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Child Life Internship Rotations

Structure

The Child Life internship at Children’s Hospital of Michigan requires the completion of 16 weeks, 640 hours. The first two weeks of our internship focuses on orientation to our hospital, shadowing rotation supervisors, and attending in services. Orientation is followed by two six week rotations (preferably one inpatient and one outpatient rotation). Each rotation consists of three segments: 1) observation of the child life specialist, 2) a teamwork approach to clinical interventions, and 3) independence during the final weeks. After completing two rotations, the last two weeks of the internship provide an opportunity to select a unit from a previous rotation to independently provide services on that unit and carry our house pager responding to all areas of the hospital. The weekly schedule varies depending on the rotations assigned.

Rotations

  • Rotations are predetermined based on semester
  • All rotations provide opportunities for developing skills in the following areas:
    • Introducing services to patients and families
    • Assessing developmental appropriate, therapeutic interventions
    • Implementing and evaluating intervention plans
    • Documenting interventions in medical record and entering daily statistics
  • Interventions include:
    • Relationship building
    • Coping skills
    • Preparation for procedures
    • Procedural support
    • Medical play
    • Therapeutic play
    • Diagnosis education
    • Non-pharmacological pain management
    • Emotional support
    • Bereavement support
    • Sibling & family support

Emergency

The emergency Department at Children’s Hospital of Michigan is an American College of Surgeons certified Level 1 pediatric trauma center. Due to the large volume of patients seen in the ED, we have to prioritize our time to effectively manage the needs of patients and families. The environment is extremely fast-paced, and unlike inpatient units where relationships grow over days or weeks, we have to develop rapport and trust with patients and families in a matter of minutes and hours. Child life presence in the ED is critical in quickly assessing patients, providing coping strategies to increase compliance and normalizing the environment to reduce fears. Interventions include, but are not limited to: preparation, procedural support, diagnosis education, sibling support and bereavement support. Child life specialists in the ED continually work to educate new medical staff on developmentally appropriate ways to work with the pediatric population and on how to utilize child life services effectively.

Radiology

The Radiology Department at Children’s Hospital of Michigan consists of several different modalities of imaging, including: x-ray, fluoroscopy, nuclear medicine, ultrasound, CT, and interventional radiology (angio). Child life in this area focuses primarily on providing preparation and procedural support during diagnostic imaging exams for both patients and their families. The greatest need for child life services is typically in fluoroscopy, which is a type of continuous or “live” x-ray. Common procedures done under fluoroscopy are voiding cystourethrogram, barium enema, and upper GI scans. Other areas of radiology, such as nuclear medicine and ultrasound, will often reach out to the child life specialist on this unit when a patient is particularly nervous or having a difficult time. While radiology is primarily an outpatient unit, this is also where inpatient children will come if they need any type of diagnostic imaging done during their hospitalization. Child life provides coverage to the MRI department. There are typically 20-30 scheduled MRI appointments per day. The patient population is primarily outpatient, but also includes any inpatients needing an MRI. Common reasons for needing a MRI are seizures, headaches, developmental delays, sports injuries, and tumors. The child life specialist in MRI provides preparation and procedural support for patients of all ages. During the weekdays, many patients are often sedated or placed under general anesthesia, and the child life specialist will focus on preparation and procedural support for IVs or induction. On evenings, the child life specialist is often focused on providing preparation for non-sedate MRIs where the patient will be fully awake and need to remain still for the duration of the exam. One unique function of the child life specialist in this department is running the MRI-Can-Do-It program. This program is designed to help patients complete MRIs without sedation. The child life specialist conducts phone consults with families before their appointment, provides education and tips on how to prepare at home, and then provides further preparation to the patient on the day of their appointment.

Same Day Surgery

Child life is well established within Same Day Surgery (SDS) and is part of the multidisciplinary team that works alongside anesthesiologists, surgeons, nurses, and other hospital staff to provide child life needs to patients and families. This very busy, fast-paced unit schedules approximately 50-70 patients for surgery each day. The SDS child life specialist provides child life needs to inpatient and outpatient children during their time in SDS, including Pre-Op, induction in the OR, and PACU. In SDS we meet many children and families whose hospital experiences range from first timers, to patients who have had repeated surgeries and hospitalizations. Child life offers “Surgery Express Tours”, CHM’s surgical preparation program, to patients and families prior to the patient’s surgery date. This program aims to provide familiarization of the hospital environment, prepare patients and families prior to surgery, aid in increasing coping skills, and minimize anxieties.

Urology Clinic

The Pediatric Urology Department treats children with all common urological disorders and complex congenital urological problems such as bladder and cloacal exstrophy, anorectal malformations and genitourinary malignancies. The department also has multidisciplinary programs for the children including kidney stones, voiding dysfunction, nocturnal enuresis and disorders of sex development (DSD). Child life presence in the clinic includes assessment of patient and family needs, education and preparation, providing developmentally appropriate play and diversional activities, and non-pharmacological pain management techniques. The child life specialist also provides services for advanced diagnostic tests including renal/bladder ultrasound, voiding cystourethrogram, nuclear medicine scans and urodynamics testing.

