Deborah Howell (Host): When children are in the hospital, the power of medical play can be a powerful component for healing, both physically and mentally. In this episode, Rita Goshert, Director of the Cherese Mari Laulhere Child Life Program at Miller Children's and Women's Hospital will discuss the power of play in the hospital setting, sharing insights on how play can significantly impact the emotional and psychological wellbeing of young patients, helping them cope with the challenges of hospitalization. We'll also talk about the innovative approaches and strategies used by the Child Life Program at Miller Children's and Women's Hospital to create a supportive and healing environment for children. Welcome, Rita.

Rita Goshert: Hi, Deborah.

Host: I am so looking forward to this. Thanks for coming on today.

Rita Goshert: Well, thank you for having me. I'm honored to be here today.

Host: Good. Well, so for people who may not be familiar, what is Child Life and what's the role of a Child Life specialist in the hospital?

Rita Goshert: So, Child Life programs are really so critical to any children's hospital, and that's where you will find them and our Child Life specialists that are, you know, the majority of a Child Life Program that make it up, our specialty is child development and family studies. So, we all are either bachelor's or master's prepared in that field. So, our specialty is to know where a child should be developmentally. Also, knowing that a traumatic event like hospitalization can really cause a child's development to regress, so to go backwards, and we don't want that to happen. So, we are trained and skilled in helping them kind of stay on that straight and narrow path of keeping their development going in the direction that it should, knowing that they're experiencing this traumatic event of being hospitalized.

So, one of the main things that is associated with a Child Life Program is play. So, you will find playrooms throughout children's hospitals, and we try to bring play wherever a child is. But as a whole, the Child Life Program, the goal is really to normalize the crazy, scary environment of the hospital. And what is normal for kids? Play. So, we want to provide play wherever the child is, wherever the pediatric patient is, we want to be able to provide play for them. That's kind of a simplistic way of describing a Child Life program, but there's more to it. But that's the basics.

Host: Sure. And what a beautiful thing it is. So, let's get into it. Let's dig deep. Can you explain the concept of the power of play in the hospital setting and why it's so doggone important for young patients?

Rita Goshert: Well, we always say, and this is from a theorist of child development, that play is the work of children. It's how they make sense of this crazy world that we live in, and especially so in the hospital setting, because that is not normal. Children should not be in the hospital. They should be in their schools, their neighborhoods, their parks, well now, beaches, because it's summertime, right? So, they shouldn't be here. We want them to be in more of a normal environment. But since they do have to be here and we need to take care of them, we need to make sure that we provide as many play opportunities as possible, wherever that might be. That might be at a child's bedside when they're staying here in the hospital. That may be in one of our clinic exam rooms. That may be in the emergency department, in the trauma room. It could be in the intensive care. Wherever the child is, we want to make sure that we're able to provide play to them because it helps them to cope, it helps them to adjust, and just all around have a better experience in this really what can be, you know, not the greatest experience being hospitalized. So, we want to do everything we can to turn that around and make it positive and we do that through play.

Host: I love it. And each child, of course, is unique. So, how do you tailor play activities to meet the individual needs of every child considering their age and their medical condition and their personal interests.

Rita Goshert: That's a great question, and that again goes back to a Child Life specialist's training, their academic training as well as our hands-on clinical internships that we must complete before we're considered a certified child life specialist. So, we really are experts in assessing where a child is developmentally. Again, going back to that fact that I mentioned earlier, that we know that a child's development can regress when they're hospitalized. So, we take that into account. So, we want to assess where they are developmentally, what's their temperament like, and how are they coping right now in that moment. So, we always want to meet the child where they're at. And that does take a special skill. It doesn't always come naturally for everybody.

We're very fortunate here at Miller Children's. We have an amazing group of Child Life specialists that are very, very skilled to that. So in completing that assessment, then we can move forward to tailor our interventions, which are primarily play, and tailor that intervention to match the child's development, match their temperament and match how they're coping in that moment. So, there's other things we want to take into account. Have they been hospitalized before? Is this their first hospitalization? Are mom and dad both there at the bedside? Are they alone in the room? You know, there's a lot of different things that we want to take into account.

 If I had the opportunity, sometimes our interactions are very fast, right? Especially in the emergency department, we just have to run in and support. But if I have the opportunity to meet with the parents first and find out a little bit more, I can even better gear my intervention to match that child's specific need: their favorite toys, let's say, their favorite game or app that they use on their iPad or tablet, that's really a helpful tool to kind of break the ice and get in to be able to prepare them even better.

