Therapeutic activities for children and teens coping with health issues

Therapeutic activities for children and teens coping with health issues
By Robyn Hart and Judy Rollins.
John Wiley & Sons, Hoboken, New Jersey, 2011, 379 p. ISBN 9780470555002.
Bibliography, pp  339-364. Includes CD-ROM.

 “Therapeutic activities for children and teens coping with health issues” is a book richly filled with activities to assist health professionals, child life therapists, counsellors and social workers in their work with families. Activities and related information promote adaptation and coping for children, adolescents and their families in hospital or living with health issues. It is great to see so many ideas presented in an easily readable format, with over 200 practical activities to choose from.

Chapters focus on promoting understanding and coping for adolescents and children through different aspects of their healthcare experiences. Topics of the 16 chapters include separation and anxiety, self expression, socialization and help with many aspects of coping with illness. Set out in a clear way, each topic covers an overview, special considerations and coping interventions. The theoretical framework behind each topic is outlined. Activities are set out using an easy-to-read table which includes: therapeutic goals, age group, adult/child ratio, required time, restrictions and precautions and materials. You will also find an extensive bibliography (pp  339-364) as well as black and white illustrations and photographs. The accompanying CD has activity sheets and templates that can be customised.

With a great mix of theory and hands on, this book is sure to be a helpful reference tool and provide both information and inspiration. In fact I think I’ll gather up my supplies and try my hand at making a volcano.

About the authors
Robyn Hart, director of Child Life at Rush University Medical Center in Chicago. Judy Rollins, coordinator of the Studio G Artist in Residence Program at Georgetown University Hospital and Adjunct Professor at Georgetown University School of Medicine. This is the second  book they have worked together on, the previous award winning book is entitled, Therapeutic play activities for hospitalized children.

Keywords: Activities; Adaptation, psychology; Adolescent psychology; Bereavement; Body image; Child life; Child, hospitalised; Child psychology; Culture; Death; Families; Group work; Hospitalization; Medical art; Medical equipment; Mental health; Pain; Patients; Play therapy; Self-esteem; Self-expression; Therapeutic activities; Therapy

Awards
Winner of the American Journal of Nursing Book of the Year 2011
(Category: Maternal And Child Health)

Other titles also by Judy Rollins available for loan from the AWCH collection:
Meeting children's psychosocial needs: across the health-care continuum / Judy A. Rollins, Rosemary Bolig and Carmel C. Mahan. Austin, Texas: Pro-ed, 2005. xv, 551 p.: Includes bibliographical references and index. Call number: 618.92 ROL 1
Core curriculum for the nursing care of children and their families / Marion E. Broome, Judy A. Rollins, Editors. Pitman, New Jersey: Jannetti Publications Inc., 1999. Call number: 610.7362 BRO 2


Review By:
Jillian Rattray
AWCH Librarian
March, 2013

Childlife Awareness Month

This month is Childlife Awareness Month. Childlife or Hospital Play has existed in hospitals that care for children since early in the 20th century often starting out as volunteer programs. However in Australia up until the second half of the 20th century and even now in the 21st century play programs are not always available in hospitals that care for children. Play gives children and adolescents the opportunity to express some of their apprehensions arising from the stress of illness. It also provides ‘normal’ everyday activities as a diversion from health care issues.

AWCH recognised the importance of play in hospital from its very early days and held a residential seminar at Armidale on play in hospital in 1976.  A first in Australia, it brought together a wide range of hospital staff, teachers and students in various disciplines and others interested in both the theoretical and practical aspects of play in hospital. It was through this seminar that play workers from a variety of hospitals and institutions and in widely differing positions became aware of each other’s existence and made recommendations for unified guidelines to be established as to their status in the hospital system. Today the Australian Association of Hospital Play Specialists promotes the importance of developmental play activities, therapeutic play, play preparation programs, medical play, diversion and distraction activities, and pre-
admission programs. In April 2013, AAHPS is holding its 7th biennial international conference, Connect and Collaborate A Hospital Wide Approach to Psychosocial Care in Melbourne.

So currently, where are we at with hospital play services in Australia? The AWCH 2005 National Survey Report on the Psychosocial Care of Children and Their Families in Hospital reported on the state of hospital play in Australia. The report found that just under 25% of surveyed hospitals had play or recreation staff and just over half provided a separate play room in or near the ward for child patients. Just a note here that these were all hospitals who provided care for children and young people. Of concern is the fact that just under 15% of those surveyed did not provide any separate play space for child patients.

