VOLUME 32 • NUMBER 3 SUMMER 2014

Let Me Tell You a Story . . . Kat Davitt Honored with 2014 Mary Barkey Award Randall McKeeman, MSEd, CCLS her, and not the other way around. It Mayo Eugenio Litta Children’s Hospital, Rochester, MN all started when Kat’s sister, an oncology nurse, encouraged her to volunteer at he storied career of Kathryn “Kat” Arkansas Children’s Hospital during Kat’s Davitt, MOT, OTR, CCLS has gained college years. After a year and four months her the recognition of her peers and T of volunteer work, Kat was hired as a the Child Life Council (CLC) by way of weekend child life assistant and stayed in the 2014 Mary Barkey Clinical Excellence that role until she graduated from Hendrix Award. The award was bestowed at the College with a Bachelor’s degree in 32nd Annual Conference on Professional elementary education. Following gradua- Issues during the Closing General Session tion, Kat was hired as a child life specialist on May 25th. for the Burn Center, Cardiovascular ICU, If you have ever had the pleasure to and the Pediatric ICU before the days of the Surgery and Orthopedic units. After a spend any time talking directly with Kat, certification by examination. At one point, six-year stint in Little Rock, Kat relocated you will know that she can tell a story and Kat made a brief four-month escape into to Texas and began working at Scott and tell it well. She claims to have a story on the world of teaching in a fourth grade White Memorial Hospital in Temple. In just about any topic. For the purposes classroom, but child life called her back to 1994 she transitioned again and joined the of this article, we should begin with the Arkansas Children’s Hospital to work in continued on page 11 story of how she entered the profession of child life. Kat shares that child life chose Child Life Alphabet INSIDE X is for X-Box: Psychological Nourishment Joan Turner, PhD, CCLS, Mount Saint Vincent University, Halifax, Nova Scotia Special Issue on Play The “Yes, and” Approach to Play remium entertainment is a mainstream The qualities that contribute to the 3 phrase used to communicate the appeal fun of the video game experience were 5 Playing for the Child Pof video platforms such as the X-Box examined within a framework of self- Who Cannot Play to a range of audiences. First released determination theory (Deci & Ryan, 2000; Point/Counterpoint: in 2001 by Microsoft, this multimedia Ryan & Deci, 2000); that is, playing video 6 Violent Play in Medical Settings console represented a shift in the delivery games provides experiences that satisfy basic of video entertainment to a social media needs. The need for competence is met Play with Infants and Toddlers: platform. Just one of a variety of video through a balance of challenge and goals; 8 Building Coping Capacities gaming brands, the latest X-Box One the need for autonomy through flexibility In Focus: stands as an example of the rapidly shifting and choice; and the need for relatedness landscape of video games available to through both cooperative and competitive The Importance of Play on children, youth, and families. But is it just social interactions. Describing the majority Whole Child Development entertainment? Przybylski, Rigby, and Ryan of video game players as “wanting to versus Book Review: Gaining a Larger (2010) reviewed the inherent properties having to play” (p. 161), the Przybylski and Perspective on Play of the experience provided by video game Ryan (2010) review of research suggests Healing With(in) Imaginative Play activities and their effect on motivation and that short-term well-being is enhanced well-being. They referred to the qualities of when these games are pursued with a competence, autonomy, and relatedness as “harmonious passion” (p. 161). psychological nourishment. continued on page 10 BULLETIN SUMMER 2014

IMMEDIATE PAST PRESIDENT’S REFLECTION

accomplished over the past year, the col- A Year of Growth laborative efforts of the Child Life Certifying Committee and Task Force 2022 also made and Development significant contributions to the profession. CLC solicited the expertise of external Amy Bullock Morse, that contributes to our profession’s body consultants in credentialing and academic MSEd, CCLS of literature. This year, CLC hosted an accreditation to explore the ways in which International Summit following the annual other associations have addressed changes in ver the past year, conference proceedings that engaged leaders preparation standards. I’m pleased that CLC it has been an of pediatric psychosocial care from over forty continues to benchmark with other organiza- honor to serve O countries in a dialogue about global oppor- tions to develop pathways that will suc- as your President, and I greatly appreciate tunities for child life. Support from CLC’s cessfully advance our profession. I am also the opportunity I’ve had to lead this dynamic partners and the director of development quite proud of the work of the Blue Ribbon organization. With your help, we have created the capacity for our organization Healthcare Task Force. Appointed in early continued to raise the bar on the quality to sustain resources that advance child life 2014, this group continues to progressively services we provide for children and families. services for children and families. explore the ways in which healthcare reform Leaving the presidency is bittersweet. I have legislation impacts the provision of child life enjoyed this role immensely, but I could not In addition to all of the other tremendous services across hospitals, ambulatory clinics, be handing the gavel over to a more energetic amounts of work CLC’s volunteer leaders transitional care settings, and the community. or talented colleague: my dear friend, Carla The task force’s work provides our profession Oliver. There are many prospects for with an opportunity to critically examine The past year has been very busy. CLC’s short- and long-term implications for new tireless volunteer leaders completed an un- growth, but one of the areas that models of care delivery and reimbursement. precedented body of work that satisfies nearly A colleague recently asked me how I would every deliverable in the 2012-2014 Strategic appeals to me most lies in the field like to see our profession develop over the Plan. Task Force 2022 and the Internship next five years. There are many prospects for Accreditation Task Force have worked cease- of literature: I would like to see growth, but one of the areas that appeals to lessly to deliver comprehensive standards for us expand our body of empirical me most lies in the field of literature: I would academic preparation and clinical training like to see us expand our body of empirical programs. The Program Standards Task research that highlights the ef- research that highlights the efficacy of play to Force presented the Board with a framework mitigate distress in medically fragile children. from which child life programs may be ficacy of play to mitigate distress in But the question also prompted me to pause recognized for excellence in clinical service and reflect upon the major accomplishments delivery. CLC offered program grants for a medically fragile children. our young profession has already attained. second year to promote empirical research Not long ago, our membership decided to move forward with a certification exam, which ensures that new child life specialists Child Life Council Bulletin/FOCUS have the skills necessary in order to support 11821 Parklawn Drive, Suite 310, Rockville, MD 20852-2539 children and families. And today, we are (800) CLC-4515 • (301) 881-7090 • Fax (301) 881-7092 building upon the expertise of our former www.childlife.org • Email: [email protected] leaders, developing and executing standards that elevate services for children and families President Executive Editor Associate Editor Executive Director Managing Editor experiencing some of life’s most stressful Carla Oliver Jaime Bruce Holliman Jessika Boles Dennis Reynolds Anne Luebering Mohl events. Published quarterly in January (Winter issue), April (Spring issue), July (Summer issue), and October (Fall issue). Submission deadlines for consideration for each issue are as follows: Winter: October 1; Spring: January 1; Michelangelo once said, “The greatest danger for most of us is not that our aim is Summer: April 1; Fall: July 1. For more information on submitting articles, please see Submission Guidelines in too high and we miss it, but that it is too the Bulletin Newsletter section of the CLC Website. low and we reach it.” I’m so very proud to For information on advertising in the Bulletin, please refer to the Marketing Opportunities have had the fortune to lead an organization section of the CLC Website: http://www.childlife.org/Marketing Opportunities/ that is committed to providing such essential Bulletin advertising is accepted in accordance to the CLC Relationship Policy and Advertising Guidelines, which services for children and families facing chal- may be found at www.childlife.org. Acceptance of advertising does not indicate or imply endorsement by CLC. lenging experiences.

2 A Publication of the Child Life Council BULLETIN SUMMER 2014

FROM THE EXECUTIVE EDITOR

engaging patients who are unable to play on Play: A Closer Examination their own and ways to improve your skills and strengthen your interventions with children. of the Roots of Child Life I think I can safely say that we all agree Jaime Bruce Holliman, MA, CCLS that play, at all ages and ability levels, is paramount, but the need for play doesn’t end lay. As child In this play-themed special issue, we invite when you reach adulthood. In fact, I would life specialists, you to return to those roots and expand say that it becomes even more important as Pwe talk about your knowledge and application of play for other responsibilities fill our calendars. As it all the time. We all levels of development and ability. After adults we have to be purposeful in making advocate for it. We participate in it. We teach reading this issue, we hope that you will feel play a part of our lives, and one of the con- (and even preach) about the importance of it. inspired to test new ways of engaging in play tributors to this play-based issue encourages Over the last year, we as a professional orga- with infants and that you will feel confident in us to do just that as a method of professional nization have engaged in many conversations articulating how play promotes their self- self-care. about play and have committed to looking regulation and supports their development. more deeply at the measureable value of play We hope that you will ponder the impact Play. It amazes me how something that in medical settings. Play is a tool, a skill, a of technology on play and consider how it seems so simple to the casual observer can coping technique, a learning opportunity, can make a difference in your practice with make such a deep impact on an individual and a universal language, and it is at the root school-age and adolescent patients. And we and how, when you get up close and study it, of our work. hope that you will contemplate techniques for can be so complex and multi-layered.

The “Yes, and” Approach to Play Kimberly Kow Mason, MS, CCLS, Hackensack University Medical Center, Hackensack NJ Jon Luongo, MS, CCLS, Maimonides Infants and Children’s Hospital, Brooklyn, NY; Bankstreet College of Education, New York, NY

mprovisation is the art of people play- A “Yes, and” approach in this moment fact the two fields share similar roots: Viola ing together on stage to create theatrical might be: “Whoa, thank goodness Spiderman Spolin, widely considered the American Ipieces without preplanning the content. is here. I should have known you would have “grandmother of improv,” studied with the Everything is made up on the spot. Three such an awesome friend — I bet the two great early 20th century Chicago sociologist strategies used to create an improvised scene of you could go together to the operating and play proponent Neva Boyd. (Moffit, are: 1. Listen; 2. Accept each scenario as pro- room.” This approach shows a willingness n.d.). Boyd had another protégé as well: posed by your partner; and 3. Help deepen to follow the child’s lead and participate child life innovator Anne Smith, who wrote the dramatic stakes as the scene unfolds. In playfully without knowing exactly what will the 1941 opus Play for Convalescent Children improv lingo these strategies together are happen next. in Hospitals and at Home. (J. Turner, personal known as a “Yes, and” approach. communication, October 19, 2012). Improv Following your partner’s lead in play can techniques and child life practices have Using a “Yes, and” approach to play with be nerve-wracking! Improv builds a healthy influenced each other since their inception. hospitalized children means staying flexible tolerance for uncertainty and the courage to rather than staying in control. For example, make mistakes. These are essential qualities So seek out an improv theater in your let’s say you are preparing a 6-year-old for for reaching out empathically to an ill child. region; take a workshop or drop in on a class. surgery when suddenly the child pulls out When we train ourselves to be completely Improv is a bold and courageous way for a a Spiderman doll to show you. The child present in the moment, we are better able child life specialist to strengthen listening makes Spidey do make-believe jumps and to listen to verbal cues and attend to body skills and become a more spontaneous, atten- feats of strength. A traditional response such language. We can inspire a child, our play tive, and imaginative play partner to children. as, “Oh, do you like Spiderman?” wouldn’t partner, to engage with her own experience “Yes, and” it’s so much fun! seem to stem from good listening, since the and come up with creative ways to cope. child clearly does. Asking questions keeps Reference Improv enthusiasts talk about play and you in control and may block a moment of Moffit, D.E. (n.d.). Viola Spolin Biography. Retrieved from the subtleties of communication styles with imaginative play from developing. http://www.spolin.com/violabio/ the same passion as child life specialists. In

