By Alanna Kanawalsky and Stephanie Colaberardino, Certified Child Life Specialists, Emergency Department, Children’s Hospital of Pittsburgh of UPMC
The Emergency Department (ED) at Children’s Hospital of Pittsburgh of UPMC has child life coverage seven days a week split between two certified child life specialists (CCLS). They are professionally trained individuals in the field of child development, psychology, and family systems. They are both have master’s degrees and have completed an extensive internship and certification process. Child life specialists promote coping through play and developmentally appropriate education and preparation for the health care experience.
As a child life specialist in the ED, the day starts at noon and finishes at midnight for Stephanie Colaberardino and Alanna Kanawalsky. Being a child life specialist in the ED is challenging, and they often wear many hats. The busy and ever-changing day may consist of providing play opportunities, to supporting a patient through a difficult procedure. They can be seen playing with medical equipment and dolls to help a child understand their care or assessing a child’s ability to cope. They may be found supporting a family in distress after a trauma or helping a new mother find comfort while taking care of her infant in the hospital. While Stephanie and Alanna share the same responsibilities and duties, their stories and experiences in their role are unique. Together, they are proud to be a part of the ED team at Children’s Hospital.
Stephanie has been a CCLS for 13 years, spending most of these years in the ED. She enjoys setting a positive tone for patients and families as they begin their hospital journey. The ED is often a child’s first real hospital experience. They do not speak the medical language and everything about it is new and potentially scary. Stephanie uses developmentally appropriate language to help ease these fears and anxieties and identifies ways for even the youngest of patients to be involved with their health care experience. To further enhance trust, Stephanie utilizes play as a primary tool for normalization. When a child is more comfortable in their environment and has an appropriate understanding of what is happening, he or she is more likely to develop trust in the health care team and may be more compliant with tests and procedures.
As a child life specialist, Stephanie understands the importance of helping a child develop coping skills in this new environment. The hospital can provoke stress in a child and they may not have developed the coping skills to “relax” on command. Stephanie works to meet the individual needs of the child by exploring coping skills that aid in the cooperation for tests and procedures. For example, instead of asking a young child to take deep breaths for an IV placement, Stephanie may offer bubbles for the child to blow.
Children’s Hospital treats adolescents and young adults in addition to small children. It is important to remember that adolescents may also have fears, anxieties, and misconceptions related to the hospital. Stephanie understands that adolescents, though physically more developed, are still growing cognitively and emotionally. Adolescents tend to do best in this environment when their questions are answered, their feelings are validated, and they feel involved in their care.
While patients are generally Stephanie’s primary focus, it is important to consider the entire family unit present in the room. Child life specialists in the ED value Children’s patient-and family-centered care philosophy by understanding that this can be a stressful place the whole family. Stephanie identifies the immediate and basic needs that she can quickly meet and serves as a support and liaison between the family and medical team. Stephanie truly loves her job as a child life specialist. Though a patient’s visit may be short, Stephanie hopes that child life services can set a long-lasting positive impression that carries on through into adulthood.
Alanna has been a child life specialist for six years. She has provided child life services in other areas of the hospital as well, but has settled into her new home in the ED recently. She understands the importance of developing a quick rapport with patients and families to provide support during a stressful time.
Alanna received a consult to support a young trauma patient who presented to the ED after a dog bite to the face. She was asked to provide distraction and support during laceration repair.
Alanna entered the trauma bay and found the patient along with the mother and father at bedside. The patient had several lacerations to the face with the most severe being under her left eye and chin. Alanna got down at her eye level and easily engaged the patient in conversation. Without prompting, the child recanted the experience that brought her to the ED. Children process and cope with a trauma by retelling their story. Alanna was able to validate the patient’s fears and provide support. She commented on the patient’s bravery and ability to defend herself against the dog. She also provided her with a blanket and stuffed animal for comfort after such a traumatic event. Alanna prepared the child for laceration repair using developmentally appropriate language, describing the sequence of events and allowing her to manipulate real medical items to become more familiar with what to expect. Patients are often more compliant with procedures if they are prepared because it can take away the fear of the unknown. During a preparation session, a coping plan is often established. The child is presented with choices to create a plan that can provide them with a sense of some control in a situation where they have very little.
In this particular situation, Alanna was going to use her iPad to distract the patient during suture placement. The iPad is one of many tools Stephanie and Alanna use in the ED to distract and support patients during procedures. The patient was easily distracted by the iPad as well as encouraging words from Alanna.
Both Stephanie and Alanna often hear from parents “I wish I knew about your job when I was younger, it seems like so much fun.” They simply smile and agree. Alanna says she loves what she does and not many people can say the same. Both agree they love that they can make a difference in the lives of children and families during some of their most challenging times.