Five Reasons Why Pediatric Settings Should Integrate the Play Specialist and Five Issues in Practice

Abstract

Article 31 of the Convention on the Rights of the Child of the United Nations identifies play as a human right (Lundy, 2012) and the European Association for Children in Hospital (1988) lists play among the fundamental children's rights in healthcare (article 1–10). Playing is also a parameter to monitor the child's physical, emotional, cognitive, and executive development and well-being (Sutton-Smith, 1999; Koukourikos et al., 2015). Entering a medical setting exposes the child to many different risks for mental health (e.g., depression, withdrawal, regression, sleep problems, anxiety, hypochondria) because his/her familiar routine is disrupted (Chambers, 1993). In these cases, structured play-activities with a specialized professional can provide the child with a sense of continuity with the life before the illness (Romito et al., 2021) or with an imaginary escape from reality (Tanaka et al., 2010; Bukola and Paula, 2017). In the 1920s, F. Nightingale and F. Erikson were the first nurses intuiting the importance of systemizing playing sessions to ameliorate children's hospitalization experience and adherence to medical procedures (Frauman and Gilman, 1989; Francischinelli et al., 2012). Then, the books “Working with Children in Hospital” (Plank, 1962), “Children in the Hospital” (Bergmann, 1965), “Play in Hospital” (Harvey and Hales-Tooke, 1972) highlighted that introducing a specialist in play-activities in the hospital was fundamental for the child's psychosocial well-being. By the same token, Brooks (1970) remarked that the “Play Lady” should not be considered a recreational figure for hospitalized children but a psycho-pedagogical intervener that supports the child when he/she is coping with the illness. As Rubin (1992) points out, a large body of synonyms (e.g., play lady, puppet lady, playing checkers, playing teacher, recreational therapist) was used between the '60 and the '80 to describe the same role. Nowadays, there are still many synonyms describing these professionals (e.g., Healthcare Play Specialist, Certified Child Life Specialist, Child Play Specialist, Medic Pedagogic Healthcare worker), and the need for creating scientific consensus around this role is urgent. As emerged from 29th January 2021 Virtual Round Table “Playing in the Hospital,” most of the international stakeholders indicated the term “Play Specialist” (PS) as an encompassing worldwide macro-label to describe this professionalism (Porto dei Piccoli, 2021). The PS differs from the play-therapist since play therapy is a counseling technique used in psychoanalytic psychotherapy (Leblanc and Ritchie, 2001). All over the world, hospitals, trusts, and charities often promote the PS in the pediatric care settings. No-profit organization are crucial to promote the PS in countries where the role is not integrated yet in the healthcare system. The lack of international guidelines for the PS practice leads these professionals to theoretical and operative fragmentation, challenges, and issues that Covid-19 pandemic is further stressing out. The aim of the present paper is promoting knowledge about the PS by defining the professionalism, analyzing the obstacles that hinders the PS practice, and emphasizing the reasons why promoting the PS in pediatric care settings (e.g., hospitals, home-based care). Notwithstanding countries terminological differences (e.g., in the UK the PS is named Healthcare Play Specialist, in the USA and Canada is named Certified Child Life Specialist), the PS can be described in the light of a common body of practice. Firstly, all over the world, becoming a PS requires a specific training accessible with a bachelor's degree in psychological or pedagogical sciences as a prerequisite (Harvey, 1984; Lookabaugh and Ballard, 2018). In several countries (e.g., Netherlands, UK, US) the Play Specialist is an official education degree, in others (e.g., Italy) the training is organized and financially supported by trust and charities, with discretion in the duration and total hours. Generally, the PS training focuses on the child development's milestones (e.g., physical, cognitive, communicative, emotion regulation, social skills maturation) from a medical, psychological, and pedagogic point of view, to enable PS to provide children with age-specific and diagnoses-specific play activities (Beickert and Mora, 2017). Completing a certified training is crucial because it predicts the use of research-based strategies by the PS to work with the child (Bandstra et al., 2008). Once trained, the PS can support children with various play techniques. Among a wide range of actions, the most practiced ones are the normative play and medical play (Burns-Nader and Hernandez-Reif, 2016). The normative play encompasses all the play activities that the child would experience at home. It conveys the message that the child can play and be creative in the hospital as he/she does in well-known places. On the other hand, the medical play helps the child to learn about health and illness and to familiarize herself/himself with the hospital context, aiming at reducing the child's anxiety toward medical procedures. According to Barry (2008), such activities can also occur outside the hospital ward by organizing house-visits and experiential weekends. Such experiential occasions help children with specific chronic conditions (e.g., diabetes) to increase their health-related self-efficacy outside their comfort-zone. A few studies have attempted to profile the PS. In the US, Lookabaugh and Ballard (2018) survey on the Child Life Specialists reports that most PS work in hospitals (93% of the respondents, n = 147). Bottino et al. (2019) add that the Child Life Specialists are mostly females, in their thirties, with 88% respondents (total n = 110) working to ameliorate children's coping, family perception of support, children collaboration in...