A Publication of the Child Life Council 3 BULLETIN SUMMER 2014

FROM THE EXECUTIVE DIRECTOR

as a quality indicator of the delivery of AAP Issues New Policy services for children and families in health care settings. Statement on Child Life Services 2. Child life services should be provided di- Dennis Reynolds, MA, CAE rectly by Certified Child Life Specialists. 3. Child life services staffing should be he American Children’s Hospital, part of University of individualized to address the needs of Academy of Florida Health in Gainesville, FL. Chris has specific inpatient and outpatient areas. TPediatrics (AAP) served as CLC’s liaison to the AAP Commit- Committee on tee on Hospital Care for the past eight years. 4. Child life services should be included Hospital Care has released a new version of in hospitals’ operating budgets as an The new statement is a revision and its policy statement on child life services. The essential part of hospital-based pediatric update of earlier AAP statements on child updated statement observes, among other care. life services issued in 2000 and 2006, and things, that: reaffirmed in 2012. In a report to the CLC 5. Additional research should be conducted The provision on child life services is Board of Directors, Chris Brown highlighted to evaluate the effects of child life services a quality benchmark of an integrated some of the major changes between previous on patient care outcomes. patient- and family-centered health care editions and the new document: system, a recommended component of As we are all aware, play is a cornerstone • The 2006 statement specified that child life medical education, and an indicator of of child life – as recognized by the special services should be provided by a “quali- Bulletin excellence in pediatric care (Committee theme focus in this issue of – and fied child life specialist.” This has been on Hospital Care & Child Life Council, the new AAP statement acknowledges this changed to “certified child life specialist” 2014, p. e1472). importance. The section on therapeutic play throughout the new version. begins by observing that “play is an essential The lead author of the statement is CLC component of a child life program and of the • The section on play is expanded, particu- past-president Chris Brown, MS, CCLS, child life professional’s role” (Committee on larly regarding “the therapeutic value of Director of Child Life Services at Shands Hospital Care & Child Life Council, 2014, play.” p. e1473). The updated statement points out • A new section on pain management the value of normalizing play, as well as the and coping strategies has been included, importance of medical play in reducing chil- Child Life Council focusing specifically on the importance of dren’s emotional distress and in helping them Board of Directors 2014-2015 non-pharmacologic techniques. cope with their circumstances. It makes the case that play is appropriate for infants, The 2006 version included a recom- President Carla Oliver, MSW, CCLS children, and adolescents, and points out the mended ratio of 1 child life specialist to 15 importance of auxiliary programs such as art, President-Elect Sheri A. Mosely, MS, CCLS or 20 inpatients, acknowledging the need music, pet, and play therapy. Immediate Amy Bullock Morse, MSEd, CCLS for adjustment in that ratio depending upon Past President patient age and mobility, institutional needs, The full AAP Policy Statement on Child Secretary Anita H. Pumphrey, MA, CCLS and the patient or unit population. There Life Services is available at: http://pediatrics. was significant discussion during the prepara- aappublications.org/content/133/5/e1471. Treasurer Lisa Ciarrocca, CCLS tion of the new version as to whether to keep full.pdf+html. Directors Eileen Clark, MSM, CCLS or eliminate that ratio, as some felt it was not We are pleased that the AAP officially rec- Meghan Kelly, MSEd, CCLS based deeply enough in evidence. In the end, ognizes the importance of child life services, the 1:15 ratio remains in the new statement Anne Claire Hickman, CCLS, CIMI and we would like to thank Chris for her as a guideline, and is accompanied by a table Jill Koss, MS, CCLS tireless work over the past several years in describing “Factors Indicating Lower Patient- reviewing and re-casting this statement. We CACLL Liaison Chantal LeBlanc, BPs, CCLS to-Child Life Staff Ratios.” hope members will find the information to CLCC Senior Chair Lucy Raab, MA, CCLS The new statement includes five spe- be incredibly valuable. Executive Director Dennis Reynolds, MA, CAE cific recommendations regarding child life eferences To contact a Board member, programming: R Committee on Hospital Care & Child Life Council (2014). please visit the CLC Member Directory at 1. Child life services should be delivered as Child life services. Pediatrics, 133, e1471-e1478. http://www.childlife.org/Membership/ part of an integrated patient- and family- MemberDirectory.cfm. centered model of care and included

4 A Publication of the Child Life Council BULLETIN SUMMER 2014

Playing for the Child Who Cannot Play Deborah B. Vilas, MS, CCLS, LMSW Bank Street College of Education, New York, NY

s strong advocates for developmentally could enter the play if he wished, but far One approach to this is the hand-over- appropriate play in hospitals, child life enough away to offer no threat. Turning my hand method, where you use your body and/ Aspecialists know the value of play for all back to him, I began to play with the garage, or technical adaptations to scaffold the child’s children and the therapeutic benefits of play zooming the cars about, complete with physical (and sometimes cognitive) abilities. for those faced with illness, injury, and hospi- sound effects. I felt silly, but my willingness I recall an encounter with a developmentally talization. But what happens when a child is to be vulnerable was effective. Within two delayed fourteen-year-old boy who had too scared, ill, debilitated, or developmentally minutes, the boy leaned over the edge of the cerebral palsy and was blind. Positioning delayed to engage in active play? Do we just bed, pointed to my car, and stated, “Not that a xylophone in his lap, I placed my hand shrug our shoulders and move on to the next one – the red one!” over his so that he could grasp a mallet and patient? guided his hand to strike the instrument. The happiness on his face when he made music None of us wants to be that person who I positioned myself close is something I will never forget. Another walks away, but engaging children who example might be helping a child paint by cannot use their bodies to play actively can be enough to his bed so that assisting the child’s hands or using his feet to a challenge. It is at these times that we need create art. Throughout your interactions, use to dig deep into our play tool kits and our he could enter the play if he child-centered language and offer plenty of imaginations. wished, but far enough away choice about colors and themes. This will give Two techniques come to mind that are the child more control over the activity as you applicable in situations when a child is to offer no threat. Turning my assist in moving his body. unwilling or unable to play: parallel play When a child is unable to participate in and playing for the child. Parallel play is a back to him, I began to play assisted play, you are called upon to play for technique that can be used to build rapport. them. Susan Wojtasik and Sallie Sanborn It is based on the developmental stage that with the garage, zooming the toddlers must master before they are ready to continued on page 10 play cooperatively with their peers (Parten, cars about, complete with 1932). Toddlers often play with similar toys in proximity to one another. When children sound effects. I felt silly, but my play in each other’s company, but not with one another, this is parallel play. They are willingness to be vulnerable transitioning from solitary play to more socially mature associative and cooperative was effective. play. This play provides the comfort of companionship, but does not require them This can be done in varying ways depend- to share or converse. In other words, it asks ing on the developmental age of the child. nothing of them. For school-aged kids, bringing in real medical Keeping this in mind, picture the child equipment and a doll can capture their atten- who refuses medication and retreats beneath tion. Or imagine yourself making a volcano in the covers whenever medical personnel enter the corner of the room; even if that child does the room. The typical verbal meet-and-greet not engage you in that moment, you have is not going to help you assess and connect established yourself as a curiosity and the child with this avoidant child. Instead, a sure way will be more open to playing in the future. to build trust is to ask nothing of the child, The second technique, playing for a child, and to act like a toddler. goes beyond rapport building. It allows you Enter the room with a toy; a play medical to assess the child’s strengths and preferences, kit or any developmentally appropriate item and use this knowledge to help the child will do. When I approached the room of a enter into play. For children with little or no four year-old boy who had refused to eat or ability to control or move their bodies, there speak, I carried a toy garage and several small are two ways to approach play; they are both cars. Plopping myself down on the floor, I directive, but child-centered language and purposefully avoided eye contact. I positioned choices are woven together to allow room for myself close enough to his bed so that he control and mastery.

