The Value of Certified Child Life Specialists: Direct and Downstream Optimization of Pediatric Patient and Family Outcomes Full Report | January 2020 Jessika Boles, PhD, CCLS Camille Fraser, MS, CCLS, CIMI Katherine Bennett, MEd., CCLS Maile Jones, MEd.(c), CIMI Jenna Dunbar, MEd.(c), CIMI Ashlie Woodburn, MEd., CCLS, CIMI Mary Ann Gill, MEd.(c) Anne Duplechain, MEd.(c) Erin K. Munn, MS, CCLS, CIMI Katy Hoskins, CCLS Abstract ____________________________________________________________________________ Today’s value-based healthcare market demands that hospitals, clinics, and medical professionals provide high quality care at sustainable costs for patients and payers alike. Top- decile performers systematically target each dimension of the Quadruple Aim, registering incremental yet cumulative gains (and savings) in safety, timeliness, effectiveness, efficiency and equity in patient-and-family-centered care. These ambitious objectives require a multidisciplinary approach, particularly when serving infants, children, adolescents and emerging adults, and their families. Certified Child Life Specialists, as psychosocial healthcare professionals with focused training in child development, family systems, and evidence-based supportive interventions, are indispensable members of high-caliber healthcare teams. In collaboration with medical and allied health professionals, Certified Child Life Specialists bring a multifocal lens, individualized to the needs of pediatric patients and their families, grounded in developmental theory, attuned to the influence of past and present trauma, and aimed at building resilient family systems. Capitalizing on the power of therapeutic relationships and the expansive benefits of play-based interventions, Certified Child Life Specialists help children, youth, and families lay the foundation for lifelong health and wellness. In these ways, child life professionals significantly reduce the financial, developmental, and psychological costs associated with the discomfort and distress that persist far beyond each episode of care. By doing so, Certified Child Life Specialists ensure a cost-effective experience for patients and families that cultivates well-informed, actively engaged, loyal consumers of healthcare services throughout the lifespan. TABLE OF CONTENTS ____________________________________________________________________________ Introduction 2 Value Driver 1: Institutional Savings 7 Preparation 8 Procedural Support 8 Institutional Outcomes of Preparation and Procedural Support 9 Value Driver 2: Psychosocial Outcomes 11 Coping Skills Education 11 Managing Pediatric Pain and Distress 12 Comfort Positioning 14 Value Driver 3: Patient and Family Engagement 14 Communicating with Children 15 Diagnosis Education 16 Adherence-Promoting Interventions 17 Parent Engagement 19 Discharge Education and Health Literacy 20 Value Driver 4: Developmental Impacts 23 Developmental Assessment and Intervention 23 Dimensions of Play 25 School Reentry 28 Transitional Care 29 Value Driver 5: Healthcare Consumership 31 Pediatric Medical Traumatic Stress 31 Infant Mental Health and Attachment 33 Mental Health Outcomes in Childhood and Adolescence 34 Sibling Support 36 Legacy Building 37 Bereavement Support 38 Child Life in Community Settings 40 Cultivating Resilience 41 Conclusion 42 Acknowledgements 43 References 44 Contributors 66 The Value of Certified Child Life Specialists: Direct and Downstream Optimization of Pediatric Patient and Family Outcomes ____________________________________________________________________________ In the era of Pay-for-Performance and the maintain an experience and culture within Quadruple Aim, healthcare providers, pediatric healthcare that others cannot. payers, and organizations must do more, in better ways, for less cost. Healthcare- Prioritizing the coping and developmental associated expenses in the United States needs of pediatric patients and families, have risen at unsustainable rates, creating a CCLSs promote and protect emotional dynamic in which high-quality service safety in times of healthcare duress. Their comes with a high price tag for both direct work is predicated on individualized and indirect stakeholders. Despite assessments of patient-and-family strengths multilevel, multifocal, and multidimensional and stressors, alongside the illness and efforts, per capita healthcare costs in the treatment factors that threaten family United States are rapidly approaching functioning and well-being. As they build double those of other developed nations - therapeutic relationships with infants, without generating comparable children, youth, and families of all improvements in population health.1-3 circumstances and backgrounds, CCLSs integrate their knowledge of child