Host: I'm sure you're some of the faces that the kids really love to see during the day.

Rita Goshert: Yes. So, my whole team wears purple shirts. So, we're the purple people. And we use that though. It's interesting that you ask that question. So, let's say I have a Child Life specialist that meets a child that enters through the emergency department, and she's in purple. And if the child finds out they're going to be admitted and have to stay in the hospital, she'll say, "You'll get to meet one of my friends. And they're going to be wearing purple too. And her name is Rita." So, it's great connection tool as well. But the kids do, they light up when we walk in the room and. And again, it goes back to that special skill. Now, if I walked into a patient's room the very first time I met them and said, "Hi, I'm Rita. I am a Child Life specialist. I would not get a great response." But I walk in the room and say, "Hi, I'm Rita. I'm from the playroom. Did you know we have a playroom here?" So, it's all in the way that we kind of introduce ourselves and from walking into the room with a kid that's crying and fearful and you can tell they're having a really rough time. To me, just introducing myself and what I do, their whole demeanor can change. So, it really makes a difference, even just from that initial introduction.

Host: Well, my whole demeanor just changed listening to you. I'm choking up. It's just such a beautiful thing you do. So, let's get into it. More specifically, how do events like pet therapy and music therapy or special visitors tie into your work?

Rita Goshert: So, our pet therapy program is a volunteer program and we are so fortunate to have our doggies here, they are able to come in and, again, just as the story I just shared, walking into that room of a child that's very scared or anxious or sad or lonely, or maybe they're missing their own pet from home. I can also tell them if they share that with me, I can say, "Guess what? We have our special friend Bo visiting today. Can I bring Bo in to say hi to you?" And then, Bo is just the most gorgeous dog and such a sweetheart. And so, I'll bring Bo in and he is just a love, and you can't help but just pet him and relax, and just to watch that child relax as they're petting them. I've had kids and parents actually tear up because their child was missing their dog so much, and to see them just calm just by petting one of our pet therapy dogs, it's an amazing, amazing, amazing program.

And our music therapist, I can't talk more highly of, they are partners with Child Life. They're part of our program. They're part of the Child Life Program. And they can come in and, again, just change the whole day for a child by playing a child's favorite song or a child maybe that's never played a musical instrument but's been here in the hospital with us for a little while and starts to be very interested in the guitar or ukulele. And our music therapists can teach them how to play guitar or ukulele. And then, we're partnered with many very generous organizations that will donate a guitar for a child to take home and then kind of continue that love of music that they've learned while they're here in the hospital in their city by taking music lessons. So, music therapy is a wonderful program that helps our kids adjust and cope with hospitalization just as Child Life specialists do.

Host: What a gift. What a gift. So, Child Life doesn't just support the patients. You also work closely with the parents and the siblings. So, kind of what does that look like?

Rita Goshert: Yes. We work very closely with our families. It's the whole family. We practice patient and family centered care here at Miller Children's Hospital. It is the cornerstone of the care that we provide. So, a child rarely, if ever, walks into our hospital by themselves, right? They are accompanied by their family and however that family is made up, you know, it's not for me to decide. And we support that family as a whole. So, we definitely support our brothers and sisters helping them to understand what's happening with their ill sibling by providing play as well, just as we play with pediatric patients. And I didn't talk a lot about medical play, so maybe I'll tie it in here with the patient as well as the sibling.

So for a patient, we want to make sure that they have that opportunity to engage, I said, in all kinds of play, right? But specifically, medical play where we bring in medical items, actual medical equipment. We actually, sometimes, depending on the child's age, we'll do a combination of play like a Fisher-Price Medical Kit as well as the real medical equipment and a doll, and really let the child explore. We use those items to also prepare a child so they understand what's going to be happening when they're having a surgery or a procedure. But then, the biggest part of it is to let them play. Let them play through what we just talked to them about. Or after a procedure or a treatment, let them play through that experience.