A Publication of the Child Life Council 5 BULLETIN SUMMER 2014

POINT/COUNTERPOINT · · · · · · · · · · · · · · · · · ·

Diane E. Levin, PhD, Wheelock College, Boston, MA Anne Luebering Mohl, PhD, CCLS POINT: Violent Play Has No Place in Medical Settings1 s believers in and proponents of the While violent play can be distressing to that contain entertainment violence. For power of play, child life specialists often professionals in medical settings, how does it these children, play often becomes an effort A see the benefits that positive and creative feel to a family arriving at the hospital with to imitate the violence they saw on screens play can bring to the lives of children. But it a child who has been a victim of real world with highly realistic toys that are linked to the can also be very upsetting to see a hospital- violence to see another patient acting out a violent shows. When children imitate screen ized child using a toy gun to shoot the “bad pretend gun battle in the next bed? Can’t a violence, it does little to help them work on guys,” or a teen absorbed in a highly violent hospitalized child who has been a victim of the kinds of issues hospitalized children need videogame. How can it be morally and ethi- violence be further traumatized by violent to work on in their play, but it does take cally acceptable to allow children to pretend play among other children in the same unit? valuable time away from the play they should to hurt someone in hospital settings where we Doesn’t allowing that child to then engage in be doing. work so hard to promote children’s well-being his or her own pretend violence in the hospital For all these reasons, doesn’t it make sense and to help them heal? Doesn’t allowing such teach him or her that adults think violence for hospitalized children’s best interests, as play teach children the harmful lesson that is an acceptable play theme? What kinds of well as for the best interests of families and caring adults think violence is okay, even fun confusing and conflicting messages does this child life workers themselves, that play with and exciting? Can’t it undermine the messages give the child about how to deal with violence violence should be banned in hospitals? Just about safety, security, and helping others that in their lives or the wider world? This juxta- as child life specialists are asked to limit child life specialists work so hard to create position of violent play with the consequences screen time and promote more play, disal- through play? Doesn’t it divert children’s of real violence can feel overwhelming and lowing violent play in favor of constructive energy away from the kind of positive and damaging to patients, families, and staff. play alternatives should also be a goal. Taking creative play they need to develop positive There also are the many children who away play with violence gives children more attitudes and understandings of their hospital have not experienced violence directly, but time for the positive play they need to heal experience, and to heal and grow? who have spent much time glued to screens their minds and bodies. COUNTERPOINT: Violent Play Is Still Play and Should Be Allowed hildren use their play to process events disturbing, but we cannot be the final arbiters experiences involve being exposed to scary or or emotions, and to work on their own of “good” versus “bad” play; children’s voices, violent things, play provides a powerful way Cunique needs in ways that they can con- as expressed through their play, must be heard. to process them. Reenacting violent scenes trol. And although it would be ideal if play children have witnessed may help them come A key goal in child life work is to use play could always be wholesome and non-violent, to grips in a way that talking and drawing to help normalize the medical setting for chil- child life specialists have long been taught to alone cannot, especially when they are young. dren. If gun, superhero, or violent videogame trust the voice of children in the play process. Even children who do not live with violence play is what a child knows and plays at home, Thus, if children bring violent content and in their lives may become overly aggressive can’t having such play at the hospital bring themes into their play, they are likely to have and explore violent themes as they struggle comfort at a stressful time, even if it does legitimate reasons for doing so. It can be their to express the strong and/or unfamiliar happen to involve modes of play that may way of working through something violent emotions they may experience in the hospital. concern us? This will be especially true for or scary that they have seen, on screens or in Sometimes the power that children display children who spend the most time at home real life. It can give them a way of expressing in their violent play is a reflection of the glued to screens that contain violence, and their anger and/or frustration at the situation powerlessness they feel, and child life special- engaged with toys and in play that involve they find themselves in at the hospital. It can ists are well aware that the lack of control in violent themes. Some of these children allow them to be in control and feel power- medical settings can propagate feelings of may find that what they see and do with the ful, at a time when it is easy to feel helpless, powerlessness. Banning violent play takes violence on screens at home is exciting and small, and without a voice, as we know can away an important outlet for understanding, satisfying, so it readily becomes a coping so easily happen with hospitalized children. expression, and feeling in control. strategy they are likely to find very helpful in Yes, violent themes in children’s play can be the hospital as well. If a ban on violent play is instituted in a hospital, where should the lines be drawn? 1 For a more detailed discussion of these issues, Another child life goal is to help children How will limits be set? Who will decide what see: Levin, D.E. & Carlsson-Paige, N. (2006). process difficult experiences and gain control is and is not violent play, when and where it The War-Play Dilemma (2nd Ed.) New York, over them. For some children whose difficult NY: Teachers College. continued on page 7

6 A Publication of the Child Life Council VOLUME 32 • NUMBER 3 SUMMER 2014

articles that bring so many dimensions to Oh the Ways We Can Play! play in this issue. Experimenting with top- ics, perspectives, and tones, this Bulletin issue has been a playful experience in imagination Jessika Boles, MEd, CCLS, Associate Editor Each one of us enjoyed a unique play his- and possibility for our editorial team as our tory in our early years that we are continuing faded beige couch in the living room authors push the traditional boundaries of throughout our lives and work. As we grew of a split level house in San Francisco play and re-envision the foundational prac- older, through our academic training we taught me everything I know about tices of child life. Dr. Michael Patte’s Focus A conceptualized and theorized play in homes, play. There I built my first pillow fort on contribution, adapted from his presentation communities, and healthcare settings. Our a rainy afternoon, got so lost in a book at the 2013 CLC Annual Conference on practicums, internships, and mentorship that I almost missed lunchtime, practiced Professional Issues and supported by the programs then gave us not only the language my figure skating choreography in front of Supporting the Field of Play for Hospitalized of play, but also the tools to play regardless imaginary Olympic audiences, and learned Children Initiative, asks us to do the same, of an individual’s abilities, circumstances, to knit, crochet, and craft with my mom and especially in the context of changing beliefs or background. Now, our participation in grandmother. I tamed basset hound circus about play in today’s world. He argues that the Child Life Council, research projects, lions, built a snow-capped train village with the days of unstructured, child-directed play and professional development opportunities my grandfather, and cared for my stuffed cat are quickly disappearing, not only in hospi- continue the evolution of our play history as when he (and I) fell ill. I played with not tals, but also in neighborhoods, schools, and individuals and as a profession. one, but two, brand new baby brothers on in all the contexts in which children develop. that couch for the first time; I also played As the incoming executive editor of By sharing highlights from his own unique “house” there with my grandmother for the Bulletin and Focus, I have been honored to play history, his work reminds us that play last time. It’s funny how you can ascribe be part of this issue that pays homage to the isn’t just a developmental need for children; such meaning to a piece of furniture, but on very concept of play that we hold so dear. instead, it’s something free-flowing, healing, the play map of my life, everything emanates Under the leadership and vision of outgoing and entirely relevant across the lifespan for out from a sun-drenched compilation of editor Jaime Bruce Holliman, I have been patients, families, professionals, and com- fabric and wood. able to “play” editor as we compiled the munity members alike.

The Importance of Play on Whole Child Development Michael Patte, PhD, Bloomsburg University, Bloomsburg, PA

lay scholars draw upon the memories screen. When I juxtapose the undergradu- Abstract of their subjects to capture an essence ate student memories with memories from Pof early play experiences. These play those 35 years and older, sharp differences This paper explores how play in America memories are often elicited through ques- can be seen in the play lives of children has morphed over the past decades from an tions and visualizations and participants in this time frame in terms of play as unstructured, child-initiated endeavor to an often report the experience being more unstructured, child-initiated, cooperative, adult-directed, structured enterprise and the powerful than expected. Vast differences and naturally occurring. Some argue that implications that this change has on whole can be seen in play memories across gen- these changes are natural, expected, and child (cognitive, creative, emotional, physical, erational lines (Brown & Patte, 2013). beneficial for children while others argue and social) development. The paper concludes that they have serious implications for whole When I ask current undergraduate child development. This paper explores the by offering recommendations to reestablish college students between the ages of 18 and potential impact that a more structured and elements of unstructured, child-initiated play 22 about their early play experiences, their controlled play life has for children in the that are essential to ensure a bright future for memories reflect adult-driven, structured 21st century. whole child development in the 21st century. play that most often took place inside, in a private space, alone, and interacting with a continued on Focus page 2 FOCUS SUMMER 2014

continued from Focus page 1 local neighborhood on daily walks to the park and I found a comfortable spot in the field to with my mother. The landmarks guiding our watch the lunar landing while our parents To anecdotally highlight the changes cul- way were not the brilliant constellations visible received a most unexpected anonymous tip about ture of play, I would like to share a personal in the night sky, but the mailboxes, mom-and- our ambitious plan and whereabouts. Soon after play memory from 45 years ago. When pop stores, and fence posts we observed along the our rations were depleted, my parents arrived viewed in a present-day context, the play way. Once at the park, our Big Wheels tricycles to reclaim my brother and me from the magical memory is quite astounding. It was a walk to became moon rovers and the sand piles the lunar field where we witnessed Neil Armstrong take remember—July 21st, 1969. surface perfect for unearthing moon rocks. These “one small step for a man and one giant leap for A Walk to Remember— fantasy play episodes went on for weeks fueled mankind.” by our unbridled imagination and my mother’s uly st If we examine this play experience from J 21 , 1969 non-interventionist approach. I was born in April of 1967 and was just 27 multiple theoretical perspectives, a variety months old and my brother only 44 months old During these daily trips to the park and at of implications can be drawn about the when we went on the adventure of a lifetime. other times throughout the day, my brother and nature of children’s play lives and how they The spring and summer of 1969 were abuzz I were planning a most ambitious mission of our have changed over the last 40 years. For my with stories of mankind’s unthinkable journey own; a secret nighttime trip to my grandmother’s brother and me, a walk to remember signified to the moon and the Apollo 11 mission. At that house to witness the lunar landing in real time. one of the crowning achievements of our time, my brother and I dreamed of becoming as- Our parents never caught wind of our plan or childhood. It demonstrated our burning de- tronauts and exploring the planets in the Milky never believed we would carry it out, but on sire to explore and actively participate in the Way and our play episodes reflected this common the evening of July 20th, 1969, all systems were world in which we live, to assess and manage theme. For starters, we settled on exploring our go. My brother and I woke around 2:00 am, risk, to devise and execute a complex plan, made our way to the kitchen, assembled some and to meet our growing need for autonomy rations (raw egg sandwiches garnished with salt and independence. All of these traits were and pepper and a thermos full of orange Tang), nurtured and developed by our parents daily About the Views and packed them up for the journey. Next, we by providing the time, space, and freedom to headed out the door and began the roughly one- daydream, explore, test boundaries, and push Expressed in mile trek to my grandmother’s house in nothing the limits. more than diapers and tee shirts. This route was From my parents’ perspective, a walk well programmed in our developing brains as we Focus to remember signified a low point in their followed familiar landmarks, but this was the Focus young careers as parents. Both my mom and It is the expressed intention of to first time we made the trek at night, in the dark, dad felt as if they had abdicated the primary provide a venue for professional sharing and by ourselves. The night was clear and the responsibility of parenthood: to protect their on clinical issues, programs, and interven- moon shone brightly in the quiet summer sky. tions. The views presented in any article children from harm. I remember my mom are those of the author. All submissions During the trip we were keenly aware of the crying for weeks and my father installing are reviewed for content, relevance, and potential dangers that stood in our way. We locks high up on the doors to prevent similar accuracy prior to publication. knew to stay on the sidewalk to avoid pointy excursions from taking place in the future. I sticks and stones that might cut our feet, we don’t remember the talk our parents delivered Focus Review Board 2013-2014 knew to be silent when passing by the houses or the punishment handed down following Katherine Bennett, MEd, CCLS with pet dogs to avoid raising suspicion, and our adventure, but I often wonder about the Brittany Blake, MS, CCLS we knew to duck behind trees and bushes when social stigma assigned to my parents from the glare of car lights approached to avoid being friends and family alike. This tension between Siri Bream, MSCD, CCLS seen or abducted. How did we come to develop a parent’s desire for control and a child’s Amanda Newberry Butler, MS, CCLS these basic survival skills? I would say through a desire for freedom has been playing out for Nicola Elischer, MA little bit of biology and a whole lot of personal thousands of years and will only continue to Laura Ianni, MA, LPC, CCLS experience. do so, but today’s parents seem to be gripping a bit tighter than any time in the recent past. Caitlin Koch, MS, CCLS Once at our grandmother’s house my brother Elizabeth McCarroll, PhD, CCLS and I began knocking on her door. We wanted The Benefits of Play on Mary Faith Roell, MS, CCLS Grandma to witness the lunar landing with us Whole Child Development from the field behind her house. Grandma never Jennifer Smith, MS, CCLS, CIMI answered the door, but the knocking did pique Today, many decisions impacting children Jennifer Staab, MS, CCLS the interest of our uncle, a construction worker focus exclusively on their cognitive develop- Joan Turner, PhD, CCLS who lived just next door. Our uncle asked what ment, or development from the neck up. However, Weissman and Hendrick (2013) Mary Tyson, MS, CCLS my brother and I were up to, and we told him about our plan to watch the lunar landing of endorse a whole child perspective that Proofreader Apollo 11. Then came the obvious question: pictures the child as being made up of five distinct selves—cognitive, creative, emo- Desiree Heide, CCLS “Where are your parents?” We told him that our parents were still in bed at home. My brother tional, physical, and social. This five-domain developmental approach underscores essential