Pinpointing a singular root cause for the development, family systems, and the industry’s transformation is problematic. healing properties of play to promote Even more challenging is identifying cost- optimal physical and psychological health in effective tactics that adequately broach the the face of stress-inducing healthcare “quality chasm”4 omnipresent in healthcare experiences.5 today. Patients and families now enjoy unprecedented access to performance In order to become a CCLS, individuals ratings, comparative indices, and customer must fulfill specialized academic reviews. When this transparency is coupled requirements, complete clinical training with the sheer number of healthcare service hours under qualified supervisors, and models available, institutions must successfully pass a standardized differentiate themselves from the certification exam. Today’s CCLSs often competition by investing in strategies that complete additional postgraduate work improve care quality, maximize and/or hold supplemental certifications in reimbursement incentives, and instill related intervention sets (e.g., grief consumer loyalty. Emerging techniques and counseling, infant massage, and patient technologies are quickly being adopted experience) to further refine their expertise across the industry; thus, expanding patient- in providing high-quality, cost-effective, and and-family-centered services is a prime and impactful psychosocial care for children and promising opportunity to elevate the patient their families. Although most prevalent in experience. Certified Child Life Specialists the United States, Canada, and Japan, (CCLSs) - frontline members of CCLSs work in children’s hospitals and multidisciplinary care teams - create and healthcare settings across five continents; 2 | ACLP the Association of Child Life Professionals clinical research,12-16 CCLSs exemplify a (ACLP) and its certifying body, the Child Life high-yield investment in patient and family Certification Commission (CLCC), maintains experience, as well as in the direct and a membership of more than 6,200 certified downstream success of healthcare professionals worldwide. Regardless of institutions. geographic location or cultural setting, CCLSs employ an individualized approach Certified Child Life Specialists integrate six that honors and serves patients and families evidence-based domains to formulate of all backgrounds, experiences, belief interventions that meet infants, children, systems, and preferences. youth, and families where they are in their healthcare experience. Combining 1) an Certified Child Life Specialists are patient- individualized approach to care, 2) a focus and-family-centered care professionals who on cultivating resilience, 3) cognizance of have established and raised the proverbial the developmental contexts in which bar for the patient experience movement in children and families live and grow, and 4) healthcare settings.6 Recognized by the consideration for the impacts of past and American Academy of Pediatrics,7 the Beryl present trauma, CCLSs 5) establish and Institute,8 the Canadian Paediatric Society,9 develop therapeutic relationships by 6) the Society of Critical Care Medicine,10 The capitalizing on the expansive utility of play Walt Disney Company,11 and decades of (see Figure 1 below). Figure 1. The Six Domains of Child Life Services. The Value of Certified Child Life Specialists | 3 It is at the crux of these six domains that adversity, and grief,17,18 resilience is a CCLSs promote and optimize patient and phenomenon capable of being both family outcomes throughout their healthcare threatened and enriched by healthcare journey. encounters. By capitalizing on the individual and collective strengths of each child and Individualized Approach. family, CCLSs reinforce and generate Given the growing call for effective adaptive coping skills,19 positive psychosocial interventions in an appraisals,20 health-promoting behaviors,21 increasingly diverse patient population, a problem solving skills, and goal setting core component of child life practice is behaviors22 - all of which are integral addressing the individual needs of children features of resiliency. The patient-and- and families to improve their care family-centered approach CCLSs employ experience. Certified Child Life Specialists includes the patient and their identified develop clinical partnerships with children family system in partnership with one and families that make the healthcare another, which achieves optimal trust and experience more empowering and positive; alliance across providers and healthcare they take an other-oriented stance that settings.23 Certified Child Life Specialists reflects advocacy, cultural sensitivity, and acknowledge the importance