I'll never forget I had this one little girl. She was about three years old in the playroom and I was just letting her go on her own in the little medical play corner while I was helping some other children with an art activity. And I turned around and took a peek and she had the doll in one hand and a syringe. No needle on the syringe, just an oral syringe. And she was giving that doll so many pokes in the face all over her cheek, her chin, her nose, her forehead. And I said, "Oh my, your baby sure needs a lot of medicine. Did you have to get that much medicine too?" And she started nodding yes with little tears streaming down her eyes. I said, "Well, show me where your pokes were." And she pointed to her arm and pointed to two little spots, "I was poked here and here." But for her, the importance of her to be able to play that out, not for me to say, ", you only had two pokes and you gave your dolly 50 pokes," that's not what the purpose was. It was for her to be able to play it out and express those feelings. So, that's just one example of the many types of medical play that can transpire with children that we work with.

But we also want to provide that to the brothers and sisters because they, as well as the child being traumatized, the patient, the siblings are as well. It's very difficult for them. Their brother and sister is not home. They're staying here in the hospital. Depending where a sibling is developmentally, they could actually think that they somehow caused their brother or sister to become ill, like, "Oh my gosh, I got in a fight with my brother yesterday. That's why he had to go to the hospital today. It was my fault." So from a developmental perspective, depending on the age of the sibling, they could actually think that. So, Child Life specialists come in to help clear up those myths and misconceptions basically that a patient could have as well as a brother or sister.

And we really want to help that sibling understand what's going on with their ill brother or sister, just as we help the patient to play through what's happening with them. It's kind of very similar. We can have brothers and sisters that maybe can't be here at the bedside a lot for whatever reason that's going on with the family. We might have them make special things that we can hang up in the brother or sister's room to personalize it, special gifts from them, special, a poster from them. So, we also try to help them to stay connected with their sibling even if they can't be here present in the hospital. So, those are just a couple of examples of how we support the siblings.

Host: Such important work. What might surprise people about the work Child Life does every day?

Rita Goshert: I think the thing that might surprise people, they look at us as the playroom people. And I think for them to understand that we really have a tremendous amount of education. The majority of my staff are masters-prepared, which isn't actually a requirement right now for Child Life specialists. So, they've gone that step farther of getting their masters. We're masters-prepared. We've completed very extensive clinical internships and training. So, we provide play, but the play is much deeper than what people see on the surface. I think that's what I would say would surprise people about Child Life.

Host: Yeah, you're not just the fun purple people. You know what you're doing.

Rita Goshert: But we are the fun purple people.

Host: All right. Now, what's one thing you wish every family knew about the role of play in healing?

Rita Goshert: So, I'm going to use a couple of the phrases that we use, and I try to repeat these to parents all the time, that while your child is here in the hospital, they need more than medicine to get well. Yes, they need the medicine. Yes, they do, but they need more than medicine. And really, that's where child life comes in. We are the more than medicine.

Also, that a child is never too sick to play. Even if they're in the intensive care unit, intubated, their hands may even be restrained so that they don't pull at their tubing. But we can help them with play if we have to. But a child is never too sick to play. They always need to play while they're here in the hospital and when they go home.

And then, the most important thing really, as I said earlier, play is the work of children and play helps children cope and adjust with hospitalization. It does. Just as medicine and surgeries help heal a child, play as well helps to heal a child. It helps them to cope with this very scary and unfamiliar environment.

Host: This is so uplifting, Rita. For someone interested in supporting Child Life or even just learning more, how can they help?

Rita Goshert: So if they want to learn more, we'd love for them to call the Child Life Department. And our number is 562-933-8060. And we'd love to help them out. We can get them on the road to becoming a volunteer with us if they'd like to start with that. Also, help them with kind of the educational steps to becoming a Child Life specialist, of course.

And then, if anybody is interested in making any donation, of course, I'm talking a lot about play and preparing children, but the tools of a child life specialist are toys. So, we always need toys continually and arts and craft supplies, which, you know, I always call them consumable items, right? So, we need crayons and markers and all of that on an ongoing basis. They also could call the same number, but they can also visit millerchildrens.org/childlife.

Host: Okay. And let's give that number. It's 562-933-8060. And once again, millerchildrens.org/childlife to learn more or to make a donation. Rita, thank you so, so much for your time and your expertise today. I learned just so much from you, and I know that our audience did as well. We so enjoyed having you on the podcast.

Rita Goshert: Thank you so much.

Host: And for more info or to listen to a podcast of this show, please visit memorialcare.org. That's memorialcare.org. That's all for this time. I'm Deborah Howell. Have yourself a terrific day.