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elements across multiple environments that children need in order to thrive. One of these essential elements is play, and recent research supports the benefits of play on whole child development: • Interactive, exploratory experiences, both features of play in unstructured social environments, enhance cognitive under- standings (Action for Healthy Kids, 2008). • According to Pellegrini (2009), different types of play foster social competence (respect for rules, self discipline, aggression control, problem solving skills, leadership development, conflict resolution, and playing by the rules). • When provided with frequent opportuni- ties to play, children develop self determi- nation, self-esteem, and the ability to self regulate; all vital elements of emotional development (Barros, Silver, & Stein, me were the only valuable bits of the These places were so appealing because they 2009). school day. We took the most roundabout were off the beaten path, secluded, and • Active physical play builds strength, routes home so that we could discover the hidden from the noisy world outside. I can coordination, and cardiovascular fitness miracles of a . . . snicket, the alleyways vividly recall making dens and tree houses and moderates childhood obesity and its and allotments edge, the wall balanc- and adorning them with personal artifacts associated health complications (Centers ing and gate swinging, the improvised to make these spaces feel like a home away for Disease Control and Prevention, 2010). gateways of pried apart railings just wide from home. Here we formed secret societies, enough to wriggle through . . . [On forged our own rules, and lived like kings • Children engaging in pretend play exhibit these adventures] there were trees and and queens. In their seminal text, Children’s a greater capacity for cognitive flexibility berries and flowers and wild corners Games in Street and Playgrounds, folklorists and creativity across the lifespan (Russ & where we could hide and make dens and Iona and Peter Opie (1969) document that Fiorelli, 2010). discoveries. In this forbidden space we children prefer quiet and natural spaces to Play in the Recent Past escaped where no parents or teachers engage in play beyond the watchful eye of were looking and ‘learned the things that adults: In the recent past, children explored their cannot be taught.’ We really played here. We forget that children’s amusements communities on their own terms by walking I do not mean the formalized playground are not always ones that attract atten- or riding bicycles just about everywhere. games that are often mistaken for a play tion. They are not prearranged rituals They knew the safest routes and the best experience . . . [these proved torturous] for which the players wear distinctive shortcuts for getting just about anywhere as to the Dyspraxic Wilson . . . But in those uniforms, freshly laundered. Unlike the these secrets were passed down from more marginal spaces, everything was different. obtrusive sports of grown men, for which experienced peers. I vividly remember the The rules melted somehow. There was a ground has to be permanently set aside daily, adventurous walks to and from school. sense of being drawn in and exploring, and perpetually tended, children’s games Each morning, rain or shine, beginning being captivated and liberated at the same are ones which the players adapt to their in kindergarten right up through eighth time (Wilson, 2012, p. 32). grade, I walked the three-mile round trip surroundings and time available. The trek to school with a group of friends. The These daily excursions were private ones peaks of a child’s experience are not visits number of children participating in this daily that happened beyond the watchful eyes of to a cinema, or even family vacations, ritual varied, but it was an impressive lot of our parents. There was a sense of trust in the but rather occasions when he escapes into characters indeed. I was reminded of these protective power of the group and a realiza- places that are disused and overgrown magical walks to school recently by Penny tion that we had to make our own way in the and silent. To a child sport is sweetest Wilson’s (2012) essay, Beyond the Gaudy world, and providing the freedom to walk to when there are no spectators. The places Fence. In the text, Wilson argues that children school each day was the first little step in that they like best for play are the secret places need to experience liminal spaces—places of direction. where no one else goes. (pp. 14-15) ill-defined purpose—for it is in these liminal There were also many secret places to be Just 40 to 50 years ago, roaming hoards spaces that children enjoy the wonders of play discovered on the walks to and from school, of children were a common sight in many most fully: and we returned in the evening hours, on neighborhoods across America. At that The walks between home and school for weekends, or whenever the chance occurred. continued on Focus page 4

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time, parents provided the time, space, and freedom to play. This unstructured time was granted each day after school, on weekends, and all summer long from dawn until dusk. Space for play was wide-ranging and boundaries were always being negotiated. Pick-up games created by the group ruled the day and organized sports were more of an afterthought. Gray (2013) provides a brilliant glimpse into the long-since-forgotten era of community play: When I was a child in the 1950s my friends and I played . . . in mixed-age neighbourhood groups almost every day after school until dark. We played all weekend and all summer long. We had time to explore in all sorts of ways, and also time to be bored and figure out how to overcome boredom, time to get into trouble and find our way out of it, time to daydream, time to immerse ourselves in hobbies, and time to read comics . . . What I learnt through my [play] has been overcome adversity, solve real-world prob- lives of their children through overinvesting, far more valuable to my adult life than lems, and become self-reliant, thus creating a overprotecting, and overprogramming. One what I learnt in school . . . (p. 1) generation of ‘tea cup’ children that are fragile reason parents tend to overinvest today is due Present Day Play and inflexible. in part to the size of the American family. As the size of the American family continues to The individualistic and competitive nature Fast forward to the present day, and the decline, parents have more time and resources of American society creates an optimal roaming hoards of children that once filled to devote to children’s schooling and extracur- environment for fearful adults worried about the local streets and neighborhoods have ricular activities (Elkind, 2007). Role strain their child’s ability to ascend the ladder of become virtually extinct. Children, like an (Parsons, 1968) is another factor associated success and discourages its youngest members endangered species, now find refuge in the with overinvestment. Role strain holds that from indulging in frivolous, impractical, and safety of their houses and through participa- as society becomes more complicated, so too unproductive activities (Patte, 2009). In this tion in a variety of organized activities and do the social roles of its members. Many of environment, many contemporary parents sports. Sociologists have documented that the parenting practices once under exclusive view play as a luxury that their children can in the last 50 years America has transitioned control of the family are now delegated to ill afford. Research on the amount of time from being a ‘front porch’ society that values others, and parents overinvest in the practices children spend in child-initiated play over community play, to a ‘back deck’ society that still under their control. favors organized and structured activities like the past thirty years supports this assertion. play dates (Putnam, 2000). In this climate, For example, even in schools serving our Overprotection is a second barrier imped- play has morphed from an unstructured, youngest children, opportunities for play are ing opportunities for children’s unstructured child-initiated endeavor to an adult-directed being overrun by more structured activities. play. Generally speaking, in the early part of activity (Marano, 2008). Although there are Miller and Almon (2009) reported that thirty the twentieth century parents focused more several reasons for this change, parental fear years ago, child-initiated play made up 40 on protecting childhood innocence and less serves as the main societal barrier impeding percent of a typical preschool day, compared on risks to physical wellbeing. Characteristics children’s unstructured play (Elkind, 2007; with just 25 percent today. Within this same of this era included bigger families, smaller Gill, 2007). timeframe, Elkind (2007) found that children houses, and greater access to outdoor play lost 12 hours of free time per week, includ- spaces for children. Time for unsupervised Marano (2008) and Sigel (1987) identify ing eight hours of child-initiated play and play and for assessing and managing risk were hyper-parenting and hothousing techniques outdoor activity. In stark contrast, the time viewed as important elements of whole child as two ways that parents attempt to create a children devote to organized activities like development. Today, however, parents are perfect childhood and provide the optimal sports has risen by 50 percent from 1980 to more concerned with protecting the physical environment for their children to grow 1998 (Hofferth, 1999). wellbeing of their children than they are and develop. The authors warn that both with protecting childhood innocence, even Elkind (2007) and Gill (2007) suggest approaches are ruled by fear and eliminate lacking any evidence claiming that children that fear causes parents to micromanage the opportunities for children to face and are in greater danger today than in the past.

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A measureable example of overprotection in child-initiated play provides children with • Risk aversion – Gill (2007) and Marano action is the vast number of parents using opportunities to experience and work (2008) identify a present-day landscape cell phones to track the whereabouts of their through challenges, discomfort, and disap- in the UK and USA where children are children at all hours of the day and night pointments. Lacking these experiences can “bubble wrapped” by their parents and (Elkind, 2007). impair the ability to develop coping skills deprived of opportunities to assess and and the inner resolve necessary to thrive in manage risk. In this type of environment, A third way parental fear about unstruc- a changing world (Marano, 2008). children are incapable of adapting to a tured play is actualized is through over- fluid world, making them risk-adverse and programming the lives of children. Today’s • Health concerns – Throughout the world psychologically fragile. parents feel pressured to help their children children are facing an obesity epidemic, develop at an accelerated pace (Elkind, and during the past forty years in the US, Recommendations 2007). We have all experienced parents who the obesity rate for children aged 6 to 11 for Reestablishing proudly share the ages at which their children has more than quadrupled (Ogden, Car- Child-Initiated Play utter their first words, take their first steps, roll, Curtin, Lamb, & Flegal, 2010). Today read their first book, tie their shoelaces, ride over twenty-three million young people Based upon the evidence, researchers, par- a bicycle without training wheels, etc. This in the US are overweight or obese (Robert ents, policy makers, children, and concerned “sooner is better” mentality often causes par- Wood Johnson Foundation, 2009). citizens can play an active role in reestablish- ents to overenroll their children in structured ing child-initiated play. The following next • Incidence of anxiety and depression – activities, leaving little time for child-initiated steps are recommended: According to Gray (2013), as opportunities play opportunities (Brown & Patte, 2013; for children’s play have declined, mental • Turn your neighborhood into a place Elkind, 2007; Marano, 2008). disorders among children have increased. for play – In his play advocacy manifesto, Lanza (2012) identifies challenges to free Implications of the Changing To highlight, anxiety disorder and major play, offers practical strategies for foster- Culture of Play depression in young people are five to eight times what they were in the 1950s. ing free play in neighborhoods across the Scientific evidence from multiple disci- Panksepp (2002) argues that play serves country, and shares inspiring stories of plines touts the benefits of child-initiated un- as the deepest wellspring of joy in human innovative communities that are making structured play for whole child development experience, which buffers us from anxiety free play a priority for children. and links the absence of such experiences to and depression. negative outcomes for children: • Advocate a slow parenting approach – In • Void of creativity and imagination – her controversial text, Free Range Kids: • Impaired social cognitive competence Kim (2011) reports that creative thinking How to Raise Safe, Self-Reliant Children – Gray (2013) documents declining among American children is declining. Without Going Nuts with Worry, Skenazy opportunities to play with a corresponding Over the last two decades “children have (2009) advocates adopting a slow parenting decline in empathy and rise in narcissism become less emotionally expressive, less approach in raising children, characterized among children with few opportunities energetic, less talkative and verbally expres- by few organized activities and an environ- to play socially. The National Association sive, less humorous, less imaginative, less ment where children are free to explore the of Early Childhood Specialists in State unconventional, less lively and passionate, world at their own pace. Departments of Education (2002) holds less perceptive, less apt to connect seem- • Explore the great outdoors – Richard that depriving children of child-initiated ingly irrelevant things, less synthesizing, outdoor play impedes the development of Louv (2008) identified a disconnect with and less likely to see things from a different nature affecting the current generation social-emotional learning and the ability to angle” (p. 292). Harrington et al. (1987) self regulate. of children in his book Last Child in the found psychological safety and freedom Woods: Saving our Children from Nature • Inability to attend and poor task to be essential elements in home environ- Deficit Disorder. Examining research across completion – The Centers for Disease ments that produced creative potential multiple disciplines, Louv argues that Control and Prevention (2007) reports in adolescents. In order to be creative, direct contact with nature is essential for that four and a half million children children need free, uninterrupted time to the development of emotional and physical between the ages of 3 and 17 are diag- think and engage in reflective abstraction health in childhood and across the lifespan. nosed with attention deficit hyperactivity (Piaget, 1981). disorder. Marano (2008) attributes the • Join with like minded individuals – • Inflexibility – Scholars argue that play There are many professional organizations high incidence to an early childhood serves as training for the unexpected. curriculum that requires children to sit and advocacy groups advancing the impor- Bekoff and Pierce (2009) identified a tance of play in whole child development, idle for extended periods of time. There ‘flexibility hypothesis’ in wolves that allows has also been a corresponding increase in including The Alliance for Childhood, The them to improvise behaviors more effec- American Academy of Pediatrics (AAP), the number of children being medicated tively through play. Further, they highlight to enhance their attention, with over 21 The Association for Child Education the importance of play in developing International (ACEI), The Centers for million prescriptions each year; a 400% children who are creative, flexible, and able increase over a decade. Disease Control and Prevention (CDCP), to adapt to new environments. The Child Life Council (CLC), The • Emotional fragility – Unstructured, continued on Focus page 6

