A Guiding Hand, A Continued Source of Support

Boston Medical Center’s child life specialists are no strangers to quickly adjusting to new and challenging circumstances. Their roles are centered on easing the fear and stress of hospitalization and being a source of support for pediatric patients and their families, which often means every day and situation are unique. “Even when we may think that we have a well laid out plan for an intervention supporting a child or family, unpredictable events can alter that process, therefore we are frequently adapting to the environment and thinking on our feet to adapt to the patient’s needs,” explains Molly Ann Duggan, MS, CCLS, child life manager.

Duggan and her team respond to a variety of patient needs throughout the hospital, in both inpatient and ambulatory settings. This includes the Pediatric Emergency Department (Pedi ED), pediatric inpatient units, otolaryngology and ambulatory pediatric clinics and, surgery. They also assist other clinical care teams outside of pediatrics. For example, there are times when children of adult patients need help coping with loss and grief or when an adolescent trauma patient is in need of psychosocial support. “I think that one of the most rewarding aspects of the work of a child life specialist is that we are members of multidisciplinary teams and have the privilege of collaborative work,” Duggan explains. “We are a small team, however become part of something bigger when consulted out of our main units.”

The team’s signature flexibility became vital during the COVID-19 pandemic. When cases began to surge at BMC, the hospital repurposed numerous units to accommodate the many COVID-positive patients who were being admitted—most of whom were adults. Although the areas they normally work in were being utilized for COVID care and there were fewer pediatric patients in the hospital, the child life team didn’t stand by. Instead, they shifted their roles to meet the immediate needs of patients, “As a general rule, child life specialist are known to wear many hats in our practice and that remained true throughout our work during the surge,” says Duggan.

Vans were set up outside the lobby of the Menino Building for pediatric patients and their families, so they could continue to receive vaccines and other facets of care without having to come into the hospital. Child Life stepped in to make sure these vans closely matched the look and feel of typical pediatric clinical spaces at BMC by outfitting them to be as child-friendly and inviting as possible. “Environmental changes can play a pivotal role in creating a positive coping experiences, allowing patients to feel safe and secure,” Duggan notes. The team also made resources readily available, by creating educational pamphlets and handouts to ensure developmentally-appropriate language was being used with children and making virtual education available for families. They also disseminated items to help patients stay distracted and entertained, especially in areas without televisions. The team continued their work in the Pedi ED and performed consults in intensive care units (ICU) to help support in any way they could.

Duggan was also part of the Palliative Care Extender Team, which was established to give ED staff additional support with end-of-life discussions and planning for the many seriously ill COVID patients who were coming to the hospital. Duggan, along with, physicians, advanced practice providers and psychosocial professionals, strove to alleviate suffering and improve quality of life for both the patient and the family. “As someone who is not typically working on the adult side of the emergency department, the environment is new and therefore can pose an additional challenge to the work. The ED team welcomed this role with open arms, therefore aiding us to offer the best support during such difficult circumstances. To be able to do that kind of work, it needs to be collaborative in nature for success. The team was so grateful to have extra support to help guide these families,” recalls Duggan.

Duggan and her colleagues also championed for staff who were caring for COVID-positive patients during this time, especially the pediatric nurses and staff from their own units. The team created bulletin boards filled with helpful information and tips, launched an Amazon wish list for staff and made giveaway bags full of items to help staff de-stress when they needed it most.

“You could really see people stretching into roles that they had never been in before,” says Duggan. “It is an amazing feat when you think about it. [The pediatric nurses] take care of pediatric patients on a day-to-day basis and some changed their entire role stepping up to take care of adults. More than anything, we wanted to support our teams in any way we could and small bits of encouragement can go a long way. Everyone really realized that we needed to be resilient, we needed to be strong. As challenging as it was, everyone really stood by each other.”

After many challenging months, COVID cases began to decline and BMC was finally able to begin the process of reopening units and commencing normal operations. Initial plans included opening the pediatric ICU, resuming pediatric surgeries and operating at fifty percent capacity for the pediatric inpatient unit, all of which came as wonderful news for the Child Life team. “We want to ensure that if children and families need care, then we are here for them. Having our units back open, we are now able to service our community.” says Duggan.

However, re-opening also brings a new “normal” to the way Child Life works to care and support their patients. One of the biggest changes and challenges Duggan notes is that children are currently unable to leave their hospital rooms, requiring adjustment to their play experiences and the tools the team previously used to help kids cope with hospitalization. “We are just trying to be extra cautious and we want to do anything and everything we can to protect our patients during their time here, while still offering safe play experiences as they receive care, ” Duggan explains.

On top of settling into their regular roles, the team has had the chance to add one more thing to their impressive skill set: members of Team BMC, the hospital’s athletic fundraising team. This September, the Child Life team will be taking on the Rodman Ride for Kids with Team BMC in order to raise critical funds for BMC’s pediatric programs and initiatives. “It is an amazing opportunity to be able to jump into something and to raise money that you know will go directly into your department. This enables us to have resources to service these patients,” Duggan says. Though the event, which Duggan credits as being a team favorite, won’t be in-person like usual, that won’t stop them from being as creative as possible to raise funds. “No matter what, these patients need our support and that is why we do the work. Going that extra mile and asking for donations during such a difficult time is a challenge, however it is so important because it is raising awareness and people do want to make a difference,” Duggan notes.

So far, there has been an astounding response from donors, which will make a tremendous impact on Child Life’s ability to help patients. “As a safety net hospital, we rely on the resources and the public’s support,” Duggan concludes. “People have delivered and we continue to be grateful.”