Intro: Welcome to Pediatric Voices, Duke Children's podcast about kids' healthcare. Now, here's our host, Dr. Richard Chung.

Dr Richard Chung (Host): Hello, and welcome to Pediatric Voices, expert insights about timely topics in children's health, brought to you by Duke Children's Hospital and the Department of Pediatrics at the Duke University Medical Center. My name is Dr. Richard Chung, a physician at Duke Children's and a co-host of the show.

Today, we'll explore the topic of Child Life. Child Life specialists are pediatric healthcare professionals who work with children, adolescents, and families in hospitals and other settings to help them cope with the challenges of hospitalization and illness. And March is International Child Life Month. And so, it is a great time to learn more about and celebrate this essential part of pediatric care.

To help us understand this better, I'll be speaking with Renee Hunte. Renee is the Child and Adolescent Life Manager at Duke Children's Hospital, where she leads a team of 13 certified Child Life specialists in positively influencing the patient experience. She has a Master's Degree in Marriage and Family Counseling, and started her career at Phoenix Children's Hospital, where she served as Director of Psychosocial Programs. She now has worked in children's hospitals for over 25 years. In her spare time, she volunteers at her church, enjoys baking and Sudoku, and spends time with her family and friends. Welcome to the show, Renee.

Renee Hunte: Thank you. It's such a pleasure to be here this afternoon.

Host: Renee, thanks for making the time out of your busy schedule. I'm so excited to delve into this topic. You know, as somebody who's trained at Duke and been a clinician for many years, I've been really an admirer of the work of the Child Life specialists and would love to understand sort of the nitty-gritty of what you do.

But before we get there, I would love to hear about you, Renee. How did you first get interested in children's health?

Renee Hunte: I first got interested in children's health, my father was actually a medic in the Air Force. And so, we went to a lot of events when we were children. And I just kind of really got interested in healthcare specifically. And then, when I was in probably about 10th grade or 11th grade, I had the opportunity to work some summer camps. And it seemed that pretty much with the summer camps, there would be a child with special needs. They always seemed to gravitate towards me, and I was comfortable with them. And so, I just kept wanting to do something with children in the hospital, didn't quite know what that was, didn't know about Child Life at the time. And so, I just continued to pursue that, went off to college at East Carolina University and learned about therapeutic recreation. I still didn't know much about Child Life at that time until my first job where I was working at the NIH. And then, I learned about Child Life through my work there with children with cancer.

Host: Got it. That's a wonderful story. It's always great to hear how people first get interested in children's health generally and then gradually kind of find their specific role to play. And it's wonderful to hear that even early in life, you had an inkling that you wanted to work with kids and kids are perhaps going through illness experiences and then gradually found the field of Child Life.

Can you share a little bit more about your personal and family background? Tell us a little bit more about how that kind of gave you the foundation for your current work.

Renee Hunte: Yes, definitely. My father and mother were just always giving and caring and really taking care of other people. And so, I think that just kind of got ingrained into my personality, if you will. And so, I really just wanted to do something that I could help people. And so, through various activities and volunteer experiences throughout my childhood and into my teen years, that just helped me to kind of know that I really wanted to help people. Again, didn't know how I really wanted to do that, but just was very excited. Once I learned about Child Life, to be able to combine my passion for helping people, but also my interest in working in a hospital environment, that just really cemented it for me at that time. Like I said, I grew up with a family of three brothers. And so, I was always kind of the caregiver, if you will. They were all older than me. And then, my current family, my husband and I, we do things where we volunteer at our church. And then, I also was blessed with a boy-girl set of twins.

Host: So, it sounds like in a variety of different ways, you've really identified that desire to be caring and serving others and have kind of fashioned those skills over time, which is great to hear. So, I mentioned that this is International Child Life Month. And for listeners who may not be familiar with the formal field of Child Life and its importance in hospitals and clinics, can you define Child Life for us and tell us a little bit more about that particular role?

Renee Hunte: The role of the Child Life specialist is to really help children who are in vulnerable situations. Most Child Life specialists work in the hospital environment. That could be on the inpatient or the outpatient side. As a Child Life specialist, our role is to really help a child understand what's happening to them in the medical environment.