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continued from Focus page 5 participation to an obligation and not actual As the tension between parents’ desire play. Through natural play children obtain for control and children’s desire for freedom International Council for Children’s Play recommended amounts of exercise, prepare continues to play out in the 21st century, (ICCP), The International Play Associa- for future sports, choose their favorite finding a balance between child-initiated, tion (IPA), The International Playground play activities, assess and manage risk, and unstructured activities and adult-directed, Equipment Manufactures Association develop social relationships with a wide structured activities is the key to whole child (IPEMA), The National Recreation and variety of children. development. Park Association (NRPA), and The US Play Coalition. There are reasons to be both pessimistic References and optimistic about the current state of play • Explore the available resources – There Action for Healthy Kids (2008). Commitment to change. Action in America. There are a variety of societal for Healthy Kids. are an abundance of credible resources that factors marginalizing opportunities for examine play across various disciplines and Barros, R.M., Silver, E.J., & Stein, R.E.K. (2009). School recess children’s play, with fear being most promi- and group classroom behavior. Pediatrics, 123(2), 431-436. from various perspectives including The nent among them. Due in part to fear and its Bekoff, M., & Pierce, J. (2009). Wild justice: The moral lives of American Journal of Play (www.journalof- mitigating factors, children are afforded fewer animals. Chicago, IL: University of Chicago Press. play.org) and The International Journal of opportunities to play at home and school Play (www.tandfonline.com/loi/rijp20#. today than in the past. However, there are Brown, F., & Patte, M. (2013). Rethinking children’s play. London: Bloomsbury. UzQ5gtx_PSE). reasons for optimism as well. Many promi- • The research is on your side – Empirical, nent professional organizations advocate for Centers for Disease Control and Prevention. (2010). The association between school-based physical activity, includ- scientific evidence documents the benefits the importance of play, and current research across multiple disciplines documents the ing physical education, and academic performance. U.S. of play on whole child development and Department of Health and Human Services. challenges the growing trend to reduce benefits of play on whole child development. Centers for Disease Control and Prevention. (2007). Summary opportunities for play at home and school In a recent essay, What is the State of Play?, Kuschner (2012) paints an optimistic picture health statistics for US children: National health interview (Patte, Pellegrini & Bohn-Gettler, 2013). survey. US Government Printing Office, Washington, D.C. about the future of children’s play. He writes: • Advocate for play at home and at school Elkind, D. (2007). The power of play: How spontaneous, – Article 31 of the United Nations’ Conven- On the one hand, much has been imaginative activities lead to happier, healthier children. tion on the Rights of the Child (UNICEF, written about how children’s play is Cambridge, MA: Da Capa Press. 1991) states in part that children have the under pressure from overly structured, Gill, T. (2007). No fear: Growing up in a risk averse society. right to relax and play and to join in a academic curriculum and testing; the London: Gulbenkian Foundation. wide range of cultural, artistic, and other paving over of wild spaces; and the chaos Gray, P. (2013). The play deficit. Aeon Magazine, 1-8. Retrieved recreational activities. Play is a child rights brought down upon their lives by such from aeon.co/magazine/being-human/children-today- and social justice issue, as under-resourced circumstances as family discord, poverty, are-suffering-a-severe-deficit-of-play/. children have fewer opportunities for play and the conflicts of war. All of these Harrington, D.M., Block, J.H., & Block, J. (1987). Testing than their adequately resourced counter- forces certainly do challenge a child’s aspects of Carl Roger’s theory of creative environments: parts (Jarrett, 2013). ability to play. On the other hand, when Child-reading antecedents of creative potential in young considering the question I was reminded adolescents. Journal of Personality and Social Psychology, • Address the societal factors devaluing of the time I had tried to eliminate some 52, 851-856. play – Provide research-based solutions to ferns growing by the side of my house. Hofferth, S.L. (1999). Changes in American children’s time, the prominent factors in America restrict- Despite my best efforts to pull them 1981-1997. Ann Arbor, MI: University of Michigan Press. ing opportunities for children to play. up by their roots and poison them into Jarrett, O.S. (2013). A research-based case for recess. U.S. Play nonexistence, they grew back. The pull Conclusion Coalition. of their nature to grow back in the very Kim, K.H. (2011). The creativity crisis: The decrease in creative If there is one constant in life, it is that same spot was stronger than my ability change is inevitable. For many, change is thinking scores on the Torrance Tests of Creative Thinking. to keep them out of my garden. In their Creativity Research Journal, 23(4), 285-295. unsettling because it displaces us from our insistence to live in my garden, it was zones of comfort. During the past 40 years, Kuschner, D. (2012). What is the state of play? International almost as if those plants were mocking Journal of Play, 1(1), 103-104. children’s play has transformed from an me. In a fundamental way, children are Lanza, M. (2012). Playborhood: Turn your neighborhood into a unstructured, child-initiated endeavor to an like those ferns; due to the pull of their place for play. Free Play Press. adult-directed, structured enterprise stressing nature, children will play even when organized activities. As the research outlined the circumstances are less than ideal or Louv, R. (2008). Last child in the woods: Saving our children from nature-deficit disorder. New York, NY: Algonquin. in this paper suggests, this transformation when there are forces at work trying to can have serious implications for whole stop them from playing altogether . . . I Marano, H.E. (2008). A nation of wimps: The high cost of child development. Elkind (2007) argues have faith that despite any current and invasive parenting. New York, NY: Broadway. that striking a balance between structured future circumstances that might not be Miller, E., & Almon, J. (2009). Crisis in the kindergarten: Why and unstructured activities is the key. He supportive of children’s play, children will children need to play in school. College Park, MD: Alliance recommends resisting the peer pressure to in- finds ways to play and, like those ferns, for Childhood. troduce children to organized sports prior to at times they may even be mocking us in National Association of Early Childhood Specialists in State the age of five or six as doing so transforms the process. (p. 103). Departments of Education. (2002). Recess and the impor-

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tance of play: A position statement on young children and studies, Vol. 9 (pp. 147-165). Lanham, MD: University Press creativity. In J. Kaufman & R. Sternberg (Eds.), The cam- recess. Available from http://www.naecs-sde.org/policy of America. bridge handbook of creativity, (pp. 233-249). New York: Ogden, C., Carroll, M., Curtin, L., Lamb, M., & Flegal, K. (2010). Patte, M., Pellegrini, A.D., & Bohn-Gettler, C.M. (2013). The Cambridge University Press. Prelalence of high body mass index in U.S. children and benefi ts of recess in primary School. Scholarpedia, 8(2), Sigel, I.E. (1987). Does hothousing rob children of their child- adolscence 2007-2008. Journal of the American Medical 30448. hood? Early Childhood Research Quarterly, 2, 211-225. Association, 303(3), 242-249. Pellegrini, A. D. (2009). The role of play in human development. Skenazy, L. (2009). Free range kids: How to raise safe, Opie, I., & Opie, P. (1969). Children’s games in street and New York: Oxford University Press. self-reliant children without going nuts with worry. playgrounds. London, UK: Oxford University Press. Piaget, J. (1981). Creativity. In J.M. Gallagher & D.K. Reid San Francisco, CA: Jossey-Bass. Panksepp, J. (2002). ADHD and the neural consequences of (Eds.), The learning theory of Piaget and Inhelder (pp. 221- UNICEF. (1991). United Nations Convention on the Rights of the play and joy: A framing essay. Consciousness & Emotion, 229). New York: Harcourt Brace. Child. Sevenska: UNICEF Kommitten. 3(1), 1-6. Putnam, R.D. (2000). Bowling alone: The collapse and revival of Weissman, P., & Hendrick, J. (2013). The whole child: Develop- Parsons, T. (1968). Sociological theory and modern society. American community. New York: Simon & Schuster. mental education for the early years (10th edition). Upper New York, NY: Free Press. Robert Wood Johnson Foundation (2009). Active education: Saddle River, NJ: Pearson. Patte, M. (2009). The state of recess in Pennsylvania elemen- physical education physical activity, and academic perfor- Wilson, P. (2012). Beyond the gaudy fence. The International tary schools: A continuing tradition or a distant memory? mance. San Diego, CA: Robert Wood Johnson Foundation. Journal of Play, 1(1), 30-36. In C. Dell-Clark (Ed.) Transactions at play: Play and culture Russ, S. & Fiorelli, J. (2010). Developmental approaches to