Hematology/Oncology Clinic

This outpatient setting located on the third floor of the Carls building has intake rooms, exam rooms, and infusion bays which are utilized for check ups, procedures, and treatment. Children are treated for a variety of diagnosis such as hemophilia, sickle cell disease, acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), various types of tumors, and neuroblastoma. For this patient population treatment plans typically require several cycles of chemotherapy, frequent injections/transfusions, and numerous count checks. Some common procedures include but are not limited to port access/de-access, PICC line dressing changes, central line dressing changes, injections, and blood draws. Child life’s role in this clinic is to collaborate with the multidisciplinary team to increase patient and family centered care and satisfaction. This can be done through having reflective conversations that can aide with identifying and communicating patient and family needs, procedural support through diversional activities that can increase compliance with treatment, preparation/education to decrease misconceptions associated with the unknown, normalizing the hospital setting through developmentally appropriate play sessions, and assisting patient and families with developing coping plans to promote psychosocial well being.

Burn Clinic

This fast paced outpatient clinic provides support for children who have encountered chemical, friction, electrical, thermal, and other types of burns who need continuing care after their injury and/or hospitalization. Prioritization is crucial within this clinic when making assessments in order to provide the appropriate interventions within a timely manner. Child life often provides a clinical orientation during the first clinic visit that introduces the patient and family to the process of events that they will encounter. Child life also provides patient and family preparation to reduce anxieties associated with the unknown, procedural support during dressing changes, developmental play to normalize the hospital setting, sibling support, and emotional support.

Cardiology & Pediatric Intensive Care Unit (PICU)

The cardiology and medical ICU provides care to patients recovering from cardiac catheterizations and open-heart surgery, among other cardiac-related conditions. This unit also cares for patients prior to and following transplants. Additionally, the PICU serves other patients in need of intensive medical care, such as after an accident or injury, pre/post surgery, or for patients with other complex medical needs. The PICU gives specialists an opportunity to support patients and families dealing with a variety of complex situations including intubations, traumatic injuries, and end-of-life issues. We work in conjunction with many disciplines, including spiritual care and social work to provide bereavement care for siblings, parents, and other family members. This unit also includes regular attendance at multidisciplinary team meetings. Child life specialists provide preparation and procedural support, emotional support, therapeutic and diversional play, education and family support to promote positive coping for patients and families facing challenging circumstances.

5E: Burn Center/Surgical & Rehabilitation Unit

This unit focuses on patients with burns and those in need of inpatient rehabilitation services. Surgical (i.e. appendectomies and fractures) and medical (i.e. asthma and pneumonia) patients are also admitted to this unit. Trauma patients typically come to this unit after being cared for in the PICU. Daily interventions include preparation for surgery and procedural support for burn dressing changes. Medical play sessions are often facilitated to allow for emotional expression, misconception clarification, and patient/family education. Common play themes involve surgery, dressing changes, PICC lines, IVs, blood draws, and NG tube placements. Since the majority of patients have experienced traumatic events, we have many opportunities to engage patients in therapeutic, self-expressive activities. Additionally, we are able to participate in weekly interdisciplinary patient rounds for both the burn and rehab teams.

5W: Medical/Surgical

(Endocrinology, Neurology, Neurosurgery, & Pulmonary)

On this inpatient unit it is important for the child life specialist to prioritize to ensure the most effective use of time to meet the needs of the patients. Assessment skills are needed to identify variables that contribute to a child’s ability to cope with their experiences in the hospital. Medical play sessions, play sessions, preparations, and/or procedures for support most often include: insertion of I.V., PICC line & port placement, spinal tap, EVD insertion/removal, shunt placement, and/or needle play for blood glucose testing and insulin injections. Guided imagery will be introduced as a means of non-pharmacological pain management. Opportunities also exist to attend multidisciplinary team meetings.

6E: General Pediatric & Infectious Diseases

(Infectious Disease, Infant and Toddler, Neurosurgery under 5)

This acute care unit treats patients ranging in age from infancy to adolescence. Children are treated for a variety of diagnoses such as RSV, asthma, bronchiolitis, meningitis, and cellulitis. This unit also cares for children ages five and under with conditions including hydrocephalus and cystic fibrosis. Child life specialist interventions include introduction of child life services, assessment of patient and family needs, preparation, and procedural support, and providing developmentally appropriate play and diversional activities to aid in normalization of the hospital experience.

6W: Hematology/Oncology, Nephrology & Bone Marrow Transplant

This unit serves patients with ITP, sickle cell anemia, hemophilia, a variety of cancers, kidney transplants, lupus, and other kidney diseases. There are many different diagnoses on this unit and patients are often being seen by a number of specialties. There are opportunities to learn and strengthen a wide range of child life skills on this particular unit; including building relationships with hospitalized children and families, medical play, preparation, procedural support, non-pharmacological pain management techniques, diagnosis teaching and facilitation of expressive/therapeutic play sessions. For the child life specialist each day on this unit is different but one thing remains that child life is an integral part of the team and works with all the medical staff to meet the needs of the patients and families.