If Child Life specialists are working with children early on, our goal is to help them develop coping strategies while they're in the hospital environment. But also, we're hoping that these coping strategies will be with them throughout their lives. And so, you hear children who have a needle phobia, we really want children to not have that needle phobia. And so, what we want to do is equip them and empower them with the skills necessary when they're young to help avoid children having a needle phobia. But we also want to help children understand the new medical diagnoses, whether that's cancer, diabetes, having an amputation. We really want to help them understand what that means. And that's children of all ages, from the preschooler, all the way up through the high schooler as well. We really want to help them understand what it means to have these various diagnoses, but also to help empower them to develop some coping strategies so that they can have better healthcare outcomes.

Host: That is really helpful to hear in terms of this explanation of where Child Life fits in. And it makes so much sense that that is a critical aspect of care. And yet, as I think about it, we often forget, right? We think that all we need to do in healthcare is to diagnose and to prescribe and treat and that that's all that matters. But then, there's the understanding underneath it all. Does the child or youth understand what's going on, whether it's the diagnosis or the procedure or the lab test? And then, not only do they understand, but do they have the skills to really cope and navigate those often very difficult experiences? And so, it sounds like Child Life specialists address both kind of that understanding as well as the skill building. Is that correct?

Renee Hunte: That is correct. If you have a five-year-old who, say for example, was diagnosed with cancer, they don't understand the word cancer, chemotherapy, all these different things that they're hearing from our physicians. And so, what we do as Child Life specialists, we might take some dolls and provide medical play to the child so that the child can understand, say for example, it's leukemia, what does it mean about your white blood cells, your red blood cells? And so, we might do some creative activities that children can see, feel, play, hear. Sometimes they don't know what questions to ask. And so, we help them play through these situations.

Host: That's really helpful. And I think one thing that we've come to understand in healthcare, as I was alluding to before, is that the experience of healthcare matters a lot, that it's not just the what of healthcare, but how it happens and how a young person and their family, for that matter, goes through that. And that experience actually matters in itself, but it also affects outcomes at some level. And it seems that as you and your team help young people to understand what's going on and then equip them with the skills to cope and to be effective within the context of illness, you're really empowering them to not just be a passenger, so to speak, or someone passively receiving the care, but at being active in their own care. Is that something you've observed?

Renee Hunte: Yes. When children have an understanding of what's happening to their bodies, they really do cope better. But they're also able to ask questions, they're also able to understand why the nurses and doctors need to do the things that they need to do to help them, but also give them more control of the environment. When they come into the hospital environment, we take away so many things for them. But if they have an understanding, but they also have choices, and the things that they can do to help, for example, if you have a 10-year-old and the nurse needs to change their port-a-cath needle, if the child is involved in that care, they feel that they're helpful, they're useful, but it also helps their emotional well-being.

Host: I'm curious about the developmental piece. Renee, you alluded to the fact that Child Life specialists are fundamentally developmental specialists, which makes total sense because as a Child life specialist, let's say at Duke Children's, you're caring not just for a six-year-old or a 10-year-old or a 16-year-old, but also even younger kids. So, you're caring for a broad range of children and youth who are very different developmentally and, therefore, have very different needs in terms of these stressful hospitalizations and other experiences. Can you talk a little bit more about how you as a Child Life specialist think about that? How do you assess the development of a kid or youth in front of you and then align your support and care with where they are developmentally?

Renee Hunte: Yes. We absolutely assess each patient that we're working with, and that's done by oftentimes just communicating with them to understand what their developmental level is. It may be through play activities, it might be through just a simple game of Uno cards. We can then assess where is their developmental level at this time. Oftentimes you might have children and teenagers who are very bright. But oftentimes when they come into the hospital environment, it's a strange new world for them. And so, where they typically may lie might be different in the hospital environment. And so, we do need to assess what is their understanding? What do they understand? So, we do that by what we call teach back. We're going to teach them the skillset and then we're going to ask them, "Tell me what you understand about getting an IV placed. Tell me what's going to happen." So, we ask them to kind of teach back those sequential steps so that we can make sure they have an understanding of it. But also, we can clarify any misconceptions that they may have.

