers play in our ability to uphold our Global Standards of Care*, which outlines procedures that allow us to provide our patients with outcomes that are consistent with the world’s finest hospitals, no matter where in the world our surgeries are performed.

Out of sheer necessity, medical environments are controlled environments.

Sterility and a vast array of medical devices – from procedural instruments to monitoring systems – are critical to ensure the best possible patient outcomes. Operation Smile care centres and medical mission sites are no exception.

The unintentional results are environments that can also evoke the non-medical definition of “sterile” – stark and uninviting. They can also strike fear and anxiety in our young patients and their families, some of whom have never before stepped foot inside a medical facility.

Understanding that patients’ and their families paths to cleft surgery are often emotionally overwhelming, Operation Smile leans on the help of volunteer child life specialists in the care centre and medical mission settings. These certified professionals provide psychosocial care and educate patients and their families about the entire surgical experience, easing their fears and anxieties through therapeutic play and activities.

“Child life specialists guide children through developmentally-appropriate activities to help them gain mastery and control over their situations,” said Kelly Raymond of Canada, a certified child life specialist of nine years who has volunteered on six Operation Smile medical missions. “Children coming into the hospital don’t get to wear their own clothes, eat what they want or see what they want. Child life gives them a piece of control over their environment.”

Operation Smile volunteer child life specialist Sandy Forseth and a patient engage in therapeutic play at a medical mission to Vietnam. Photo: Operation Smile.

For many children, medical equipment like anaesthesia masks – or even just being in a hospital – can appear to be ominous. Child life specialists use these devices as props during therapeutic play sessions so that young patients will not be surprised and frightened when they are used during their procedures. They also use this play time to help nervous parents understand what they can expect through every phase of the surgical process.

The child life area is also a place where silliness and fun is encouraged through age-appropriate play and activities, allowing kids to just be kids amid the stressful and unfamiliar environment.

“Receiving surgery can be a potentially frightening experience – (young patients) are exposed to strangers wearing strange clothes in a strange place. Play helps to normalise the health care experience for kids,” said Operation Smile volunteer Robert Wing, a certified child life therapist of 20 years from New York who now works at Sidra Medical and Research Center, a women and children’s hospital in Qatar.

“It empowers kids and gives them coping skills. Some of the kids leave the medical mission saying they had a fun time. That’s a powerful shift from being scared and frightened.”

Operation Smile volunteer child life specialist Robert Wing.

The positive effects for children go beyond preparation for their individual procedures, explains Sandy Forseth, a certified child life therapist from Minnesota who has volunteered on four Operation Smile medical missions.

“In the playroom, children are seeing other children with their condition. They’ve been shunned or shamed by other people in their communities, so I think there is positivity when they get to meet other kids with cleft lip and cleft palate,” said Forseth, a 15-year practitioner of child life who currently works at the University of Minnesota Masonic Children’s Hospital.

She added: “From being a certified child life specialist, I have seen research that shows that when children are prepared ahead of time, they heal faster because they know what to expect.”

Operation Smile volunteer child life specialist Sandy Forseth. Photo courtesy Sandy Forseth.

Building trust between children, families and the medical mission or care centre team is another key function of child life specialists. Raymond recalled a challenging-but-rewarding experience from a medical mission to Ethiopia in which her skills were tested by a fearful child.

“She clung tightly to her mother while crying and wouldn’t make eye contact with me. Teaching children about what to expect when they go in the operating room is our priority, but without trust, this can’t be done,” Raymond said. “Instead, I pulled out two wind-up toys and positioned them on the ground so they could race. She slowly started to peer out as the ladybug toy went in circles and the giraffe wind toy hopped along.”

“The girl started to laugh. When they finished racing, the girl looked at me, expectantly. So I wound the toys up again, setting them on another race. This time the girl sat up so she could watch the path the toys took. After a few more wind-up toy races, the girl crawled off of her mom’s lap, and she started winding up the toys herself…

“Eventually, I was able to teach her about the anaesthetic mask. We practiced blowing bubbles and then blowing up a balloon with the anaesthetic mask. She proudly showed her mom what she learned and even brought the mask over to her so she could try.

“When it was her time to go in for surgery, she held my hand as we walked down the hallway into the operating room… That simple act of play can change a child’s perspective and lead to empowerment and confidence. It’s situations like this that keep bringing me back to Operation Smile medical missions.

Operation Smile volunteer child life specialist Kelly Raymond. Photo: Rohanna Mertens.

*Global Standards of Care © 2006, 2015 Operation Smile, Inc. All Rights Reserved.