Gaining a Larger Perspective on Play a r evIeW of russ, s. W., & nIec, l. n. (2011). PLaY iN cLiNicaL Practice: evideNce-Based aPPrOaches. neW york, ny: guIlford Press. Christa Peterson, CCLS Seattle Children’s Hospital, Seattle, WA lay is a rudimentary part of children’s In essence, Play in Clinical Practice pro- lives that enables them to engage in new vides a thorough overview of the necessity of Pexperiences and make sense of their play, including its origins, types, and eff ects, surrounding environments (Russ, Fiorelli, as well as information on how to conduct & Spannagel, 2011). Play also promotes play assessments and interventions. Play in freedom of expression and creativity while Clinical Practice also reviews child therapies facilitating physical, cognitive, social, and that incorporate play—and describes how emotional development (Russ et al., 2011). play can be eff ectively used to treat children family-centered interventions. Moreover, Russ In Play in Clinical Practice: Evidence-Based and adolescents with various psychiatric and Niec reiterate the necessity of hospital- Approaches (2011), editors Sandra Russ and conditions such as generalized anxiety, social based play programs for children coping Larissa Niec feature 14 chapters written by phobia, posttraumatic stress, oppositional with physical and mental illness and examine experts in the fi elds of child development and defi ant disorder, disruptive behaviors, autism, the importance of play in early childhood play therapy. Russ and Niec further divide Asperger’s, attention-defi cit hyperactivity education and primary school settings. Play the chapters into four sections, (1) play in disorder (ADHD), selective mutism, and in Clinical Practice is an informative work child development, (2) play in evidence- children who have been victims of physical that can be utilized by multiple practitioners, based assessment, (3) play in evidence-based and sexual abuse. When discussing these from child life specialists to social workers and intervention, and (4) play in evidence-based treatments, Russ and Niec (2011) include clinical psychologists. Although some of the programs in school settings. In each section, real-life case studies that demonstrate the interventions mentioned (i.e., neurological selected authors discuss diff erent aspects and benefi ts and challenges of working with testing and psychotherapy) are outside of the uses of play while simultaneously emphasiz- children who have physical and/or mental scope of practice of child life professionals, the ing the importance of play throughout health conditions. book is a benefi cial resource for individuals child and adolescent development. Th e In addition to providing in-depth discus- who desire to incorporate more play theory central argument of the book is that play is sion on play and its uses, the editors and and techniques into their clinical practice. a critical component of children’s lives and authors suggest numerous resources that that children with more sophisticated (i.e., efereNces practitioners can use to augment their work. r fl exible, creative, and dynamic) play skills are Th ese resources appear to be valuable and Russ, S. W., Fiorelli, J., & Spannagel, S. (2011). Cognitive and generally more emotionally and socially well aff ective processes in play. In S. W. Russ, L. N. Niec (Eds.). could be used by child life specialists and adjusted than children with less developed Play in clinical practice: Evidence-based approaches (pp. other individuals who serve youth. Play in play skills. Th e editors contend that children’s 3-22). New York, NY US: Guilford. Clinical Practice also describes numerous play abilities are positively associated with research studies that highlight the ben- Russ, S. W., & Niec, L. N. (2011). Play in clinical practice: their cognitive functioning. Evidence-based approaches. New York, NY US: Guilford. efi ts of incorporating play into child- and

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nurses improvised many different hospital Healing With(in) Imaginative Play situations such as the loss of patients with whom they had developed close connections, Anthony Perone, PhD, University of Memphis, Memphis, TN The value of imaginative play for these interactions with distressed family members, professionals not only provides them with here is a rich and varied literature on the “learning the ropes” as a new nurse, and self-care and stress reduction, but also makes presence and value of imaginative play to experiences with serious illness in their own them more present for, vulnerable with, and contend with issues of affective and physi- lives. Taking part in these improv activi- T supportive of their colleagues, their patients, cal significance. Conceptually, developmental ties, according to Salit (2011), created play and their patients’ families. While there are psychologists Jean Piaget (1962) and Erik spaces for the nurses to let go of their more many forms that imaginative play can take, Erikson (1976) contend that young children constrained and “scripted” performances, to such as young children who play dress up engage in imaginative play to illustrate mastery have more open and honest dialogue, to be of or adults who attend Halloween parties or over experiences, including those that have greater support to one another, and to better Comic Con, I would like to focus on one affective significance. For example, children handle the stressful and painful circumstances particular example: improvisational theater may “play out” a visit to the doctor’s office in they were dealing with on a daily basis. activities (improv), where people engage their imaginative play to feel more comfort- together in imaginative and spontaneous From this example, it seems that imaginative able than they might during a “real” visit to games and scenes. Indeed, some authors (e.g., play can be a social and developmental activity the doctor. Empirical work by scholars such Göncü & Perone, 2005) consider improv to for adults in the health care field. Imaginative as Cindy Dell Clark (2007) explores children’s be an adult version of the pretend activities play can provide opportunities to heal and co- psychological healing and stress reduction children do. What’s more, evidence suggests create new experiences and new ways of relat- via imaginative play. Clark studies the value that improv is not only relevant for actors ing with others. Based on the work of POAL, of imaginative play for children living with or other creative types; rather, it is a form of I encourage adults in the helping professions to ailments such as diabetes and asthma. In her engagement that is invigorating, adaptive, perceive imaginative play as not only of benefit work, children who live with these physical self-caring, and relational for people of all to the health and well-being of their patients, challenges and who engage in imaginative walks of life (Holzman, 2009). but also of themselves. Imaginative play, as play around themes of their illness and/or seen in the form of improv, can be a means to For example, Performance of a Lifetime treatment are calmer and more empowered contend with issues of affective experience, and (www.performanceofalifetime.com) conducts during the process. Applied work by individu- in doing so, build support, create and sustain improv-based workshops for adults across a als such as Patch Adams (www.patchadams. community, and develop new relationships host of different fields and with a range of dif- org) illustrates that children’s well-being, with ourselves and others. particularly when their health is compromised, ferent goals: to build teams, to address work- benefits from playful interactions. place concerns in new ways, or to improve the References health and well-being of staff. As an illustra- While I applaud theory, research, and Clark, C.D. (2007). Therapeutic advantages of play. In A.Göncü & tion of such goals, Performance of a Lifetime S. Gaskins (Eds.), Play and development: Evolutionary, sociocul- applications in this area, I contend that the worked with members of the staff of oncology tural, and functional perspectives (pp. 275-293). presence and value of imaginative play in the nurses at The Sidney Kimmel Comprehensive New York: Taylor & Francis. context of health and treatment should not Cancer Center at Johns Hopkins University. Erikson, E. (1976). Play and actuality. In J. Bruner, A. Jolly, & be limited to young children. The play-based As is often the case for health care profession- K. Sylva (Eds.), Play – its role in development and evolution activities we support for children who are (pp. 688-704). New York: Basic Books. als, the nurses at Johns Hopkins have found coping with physical and psychological themselves stressed out or otherwise taxed Freysinger, V.J. (1998). Play in the context of life-span human stressors should be extended across the lifes- development. In D.P. Fromberg & D. Bergen (Eds.), Play from by the demanding work they perform on a pan and include the multiple partners who birth to twelve and beyond (pp. 14-22). New York: Routledge. regular basis. As well, factors such as long advocate for the health and care of children. Göncü, A. & Perone, A. (2005). Pretend play as a life-span activity. hours, isolation from other professionals, and Across conceptual, empirical, and applied Topoi, 24, 137-147. emotionally challenging work environments contexts, imaginative play is no longer “just Holzman, L. (2009). Vygotsky at work and play. New York: are often present. How might these adults for kids”; motivations for imaginative play Routledge. contend with their work-related issues of and examples and benefits of it are present Perone, III, A. (2013). The presence and significance of imaginative affective significance? Might improv be a way play in the lives of Mexican-American adults (Doctoral dis- throughout the lifespan (e.g., Freysinger, to address these issues? The Performance of a sertation). Available from ProQuest Dissertations and Theses 1998; Holzman, 2009). For example, in my Lifetime (POAL) team thought it might. abstracts. (UMI No. 3573334) interviews with adults about their life-span Perone, A., & Göncü, A. (Under review). Life-span pretend play in imaginative play (Perone, 2013; Perone & According to literature provided by Cathy two communities. Göncü, under review), participants shared Salit (2011), chief executive officer of POAL, Piaget, J. (1962). Play, dreams, and imitation in childhood. how imaginative play beyond early childhood the oncology nurses at Johns Hopkins en- New York: Norton. helped them deal with issues such as feeling gaged in improv activities over the course of Salit, C. (2011, January). Final Report to The Sidney Kimmel depressed or lonely or to contend with family eighteen months that provided them oppor- Comprehensive Cancer Center at Johns Hopkins University. issues such as domestic abuse or divorce. tunities to act out the “scenes” of their work New York: Author and lives, explore how they interact with each For the purposes of this commentary, I other and their patients, and experiment with The author acknowledges Cathy Salit for would like to share the potential for imagina- new ways to perform their daily activities to her assistance in the preparation of this tive play for adult health care professionals. become more resilient. For example, these manuscript.