Host: Got it. So, it sounds like every conversation is sort of a bi-directional back and forth exchange. You know, you're sort of getting input from the patient as well as providing input to them and you're actively assessing every step of the way, it sounds like, in addition to providing the care and support.

Renee Hunte: Every step of the way, every day, because each day is different. Something could have occurred that night that may impact the child's emotional well-being. And so, the Child Life specialist that next day will definitely do another assessment. And that's just kind of going through their mind and kind of assessing where the child is. And again, that's through questions and answers and gauging where that child is in that moment.

Host: That's so interesting. So, it's not just that they're a 13-year-old, or a 16-year-old, or a 5-year-old, but they're also that same age, but after what happened last night or the day before. And so, there's a certain day to day change, which is really interesting to consider. I'm curious about teenagers. For myself clinically, I work primarily with teenagers. I'm very curious your approach and how it might differ for that somewhat older age group within a children's hospital. Do you have particular strategies or things that you find effective in engaging them and finding how best to support them?

Renee Hunte: I think with teenagers, the main thing that we do as child life specialists is to really, especially in the beginning, got to build that relationship. If you don't build that relationship, there is no trust. If you don't have trust, there is no connection. And so, you've got to build that trusting relationship early on.

And sometimes with teenagers, it's not the first time, it's not the second time, it's not the third time. It may be the fourth or fifth time before you have some type of connection with them. And so really, in working with teenagers, it's the repetition. It's the going back, even when they send you away, the next day you might have to go back in there and start all over again. And so, that repetition, so that they can also know, "Here is a person, even though I'm pushing them away, they're going to come back. And they're trying to make an inroad with me." And so, that's how we work with teenagers best, that repetition, building a trust, and then continuing to work with them to maintain that trust. And you see the relationship build with teenagers definitely over time, it's not an overnight process.

Host: That makes total sense. And it's something that I've observed. I think it's important in my role in an outpatient clinic that, again, it's not just the first impressions, but it's the fifth time that you have that same conversation and you bring that same level of care and concern that they, at that point, then feel like they can trust you with whatever those needs might be.

And certainly, I have a big heart for teenagers and very kind of sympathetic to that experience, that illness during adolescence, right? When you're going through a natural time point where you are already facing a lot of challenging changes and are naturally seeking control and autonomy and then, to be way later thrown off track by an illness and then put in a hospital setting where you may not feel like you can exert so much control, that can be very difficult. And so, I'm glad that you and your team members are there to care and support them.

Renee Hunte: And I think with teenagers, you know, sometimes if they're in our hospital with a new diagnosis that's a long-term diagnosis, they're going to go through the stages of grief. And so, loss of potential friends, loss of activities that maybe they're not going to be able to do because they're in the hospital. We've got to give them space so that they can go through these various stages of grief, but then make sure that they are adapting and understanding what's happening to them so that they can then begin to just really work in the context of where their life is currently with the new diagnoses.

Host: Excellent point. As you mentioned, teens going through their own process of navigating new information or new experiences, I also think about parents and guardians and other caring adults, other adult family members who also during a hospitalization are going through their own experience, albeit not as the patient themselves. What do you and your team members do to support parents and other caring adults? How do you generally engage them? And do you typically give them guidance on how to best support their child?

Renee Hunte: Absolutely. Some of the ways that we do that, we really encourage the parents, the caregivers to be honest with the child, with the teenager. And so, sometimes it's hard for parents to do. We've had that oftentimes. So for us, it's important to then build a relationship with that parent or caregiver, because if we don't have a relationship with them, they're not going to allow us space to be with their teenager. And so, we really want to build that relationship with them as well so that we can then share the hard news that maybe the teenager needs to hear. But we also encourage them to be open, be honest. And it's very interesting sometimes in various cultures, that's often hard to do. But we want to meet them where they are and then work with them where they are and continue to build that trust so that we can encourage them to be open and honest with their child, no matter what the situation may be. And oftentimes, we find that teenagers really do know what's going on, even if you don't tell them. And so, you want to make sure they have the right and the correct information instead of formulating ideas in their mind that may not be true. And so, we do want to make sure that we have that relationship with both the caregiver, the guardian, and the teenager.