AWCH made several recommendations:

• Hospitals admitting paediatric patients should allocate a suitable space for play and recreation activities
• Hospitals providing care for paediatric patients should employ appropriately qualified staff to conduct play activities, preparation for specific medical tests and procedures, medical play and distraction
•  Hospitals providing care for paediatric patients should allocate appropriate play space, as recommended by the American Academy of Pediatrics
• In areas where children are required to wait, suitably qualified play staff and/or suitable play or recreation space should be available to provide developmental, medical and preparation activities

So…are we doing any better in 2013? Does every hospital that cares for children and young people have play and recreation services available? What is the state of ‘play’ at your local hospital?





Anne Cutler
Program Manager AWCH

Book Review: Extraordinary Parenting

'Extraordinary Parenting'  is a helpful manual written for parents who have children with chronic physical or medical conditions. The book is set out in a readable format with clearly presented information. You will find simple illustrations, photographs and a bibliography. In addition, it is written in an Australian context.

Ordinary children are faced with extraordinary circumstances and in the book parents are given psychosocial information to support their children. Topics covered are varied and range from looking at a child’s psychological and emotional world to experiences such as hospitalisation, medication taking, sleep overs and camps or life in the school playground.  Extraordinary parenting encompasses child development stages and age appropriate information for up to early teens. There is an emphasis on raising awareness of what a child and family may be experiencing whilst looking at important emotions such as anxiety, self-perception and depression. Parents are encouraged to focus on their “best intentions” rather being caught up in guilt. Find an abundance of practical information, for example throughout the manual at the end of each chapter, readers will find the heading “Psychological protection : what you can do”.  Children and families can build understanding and develop skills for good self-esteem and resilience.

The author draws on her experience of over 20 years from working children, adolescents and adults in the fields of psychology, social work and literature. Dr Bruce works in private practice at the Emotional Health Centre, Cheltenham, Victoria. Extraordinary parenting can be viewed online in chapter format and/or purchased at: http://www.emotionalhealthcentre.com.au/page.php?id=557

The AWCH library holds two copies and both are available for loan.
  

Extraordinary parenting : protecting self-esteem and minimising depressive outcomes in pre-adolescent children who have significant medical or physical conditions (Cover title: Extraordinary parenting : a manual for parents of children aged 0-12 with chronic physical or medical conditions). Emotional Health Centre, Cheltenham, VIC. 2007, 168 p.  ISBN 9780980420609.
By Dr Elizabeth J. Bruce PhD, edited by Dr Cynthia L. Schultz, illustrations by Colin Bruce
Subjects:  Chronic diseases in children - Psychological aspects. Chronically ill children - Family relationships.  Chronically ill children - Education. Chronic disease - In infancy & childhood.

Review by:

Jillian Rattray

AWCH Librarian

I felt sure his mother holding his hand and comforting him would have helped…..

Edited excerpt from ‘As it Was – The First 10 years’ by Doris Hart, first Secretary and the first National Organiser of AWCH - the moving force behind the Association's initiatives from 1973 to 1983.
 

In the newspapers and magazines of the 1960s/70s, information about children in hospital centred around hospital success stories; visits of royalty and film stars; Easter bunnies delivering a surfeit of Easter eggs; and Father Christmas and his helpers with an abundance of toys and good cheer. The stories conveyed images of hospitals working near miracles; of everyone caring about children in hospital and of the kindness shown by hospitals for their child patients. All of this was true but it hid a very dark underside to the hospitalisation of children - long term, often devastating, emotional trauma.

In Australia, the need for change was heralded by the concern expressed in 1970 by the Aust. & N.Z. College of Psychiatrists. Their Position Statement entitled “The admission of mothers to hospital with their young children" accused hospitals of……doing more damage in one year than all the psychiatrists together could undo in several years. . .

That hospitalisation could have such devastating effects on young children was well known to me. In the late 1960's I worked for three years in the children's unit of a psychiatric hospital handling the most severely emotionally disturbed children in the State. Hospitalisation at an early age appeared regularly in the case histories of these children.

One would have expected the psychiatrists' position statement to bring forth cries for an immediate enquiry and remedial action. Instead, it was virtually ignored. The hospitals' case was that parents upset children who were soon settled and better off without them. A fallacy already forcefully disproved by the published works, both written and audiovisual, of James and Joyce Robertson http://www.awch.org.au/2-year-old-goes-to-hospital.php . 