8 A Publication of the Child Life Council BULLETIN SUMMER 2014

POINT/COUNTERPOINT · · · · · · · · · · · · · · · · · · can occur? Are only realistic-looking guns others are less likely to be affected? What if reality is that the nature of our relationships disallowed? What about colorful Nerf® guns an 18-year-old on your unit wants to play a with most of the patients with whom we that shoot harmless foam? Should we even violent video game? A 12-year-old? What if work is transient, and our influence on their ban guns that squirt water or blow bubbles? a parent brings a toy gun as a gift for a child? lives outside of the medical realm is limited. Does the ban extend to violent video What happens when a child bites his Pop- Banning play with violence for a week while games—with what ratings? What about Tart into the shape of a gun (as happened in children are in the hospital may be taking violent television? What about therapeutic a Maryland school) and starts shooting? away something familiar, something that target games that many child life specialists allows them to feel powerful and in control, Although it’s nice to think that we could use to help kids process negative emotions? and something that they are likely to go back have an influence on a child’s future choice It can get pretty heated! Would a ban on to once back in their usual environment, if it of play materials and the lessons they learn guns and violence be limited to the playroom, was present there before the hospital stay. by disallowing gun play in our hospitals, the or would it extend to private rooms where THE MIDDLE GROUND: All War Play Is Not the Same; Balancing Safety, Values, and Patient Needs es, violent play can be difficult to watch. of what children see on screens. They are adult support. Child life specialists, whose But the answer to dealing with violent designed for a single purpose and come with goal is to promote the wellbeing of children, Yplay is less about banning or allowing it, an implicit script that leaves little room for need to find ways to balance children’s needs and more about observing it, evaluating what creativity. These toys encourage imitative and their own values, and at the same time it means to the child and how it changes over play, and providing more open-ended toys for influence the needs children are trying to time, and making decisions about what to do, redirection of play is generally beneficial. meet and lessons they are learning. based on both what you learn from observing Some children reenact violence that they the child’s violent play and what else you have witnessed. They may be struggling to know about the patient’s needs. comprehend something that adults don’t Milestones All play with violence is not the same. fully understand. It is important to watch After a long career in child life, Kathleen Things are going well when you find violent how this play evolves. If the same scenes are McCue, MA, LSW, CCLS, retired in June. play that: 1. is creative (i.e., created by the replayed over and over with little variation, Widely known for her book, How to Help child, not just imitation of something he or the child may not be moving forward and she saw on a screen); 2. changes over time, may need special support in interpreting the Children Through a Parent’s Serious Illness, and is not just the same violent actions experience. And then there are the children Kathleen spent much of her career as the repeated over and over; 3. shows evidence of who bring both the pretend and real violence supervisor of child life at the Cleveland Clinic the child using his or her own imagination they have seen into their play. They often Foundation (CCF), where she came to the and special play abilities to create play unique need help sorting out what is pretend and realization that children of adult patients were to that child; and, 4. is open to the input what is real, both in and out of their play, as impacted by the illness and hospitalization of of an adult, who can work with the child well as help bringing content other than just their parents. She spent seven years develop- to tame the violent themes, and help the violence into their play. ing her skills and programming for these child bring more into the play than just the children at CCF before founding the Children’s The truth is that the children we see in violence (e.g., making a meal and bed for the Program at The Gathering Place, a community hospitals today are growing up exposed to real superhero to go to when he is done fighting). support center for families coping with cancer and entertainment violence. Because children in Cleveland, OH, where she has worked for Violent play that looks more like a TV use their play to work out experience, we script and which the child seems to exert can expect this exposure to enter their play. almost 15 years. little control or imagination over, and which We are right to be concerned about how our Kathleen’s contributions to CLC are many: does not change or evolve over time, is likely willingness to let children engage in such She has served on the board as secretary and to be imitation, not child-created play, and violence might affect their future relation- president, has worked on numerous commit- thus, is not therapeutic. Imitative play is not ships, problem-solving abilities, and mental tees and task forces, and has shared her exper- creative, and a child who is merely imitating health. At the same time, children need some tise in many presentations and publications. violence is not reaping the transformative way to work out and resolve what they see, Her contributions were recognized in 2001, benefits of play. and we can help them do that in their play. when she was honored with the Distinguished Thus, violent play should not be banned, but Some toys engender violent play by their Service Award. We wish Kathleen a happy neither should children be left to navigate nature: they are highly realistic replicas retirement. and explore violence though play without

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Play with Infants and Toddlers: Building Coping Capacities

Erin Munn, MS, CCLS, Monroe Carell Jr. Children’s Hospital single-word utterances, and forming word or by assisting the child’s parent in adjusting, at Vanderbilt, Nashville, TN combinations. Developmental play activities the type or pace of the interaction to assist that target these concrete, visible behaviors the child in returning to a calm state. As the t its essence, a child life specialist’s role on the part of the child provide a clear path adult recognizes and adapts to the infant’s with children and families boils down to for identifying goals, choosing additional play emotional needs in the play interaction, two primary goals: supporting chil- A activities that support the goals, and evaluat- the infant experiences the ebb and flow of dren’s optimal development and facilitating ing the outcomes of these interventions. high arousal or excitement with a return to positive coping in the face of challenging calm. Theory regarding the development of circumstances. The connection between play and sup- self-regulation points to this early experience porting coping capacities for infants and In considering play in the first two years of of synchrony and attunement in relationship toddlers may seem less clear but it is no less life, many play activities that support specific with caring, responsive adults as a build- important in the services that child life spe- developmental milestones readily come to ing block for infants’ growing abilities to cialists provide. Many times, the same play mind. Some of these may support motor self-regulate, with young children progressing activities that focus on specific developmental milestones such as tracking, reaching, grasp- over time from relying on more external milestones provide opportunities to work ing, rolling over, sitting, manipulating a toy resources for regulation to internal (Institute toward enhanced coping capacity. When an with fingers and exploring it orally, pressing of Medicine, 2000). infant expresses distress during play, perhaps buttons, and crawling. Others may support from overstimulation or increasing fatigue, During play interactions, the adult’s ability language milestones like cooing, babbling, a child life specialist responds by adjusting, to recognize and adjust to the infant’s self- generated activity and emotional needs is a Table 1. Identifying Play Goals and Activities that Support fundamental component of the play relation- Development of Coping Capacities in Infants and Toddlers ship. Jean Piaget highlighted the importance of self-generated play, in which the child Goal Activity initiates and controls actions. According to Enhancing self-regulation Playing with sound, touch, and movement in different ways to discover Piaget’s theory, the primary mode of play in what is most engaging to the infant, what brings pleasure, and to learn the first two years of life occurs in senso- the infant’s preferences regarding type and level of stimulation rimotor exploration and interaction with Providing the infant with the experience of synchrony and mutual the world around them (Santrock, 2013). regulation by pacing play interactions to balance high arousal or Vygotsky’s theory of cognitive development excitement with a return to calm goes a step further, proposing that children learn through hands-on activities and social Supporting emerging concepts of self Engaging young infant in imitation play – a “dialogue” of action and interaction (Santrock, 2013). In Stanley through “self-other action play” in which the response in facial expressions, vocalizations, or gestures Greenspan’s model of Functional Emotional infant begins to experience differentiation between self and other Responding to and expanding on older infant’s initiation Development Levels (Greenspan, 1999), the of turn-taking games first stage specifically identifies the impor- tance of regulation of state and emotion as • Give and Take, in which the infant hands you an object, it relates to infants’ abilities to focus on and and then you hand it back – “ I give it to you, and you attend to the sights, sounds, touches, tastes, give it back to me” and smells around them. In describing this • The “Drop” Game, the game in which infants repeatedly drop stage, Greenspan also highlights the signifi- a toy over the side of their high-chair or crib – “ I drop it, cance of infants’ relationships with caring and you pick it up” adults in the process of becoming interested Playing peek-a-boo and engaged with the world around them and in learning to regulate their reactions and Enhancing sense of mastery Engaging the infant in play with cause-and-effect toys or interactive states of arousal. through “self-as-agent play” games in which he controls the outcome by his actions • For young infants, and older infants or toddlers with less strength When working with infants, child life spe- or energy, loosely tying the string of a balloon to their wrist or cialists have the opportunity to communicate ankle provides them with a way to experience cause and effect – with the family and health care team about “I move my leg, and the balloon dances” the connection between specific developmen- tal goals and play activities, to make what is • Games in which the infant initiates an action and the adult implicit in infant play interactions explicit. responds contingently – for example, the familiar “Drop” game may fall into this category of “self-as-agent” play for older infants, Table 1 identifies several examples of com- as they often respond with such joy in the repetition of the adult mon play activities that support developmen- response of picking up the toy and handing it back. tal goals related to coping.

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danced and sang at his command. in babies and young children. New York: Da Capo. Though the activity evolved entirely Institute of Medicine (2000). Acquiring self-regulation. In From neurons to neighborhoods: The science of early without planning on my part, I did recognize childhood development (pp. 93-123). Washington, DC: the value to Ty of a form of play that handed The National Academies Press. Retrieved from http:// control to him, turning on its head the www.nap.edu/catalog.php?record_id=9824 situation he had been experiencing for the Santrock, J.W. (2013). Children (12th ed.). New York: several days he had already been hospitalized McGraw Hill. in which he had very little opportunity to express his autonomy, let alone to experience Additional Resources the sense of mastery and self-as-agent as he Bergman, A. & Lefcourt, I.S. (1994). Self-other action play: controlled the actions of this one adult. A window into the representational world of the infant. In A. Slade & D. P. Wolf (Eds.), Children at play: Clinical and Play is an especially important mode of developmental approaches to meaning and representation communication with our youngest patients, (pp.133-147). New York: Oxford University. and, as demonstrated, allows opportunities to build young children’s sense of mastery and Gillespie, L. G. & Seibel, N.L. (2006). Self-regulation: A cornerstone of early childhood development. Beyond control, presents them with occasions to un- the Journal: Young Children on the Web. Retrieved from derstand predictability, and offers chances to Putting the Concepts into http://journal.naeyc.org/btj/200607/Gillespie709BTJ.pdf develop self-regulatory skills. By purposefully Action: An 18-month-old, engaging in play with infants and toddlers, Goldberger, J. & Mohl, A. L. (2008). Issue-specific guided play to support infants, toddlers, and their families in health a Child Life Specialist, we can help them gain skills that enhance and a lashlight care settings: Rationale and interventions. In C.E. Schaefer, F their coping abilities. S. Kelly-Zion, J. McCormick, A. Ohnogi, & J. Aronson Greenspan encourages caregivers to focus (Eds.), Play therapy for very young children (pp. 249-277). eferences on following the child’s lead in play, noting R Lanham, MD: Rowman & Littlefield. Brazelton, T. B. & Greenspan, S. I. (2000). The irreducible needs that “many of our most prized and precious Saarni, C., Campos, J.J., Camras, L.A., & Witherington, D. magic moments with our babies and toddlers” of children: What every child must have to grow, learn, and flourish. Cambridge, MA: Da Capo. (2008). Principles of emotion and emotional competence. (Brazelton & Greenspan, 2000, p. 40) take In W. Damon & R. M. Lerner (Eds.), Child and adolescent place when we follow the child’s lead and Greenspan, S.I. (1999). Building healthy minds: The six development: An advanced course. Hoboken, NJ: John engage in the direct and continuous com- experiences that create intelligence and emotional growth Wiley & Sons. munication that results. This was certainly the case when I found myself in the room of Ty, an 18-month-old on isolation whose parents had had to step away from bedside for the afternoon. With each of my attempts to engage him in play, including separation play, he responded to each toy, song, and game with brief interest and engagement before seeming to tire and look for something else. Out of toys to try, I noticed the flashlight in its usual station at bedside and picked it up to show him how it worked. As he had been with the other toys, he responded with initial interest, figuring out how to push the button, then shining the light on his mattress, the ceiling, the wall, and then on me. When the beam of light rested on me, I acted like it was a spotlight and began to dance and sing a little bit. He grinned, then moved the light, and as the light left me, I stopped dancing and singing to talk about where the light was now shining. As he turned back to me, the light fell on me again, and again I started to dance and sing a little bit. This was the start of more than 20 minutes of joyful interaction, with Ty bouncing up and down in excitement as he moved the light around the room, always returning it to shine on me, and laughing and bouncing some more as I

