For the last couple of months, Emily Gerster, a senior at the College of St. Benedict, has had a child’s-eye view of life inside a hospital. As the first-ever participant in the child life specialist practicum program at Fairview Ridges Hospital in Burnsville, Gerster has spent over 160 hours closely observing the day-to-day work of the hospital’s staff of child life specialists, a team of professionals trained to support children and their families through a range of health-care procedures and crises.
Certified child life specialists guide and educate children through routine hospital visits — like coping with the stress of a broken bone or stitches. They also help take the stress out of childhood surgeries like tonsillectomy with kid-friendly pre-op hospital tours. But a child life specialist’s work isn’t always simple: They help kids cope with the reality of a challenging health diagnosis for themselves or a parent, or educate and support children through the hospital death of a close family member.
“I frequently work with kids and grandkids when an adult is dying,” said Amy Feeder, one of five certified child life specialists employed at Fairview Ridges. “Sometimes that kind of work means explaining what it means to die and facilitating memory making. I like to give children activities to do at this time, like making a charm with their loved one’s fingerprints. It’s very difficult but it’s also very rewarding.”
In the early days of the profession, child life specialists were most often employed by large children’s hospitals; today many community hospitals like Fairview Ridges employ a staff of child life specialists. They work on call in different departments throughout the hospital, ready to step in to help a child wherever needed.
“Every day is completely different,” Feeder said. “Because our surgery cases are usually scheduled right away in the morning, I start out in surgery. We’ll usually have a couple kids getting ear tubes or their tonsils taken out or a GI procedure. From there, I head up to the peds unit and assess the needs of who’s admitted. Are there scheduled procedures or tests? How’s the patient coping?”
While she’s moving around the hospital, Feeder wears a pager and carries a phone.
“I’m constantly getting calls,” she said. “If a kid comes in to an outpatient department for a procedure, I am called in. I go to our pediatric specialty clinic and our radiology department. I also go to our outpatient lab and the emergency department. I support kids who having CTs and MRIs. More and more frequently I’ve also been supporting children or grandchildren of adult patients around a new diagnosis. If a parent has been diagnosed with cancer, for instance, I can provide support and teaching for the child.”
Jack of all trades
During her practicum, Gerster, a psychology major, has had the opportunity to get up-close-and-personal with patients and families, supporting and comforting children through a range of medical procedures. It’s just the opportunity she wanted, she said. Getting a taste for the daily routine of a practicing child life specialist only makes her more confident that this is the right job for her.
During the practicum, which wraps up next week, Gerster said: “I’ve seen lumbar punctures, catheters, foreign-body removals. One day, a child had a battery stuck in her nose. The family brought the child into the ER to have it removed.”
On Gerster’s first day on the job, she got to witness one of the most important roles a child life specialist can play in the hospital. “I had the opportunity to work on an end-of-life situation,” she said. Gerster was shadowing Feeder when they were called in to support a family during this sacred time. “A parent was passing away,” Gerster recalled. “We provided support and comfort for the children and the family.”
The observation opportunities offered by this unpaid practicum experience are important to Gerster: In order to achieve certification, she will need to complete a 460-hour internship at a hospital somewhere in the United States. Child life internships are highly competitive, Gerster explained, and she believes that completing a practicum like the one she’s wrapping up at Fairview Ridges, while not required for the internship, will help give her a leg up. This month, she’s sent out applications to more than 60 internship opportunities around the country, hoping that she’ll get selected for one of these unpaid positions. Once she completes her required internship hours and sits for the national certification exam, Gerster will be ready to look for work at a hospital.
“During this practicum I’ve seen how rewarding the profession is and what an impact in can make on children in a hospital setting,” Gerster said. “This practicum experience is what has pushed me even further to go through the trials and tribulations of getting the internship. I am so ready to take this next step.”
Highly competitive field
Soon enough, would-be child life specialists will have to clear another hurdle. By 2025, Feeder said, the National Child Life Council will require that candidates earn a master’s degree in child life in order to achieve certification. “Right now, no schools in Minnesota offer that degree,” Feeder said. “The closest bachelor’s degree is at Edgewood College in Madison, Wisconsin.”
Feeder said that the child life staff at Fairview Ridges advocated for offering the practicum — the first to be offered by a hospital in Minnesota — because they understand how tough it can be for people interested in entering the profession to get the experience they need to earn the required internship hours: “We will take on one more student this fall. Our hope is in 2017 that we can increase that number to two-to-three students a semester.”
If she does get offered one of the 60 internships she applied for, odds are high that Gerster will have to travel out of state.
“It’s really competitive to get these internships,” Feeder said. “I believe there are only three internships available in Minnesota this fall.” Completing a practicum is not the same as an internship, but it does help make a candidate more attractive for snagging prime spots, she said.
Because the best interests of children are too often overlooked in a medical setting, child life specialists consider it their responsibility to advocate for the rights of youngest patients in the hospital.
Feeder, who was drawn to work in a medical setting but didn’t feel excited about a career as a nurse or physician, likes to describe her job as: “being a teacher for kids in a hospital. The only difference is I’m teaching about medical stuff — not school stuff.”
With Feeder’s focus on developmentally appropriate communication and clear, honest education, children can find the strength to face even the toughest medical realities.
“My job is to figure out how we can help kids understand what’s happening with their bodies or a new diagnosis or dealing with a scary procedure,” she said. “With my help, kids feel empowered and their ability to cope with that procedure is increased.”
What makes child life specialists different from hospital social workers, who often assist families through trying times? Feeder said that the difference is in the training, and the focus on the developmental needs of kids.
“We have a team of social workers within our hospital,” she said, “but their job is to focus on a range of different things that affect the whole family. Child life specialists are specifically trained to teach kids a variety of coping skills in a developmentally appropriate manner. The way I teach a 4-year-old about stitches is very different from the way I teach a 13-year-old about stitches, for instance. We’re always assessing their development and coping skills, their previous experience with the procedure and who’s here with them today.”
Child life specialists believe that the natural resiliency of a child is like a flower: With the right amount of support and encouragement, most kids can face tough challenges with amazing grit. In the past, medical professionals felt that there were some kids who just couldn’t handle trauma, and they forced procedures on them, often without much warning.
“Hospitals have these awful things called ‘papoose boards,’ ” Feeder said. “Oftentimes, back in the day, it was routine to use a papoose board when a kid was resisting a painful medical procedure. A papoose board is like a backboard with Velcro straps that holds a patient down. When you lay a kid flat and strap them down to perform a procedure, it only makes them more anxious. We advocate against that now.”
Physical restraint only emphasizes a child’s powerlessness, Feeder said. Developmentally appropriate education and communication, a central focus of child life specialists, hands back some of that power.
“When you work with a child and let them play with the tools, they gain a sense of mastery,” Feeder said. “Then we come up with a way to distract the child and position them in the most comfortable, nonthreatening way. Even the most anxious kids are able to sit still and cope with the most uncomfortable situation, even things like stitches on a forehead. Children are stronger than most adults realize.”