The "cage” cot with a wire frame 1976

If the mother (or the child's caring person) was not admitted, how did hospitals cope? Nurses did their best in an often impossible situation. For the most part, children simply cried until they became withdrawn and “settled". Distressed toddlers were particularly difficult to manage. In their anguish they often tried to climb out of the cot. Fearing that they would harm themselves they were sometimes put in restrainers. Documented cases of children choking to death in them discouraged the practice. Another method was to put a wire frame over the top of the cot thus making it into a cage. In the 1970's, I saw one of these in a regional hospital in NSW, another one in Victoria. In each case, the hospitals saw the cage as a perfectly valid solution that ensured the child's safety, even though there were empty beds at the side of the cot which could have been used by a parent. Indeed, in Victoria I was told the cage was used because the child was the only one in the ward so, instead of having a nurse there just for one patient, the sister in the adult ward kept popping in. When I asked why they hadn't admitted the child's mother in these circumstances, I was told it wasn't hospital policy. The nurse admitted she would willingly have let the mother stay (had it been allowed) as the toddler was a nuisance disturbing and upsetting her patients all night

Of course, most hospitals did not use restrainers or cages, but there were still very distressing sights associated with necessary treatments. I remember seeing a very young child in a side ward with his eyes swathed in bandages and his wrists tied to the sides of the cot so that he did not pull off the bandages. He was kept heavily sedated but one couldn't help wondering what fears or dreams he was having in that twilight state. I felt sure his mother holding his hand and comforting him would have helped.

Cracking the system

In the literature, the problems of hospitalisation of children had been identified and the solutions outlined. As hospitals failed to implement more humane policies, there were various attempts by individuals and groups to force action but none had been successful. Hospital boards were thought to be omnipotent. To challenge them from inside the hospital was to invite personal disaster career-wise; to challenge from the outside was to invite ridicule as a trouble-maker.

At the first meeting of the group which subsequently became AWCH I voiced my strongly held convictions:

• that infants and young children needed their mothers in hospital and that need had to be met
• that parents and professionals must work together publicly if the above aim was to be achieved

I believed that we could do better by drawing upon Australia's egalitarian ethos and creating a platform from which all could speak on behalf of the children, free of professional, personal or vested interests.

Thus AWCH was born in the belief that parents and professionals together could crack the system' for the good of the children.

The Magic Number

Self discovery is a wonderful thing and I believe we are evolving as individuals every day. But often those with a chronic illness reach a particularly bad patch during their lives, one which shatters their world.

From my conversations with various other people and professionals it seems the magic number for those with complex or chronic issues is that of 20-something. You reach 20-something and your health does a belly flop and you wonder where the good days went. I myself as a 20-something year old hit my bad patch roughly two years ago and it took me almost 2 years to stabilise and come to terms with my new 'normal'. The biggest realisation was how stressful my life actually was and how it was impacting on my already problematic health.

We live in a world which is so fast paced and over scheduled that often we forget to take the time out for ourselves (which I am very guilty of) which is so vital when you have a complex or chronic health issue.  Having the ability to stop and say 'leave me alone I need to do something for me' is what has brought me to my new 'normal'. For me it was a trip to Thailand before I realised that my job wasn't helping my health amongst other things and after much anguish I made some terrifying (initially) sacrifices which in turn helped me stabilise, reduce my medication intake, become happier and less sore.

I am writing this now as with the lead up to Christmas everyone is stressed and sometimes we don't even realise what the stressors are to remind us (including myself) all to do something each day for yourself, go for a walk, take up fencing, play with your pet, lie in the grass and look up at the clouds. If it all gets too much remember there are services you can access any time of the day or night to help you through the silly season, your health transitions and life. GP's are a fantastic first point of contact but if your not comfortable talking to yours or you don't have a 'good' GP then there are services such as below available for you.

At the end of the day we are all on this crazy roller coaster together!
 

http://www.psychology.org.au/community/links/mental_health/

http://www.theshedonline.org.au/

http://au.reachout.com/

http://www.beyondblue.org.au/index.aspx?link_id=107.1007

This Blog was contributed by:
Michelle Taylor
AWCH Youth Representative

DISCLAIMER: The views expressed here are solely those of the author in her private capacity. Information provided by blog contributors are not intended to replace qualified medical or other professional advise and for diagnosis, treatment and medication you should consult a health practitioner.