A Publication of the Child Life Council 9 BULLETIN SUMMER 2014

practice, I received a consult for a teenage well-being of children – in this case with X is for X-Box boy with mild developmental delays, video games. When explained through admitted for cyclic vomiting syndrome. the lens of self-determination theory and continued from page 1 All he would do was sit in bed, clutching supported by a program of research, the Despite concerns about their negative his basin, while rocking/moaning and significance of child life interventions such effects on children and youth1, video games frequently dry heaving. I offered every as the use of video games can be communi- have become a cornerstone of play programs normalization play and therapeutic play cated between professions as if in a shared in hospitals across North America since the option I could think of, but he turned me language: “Theories are a helpful tool in the late 1980s. Often promoted as an appealing down because he “was too sick to play.” explanation of why we support and promote feature of hospitalization, the examination of I had read about “play by proxy” and specific interventions and policies” (Turner, the value of video games from a theoretical gave it a try. I picked a truck racing game 2009, p. 34). In the case of the X-Box, perspective can support an argument that on the Wii and started to play while he self-determination theory is a useful perspec- video games also serve as an innovative tool moaned and dry heaved beside me. tive for discussions around psychologically satisfying play experiences gained through linked to specific outcomes. I am inclined to The more I played the less he heaved! intrinsically satisfying play (Przybylski, Rigby, think that the social elements of video game After about half an hour, we were up to & Ryan, 2010). activity dominate a novice perspective of the a solid 8 to 10 minutes between heaves, possible gains to be achieved; for example, and I started to “lose” some of my driving References hanging out, joy of competition, peer teach- skill … he started coaching me! At first ing and leading, and making friends (Olson, Deci, E. L. & Ryan, R. M. (2000). The “what” and “why” of goal just a word or two, but gradually more pursuits: Human needs and the self-determination of 2010). However, perspectives can change as and more until finally, when I just kept evidence-based theoretical models are applied behavior. Psychological Inquiry, 11, 227-268. driving through the giant mud puddle Olson, C. K. (2010). Children’s motivations for video game play to practical anecdotal cases like the one instead of jumping over it, he demanded posted by Teresa Schoell, MA, CCLS on the in the context of normal development. Review of General that I hand over the control so that he Psychology, 14(2), 180-187. CLC Forum (July 10, 2013). The indicators could show me how to do it right. He got Przybylski, A. K., Rigby, C. S., & Ryan, R. M. (2010). A of competence, autonomy and relatedness are it right on the first try and just kept play- apparent: motivational model of video game engagement. Review of ing for almost 2 hours – He went a full General Psychology, 14(2), 154-166. As to your question about video games as 65 minutes without throwing up. By the time evening rolled around, he had asked Ryan, R. M. & Deci, E. L. (2000). Intrinsic and Extrinsic motiva- a motivator … Early in my first year of tions: Classic definitions and new directions. Contemporary the nurse for a tuna sandwich for dinner. Educational Psychology, 25, 54-67. 1 Przybylski, Rigby, and Ryan (2010) also Psychological nourishment, indeed! The Schoell, T. (2013). Early memory of video games in child life, reviewed the negative influence of video games psychological outcomes of competence, CLC Forum thread, July 15, 2013. for the subset of players who are attracted by autonomy, and relatedness demonstrated Turner, J. (2009). Theoretical foundations of child life practice. the violence and aggression of games or where by Teresa’s case underscore the merit of In R.H. Thompson (Ed.), Handbook of child life (pp. 23-35). an obsessive passion was a factor: perhaps that the intentional use of play to influence the Springfield, IL: Thomas. will be a topic for a future column.

ability. This differs from parallel play in that In these and all instances, child life special- Playing for the Child the intention is to encourage interaction from ists must have the courage to initiate play, as continued from page 5 the onset of play. well as the humility to follow the child’s most subtle expression for preference and control. The permissiveness and openness of the Being the perfect playmate requires you to presented an excellent case study in Nancy adult is essential. The specialist must use follow your intuition and to trust the innate Boyd Webb’s “Play Therapy with Children words, tone, and body language that invite, need of all children to be participants in play, in Crisis” (Webb, 1991). Their work with but do not demand or pressure. Check in even when their bodies cannot. a boy who is paralyzed demonstrates how with the nonverbal child regularly to see if he a specialist empowers a child to direct play expresses a preference or wish. Child-centered References verbally, by enacting whatever the child’s language, empathic responses, and narrating imagination conjures. The child takes on Landreth, G. (2012). Play therapy: The art of relationship. NY: or tracking (Landreth, 2012) are perfect skills Routledge. the role of director, narrating what the adult to use in these situations. Narrate your own Parten, M. (1932). Social participation among preschool should draw, paint, act out, or build. Even actions as you string a bead necklace, build a if a child cannot verbally participate in the children. Journal of Abnormal and Social Psychology, 27, volcano, make oobleck out of cornstarch and 243-269. moment, watching an adult play provides water, or create and use a toilet paper target. the possibility of interaction in the future. It It does not matter what you play, as long Wojtasik, S. & Sanborn, S. (1991). The crisis of acute hospi- presupposes that the child wishes to engage in talization. In N. B. Webb (Ed.), Play therapy with children in as you roll up your sleeves and enter into it crisis: A casebook for practitioners. NY: Guilford. play no matter his level of physical or mental wholeheartedly.

10 A Publication of the Child Life Council BULLETIN SUMMER 2014

membership in CLC and the Association for Kat Davitt Receives Mary Barkey Award the Care of Children in Healthcare. She has been a remarkable leader, serving as chair of continued from page 1 was moving around the hospital looking very the Publications Committee, adjunct reviewer team at Cook Children’s Medical Center in intently at his surroundings; when Kat caught for the Conference Planning Committee, Fort Worth. This is where Kat’s story plot up with him, he was staring at a particular chair of the Conference Planning Committee, takes a unique twist: Kat took a six-month mobile. When Kat asked what he was doing, a member of the Leadership Development educational leave in 2000 to obtain a Master’s the boy said, “I want to see things one last and the Education and Training committees, degree in Occupational Therapy. Just as she time.” This was the beginning of a very and was previously secretary on the Executive was about to jump tracks and follow the OT earnest discussion about surgery, anesthesia, Board of CLC. Kat has been a presenter at path, another great opportunity came her way and misconceptions about “going to sleep.” numerous CLC conferences and has been the which kept her rooted in child life, and she The other vignette that Kat holds near to co-chair of the South Central Regional Child has stayed with us ever since. her is about a neuro-rehab patient who was Life Conference. And this list is by no means anxious to the point of nausea. Kat put this the complete story. At Cook Children’s, Kat has engaged in a young patient in charge of the “Dance Party wide range of responsibilities, including sev- Over the past several years, Kat has partici- Thursday” patrol - making sure that each and eral different camp programs, animal-assisted pated in a partnership program with Emanuel every doctor, nurse, and patient demonstrated therapy, infant massage, student program University in Oradea, Romania where she has their dance moves to the song “All Star” by management, teen support programming, provided education and training for medical, Smash Mouth. Almost magically, the patient’s community re-integration, and school social work, and child life students as well nausea abated for the whole party! re-entry. She has coordinated volunteers as hospice staff. She has also served as an and special events as well as managed the adjunct professor in child life at the Univer- hospital’s in-kind donations program. Her In describing the proudest sity of North Texas. current clinical assignment is in the neurol- accomplishments of her Outside of child life, Kat enjoys hiking, ogy, palliative care, and rheumatology clinics. travel, reading, and socializing with friends. This impressive list is really just a part of child life career, Kat recalls Always one to share credit for her incredible her story. What has earned Kat this most story, Kat is very grateful to the Child Life recent recognition is the clinical skills she em- her participation in the first Council and to her current supervisor, Jill ploys to provide exemplary child life services. major strategic planning Koss, MS, CCLS. Kat Davitt exemplifies the The criteria used in evaluating nominations rich tradition of clinical excellence and selfless for the Mary Barkey Clinical Excellence program for the CLC in 1996 service to patients and families and Mary Barkey would be justifiably proud. Award include called “Vision to Action.” • collaboration, • critical thinking with a commitment to continuous improvement, In describing the proudest accomplish- • effective interventions, ments of her child life career, Kat recalls her participation in the first major strategic • modeling team behavior with respect planning program for the CLC in 1996 called for diversity, “Vision to Action.” It was a watershed event • demonstrating professional relationships, for the profession and for the CLC. Kat also • sensitivity to unique circumstances, describes her sense of pride and satisfaction in • family-centered care, seeing some of her students thrive and excel • incorporating evidence-based practice, in our profession, including some who were former patients. • mentoring students and new child life specialists, and Speaking of students, Kat has three pieces • active participation in the Child Life of advice for those participating in child life Council. training. First, do not be afraid to take care In all of the identified areas, Kat Davitt has of yourself. Seek balance and trust that it significantly excelled. Her nominating peers will make you better at your work. Second, were eloquent in vividly describing Kat’s work remember to recognize the blessings of our in each of the aforementioned criteria areas. work, as it is a privilege to have our job and do this work. Finally, don’t be afraid to keep Kat recalls two specific patient-related sto- learning. ries that have continued to stay with her over the years. The first begins with a ten-year-old Kat has generously given of her time boy with bright red hair who was preparing and skills for the benefit of the CLC. Her to have his tonsils removed the next day. He involvement dates back to 1986 with

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VOLUME 32 • NUMBER 3 SUMMER 2014

CLC Calendar Upcoming Events July September 19-21, 2014 1 Deadline for Bulletin and Focus articles for consideration for the Fall 2014 issue Florida Association of Child Life Professionals 23 CLC Webinar – Child Life Consultation in the Adult Hospital: Helping Children Cope with the Death or Impending Death of a Loved Adult 23rd Annual Conference Navigating Uncharted Waters 15–31 Call for Papers for 2015 Annual Conference in Cincinnati, Ohio Hyatt Regency, Miami, Florida August For information, visit: www.faclp.org 13 CLC Webinar – Difficult Conversations Do Not Come With a Script: Adapting to the September 20, 2014 Unique Needs of Families at End of Life 15-30 Child Life Professional Certification Exam Administration Testing Window Mountain West Child Life Association 2nd Annual Conference September (For Professionals & Students) 17 CLC Webinar – Co-Creating Meaning: Loose Parts in the 7th Dimension Child Life Elevated 20 Deadline for applications for the November 2014 computer-based Certification Exam Salt Lake City, Utah Administration Contact: Stephanie Steed at [email protected] or (801)285-1663 For information, visit: www.mwclassociation.wordpress.com October 1 Deadline to submit articles for consideration for Winter 2014 issue of Bulletin and Focus November 3, 2014 15 CLC Webinar – Promoting Quality Play in Medical Settings in a Media-Saturated World 21st Annual Child Life of Greater New York 15 Deadline to withdraw from November Administration of the Child Life Professional Professional Development Conference Certification Exam New York Academy of Medicine, New York, NY 31 Late Deadline to recertify with Professional Development Hours (late fee and additional Contact: Nicole Almeida at [email protected] or (516) 663-2761 paperwork required) For information, visit: www.CLGNY.com

November November 8 - 9, 2014 1-15 Child Life Professional Certification Exam Administration Testing Window 19th Annual Midwest Child Life Conference 3 21st Annual Child Life of Greater New York Professional Development Conference Children’s Hospital of Wisconsin, Milwaukee, WI 19 CLC Webinar – Teaching Child Life Contact: Megan Massey at [email protected] or (414) 266-8525