Host: Great points, Renee. I did want to ask you actually about other care team members in the hospital. And so, whether you're a doctor or nurse or medical student, you know, there are a lot of different people involved in the care of a child or youth while they're hospitalized. And as a Child Life specialist who is directly involved, but then also observes the roles that these other people played, are there tips you would offer or suggestions you would give to these other team members to support a positive experience for children and youth, to make it less stressful and to, as you mentioned, help them cope and have a positive experience?

Renee Hunte: I definitely agree that having multidisciplinary touchdown meetings, team little huddles, just to have that open communication so that everybody understands where is that team or that patient today? Where are they at emotionally today? And so, having that time to just touch down and have a brief conversation makes all the difference in the world so that everybody's on the same page on that given day with that patient or that teenager.

Host: I love that. So when we, as a team, might round, let's say, and have a conversation about the clinical plan for the day, that conversation doesn't just have to be what are we prescribing ,or what are we testing today, and what's different about the medical plan, but where is this young person in their experience of the hospitalization? How are they doing with their overall stress and coping, and what can we do to make the experience even better today than it was the day before?

Renee Hunte: Absolutely. I think just their emotional well-being is a priority that we place in the hospital environment as Child Life specialists. And so, we really do want to encourage other disciplines to also focus on the emotional well-being of patients and children in the hospital environment.

Host: That's great. Caring for the whole child, right? The whole person, including their emotional selves and the experience of their hospitalization. Renee, are there opportunities for listeners to learn more about Child Life and even to support Child Life activities at Duke?

Renee Hunte: Absolutely. One of the biggest places I encourage people to go to learn more about Child Life broadly is childlife.org. It has lots of information just about the Child Life profession in general. And here at Duke, they can go to Duke Children's and look up Child Life. And we have lots of opportunities for whether it's in-kind donations, whether it's a monetary donation, we are always looking for help. We are what they consider soft money in the hospital environment. We don't bring in the money. We don't charge families for our services. But we are always looking for folks to contribute, whether that It's a new stuffed animal for patients, whether it's having a toy drive, whether that's coming to volunteer in our activity rooms with patients. We are always looking for support for our Child Life team here at Duke.

Host: Renee, I appreciate your mention of Child Life as being soft money. And yet, like with many things in pediatrics, the return on that investment is so huge. The value that you and your team brings, it might not be easy to calculate, but we know that it's substantial. And so, thank you for the work that you do.

Renee Hunte: Thank you so much for just giving me the opportunity and the space to talk about the amazing work of our Child Life team here at Duke and the great work that they do to enhance the patient experience.

Host: Thank you again, Rene. I've learned a lot. And as I'm reflecting here, it's so easy to focus solely on what care is needed without paying attention to the day-to-day experience of that care. And it's also easy to forget that our patients are each unique in where they are developmentally and how their care experiences may impact them. And you and your team bring incredible expertise in child development, health, and combine that with various strategies and approaches to cultivate positive experiences and promote healthful coping despite the challenges of illness, and that's amazing.

My last question to you, Renee, for the final word, what inspires you most day to day in your work?

Renee Hunte: I am mostly inspired by my team. On a day in and day out basis, they work directly with patients. They get to see the highs and the lows of patients and families. They get to see the joys and the defeats. They get to see the trials and the triumphs. And they are just highly motivated individuals that come in here every day and do this work with patients and families so that we can make it a better environment for patients and families, but also that patients can have better healthcare outcomes and their future healthcare experiences.

Host: Wonderful. Thank you again, Renee, for taking the time to share with us about Child Life. It's been a real pleasure talking with you.

Renee Hunte: Thank you.

Host: Pediatric Voices is produced by the team at Doctor Podcasting. The show has been developed by my co-host, Dr. Angelo Milazzo, and me. Thanks to Dr. Ann Reed and the administrative team at Duke Children's, particularly Debbie Taylor and Courtney Sparrow for their support.

Find our show and hit the subscribe button wherever you find your favorite podcasts. And we want to hear from you. You can connect with us at dukechildrens.org, Facebook, X, and Instagram. Please send us your feedback about the show, including your suggestions for future topics. Thanks for being a part of the show. I look forward to talking with you again.