The Role of Child Life in Pediatric Pain ... - Child Life Council

Child Life Council 

26 th Annual Conference on Professional Issues 

14. The Role of Child Life in Pediatric Pain Management: 

Research Findings and Implications 

Presented By: 

Chantal LeBlanc, CCLS, Child Life Specialist, IWK Health Centre 

Ellen Hollon, CCLS, Director, Child Life Department, Children's Medical Center Dallas

The Role of Child Life in 

Pediatric Pain Management: 

Research Findings and Implications 

Presenters: Chantal LeBlanc & Ellen Hollon 

Research Investigators: Nancy Bandstra, Linda Skinner, 

Chantal LeBlanc, Christine Chambers, Debbie Brennan and 

Chantal Beaver 

Rationale for the Study 

1. Need for current research describing 

strategies used by CLS 

2. The stage was already set at the IWK: 

� Personal interest in child life 

� IWK CLS interested in research 

� CLS in North America interested in research 

The Truths of Pediatric Pain 

� Inadequately treated pain can lead to longterm 

negative consequences 

� Strong evidence for non-pharmacological 

approaches 

� Children continue to be undertreated for 

their pain 

Training Health Professionals 

� Empirical evidence available 

� Translating evidence � practice 

� Review of pain mgt. training programs 

(MacLaren & Cohen, 2005) 

� a variety of trainees 

� shifts in knowledge & attitudes 

� Interdisciplinary teams

General Research: Child Life 

� Primary goal is to reduce anxiety and 

distress (Ricks & Faubert, 1981; Mather & 

Glasrud, 1981; Gaynard, Hausslem, & DeMarsh, 

1989) 

� Provider of non-pharmacological 

techniques (Doellman, 2003) 

Objectives of the Study 

� To describe the strategies currently used 

� To describe the efficacy of strategies 

� To determine level of past training and to 

assess level of interest in future training 

Survey Items 

� Placed into 1 of 4 categories: 

1. Behavioural 

2. Cognitive 

3. Complementary 

4. Physical 

� Rated by experts for empirical support: 

1. Strong Support 

2. Moderate/Mixed Support 

3. Not Effective 

4. No research / Not familiar with lit… 

Child Life in the 

Emergency Department 

� ED research suggests beneficial services in 

the area of pain management (Krebel et al., 

1996) 

� patients recover faster 

� patients require less pain medication 

Survey Development 

� Interdisciplinary research team 

� pediatric pain researchers 

� child life specialists 

� Survey items reviewed by: 

� 3 experts in pediatric pain 

� 5 child life specialists 

� 2 graduate students 

� Online version completed by research team 

� 2006 Child Life Council Directory 

� limited to hospital-based programs 

Recruitment 

� sent to all listed programs in US and Canada 

� Notification of survey sent to directors 

� Survey in English or French (Canada only)

Online Participation 

� Participants responded to an online survey 

� Required ~ 25 minutes to complete 

� A donation of $2 (per participant) was 

made in honour of participation 

Obtaining Consent Online 

� Becoming more common 

� Little difference between whether 

participants gave informed consent online 

or in a face-to-face paper distribution 

method (Varnhagen et al., 2005) 

� Participants encountered the following: 

If you agree to participate, please click the 

“I agree to participate” button below. 

The Online Survey The Online Survey (continued…) 

The Online Survey (continued…) The Online Survey (continued…)

Results 

� Approximately 400 institutions contacted 

(39 in Canada, 363 in US) 

� 14 institutions unable to be contacted 

� 711 child life specialists contacted in total 

� 607 responded 

� response rate � 85.4% 

General Education & Training 

� Highest level of completed education 

� University/College Graduate = 59.2% 

� Graduate School / Prof. Training = 37.2% 

� 84.2% reported being certified CLS 

Descriptive Analyses 

� 97.4% female 

Participants 

� Average age: 34.1 years (SD = 9.60) 

� 18.1% (110) from Canada; 81.9% (497) 

from US 

� Reported working an average of 8.6 years 

(SD = 7.69) in the child life profession 

Pain Training & Experience 

� 66.1% reported training in pain mgt. 

� 65.0% reported providing pain mgt. 

services to >50% of their patients 

� Most respondents rated their knowledge 

(52.9%) & skill (54.4%) as ‘good’ 

� Far fewer rated their knowledge (8.9%) & 

skill (9.7%) as ‘excellent’ 

QUESTION: 

Frequency of Use 

� “How often do you use [strategy] to 

manage a child’s pain? 

SCALE: 

� 1 = never 

� 2 = rarely 

� 3 = sometimes 

� 4 = very often 

� 5 = always

Mean Frequency of Use 

5 

4 

3 

2 

1 


5 

4 

3 

2 

1 

Spot Pressure / Coun... 

Going for a drive… 

Experts report on the evidence for each strategy 

Red = Not Effective 

Yellow 

= Some/Mixed Support 

Green = Strong Support 

Massage 

Cognitive Strategies 

Virtual Reality 

Hypnosis 

Thought-Stopping 

PMR 

Memory Change 

Coping Self-Statements 

Relaxation Training 

Imagery 

Suggestion 

Cognitive Distraction 

Breathing Exercises 

Comforting / Reassurance 

Preparation / Information 

Physical Strategies 

Healing / Therapeuti... 

Heat / Cold Therapy 

Comfort Positioning 



5 

4 

3 

2 

1 

5 

4 

3 

2 

1 

Art 

MOST: 

� Prep/Info 

� Reassurance 

Behavioural Strategies 

Modeling 

Medical Staff Coaching 

Desensitization 

Parent Training 

Rehearsal 

Parent Coaching 

Behavioural Distraction 

Positive Reinforcement 

Complementary Strategies 

Music 

� + Reinforcement 

� Beh. Distraction 

� Therapeutic Play 

Medical Play 

Play 

Frequency of Use 

LEAST: 

� Virtual Reality 

� Hypnosis 

� Spot Pressure… 

� Thought-Stopping 

� PMR 

� Massage 

� HT/TT 

� Memory Change

� 70% cut-off 

Perceived Effectiveness 

� 8 strategies did not meet this % 

� Healing/Therapeutic Touch 

� Hypnosis 

� Massage 

� Memory Change 

� Progressive Muscle Relaxation 

� Spot-Pressure/Counter-Irritation 

� Thought Stopping 


MOST: 

� Prep/Info 

� Medical Play 

� Therapeutic Play 

Training Received 

LEAST: 


� Spot Pressure… 

� Hypnosis 

� Thought-Stopping 

� Memory Change 

� Massage 

� HT/TT 

� PMR 

Predicting the Use of 

Empirically Supported Strategies 

Perceived Effectiveness (cont’d) 

MOST: 

� Prep/Info 

LEAST: 

� Coping Self-Statements 

� Medical Staff Coaching 

� Heat/Cold Therapy 

Interest in Future Training 

� High levels of interest in receiving future 

training in all of the strategies: 

� High End: Desensitization - 94.7% 

� Low End: Hypnosis - 79.1% 

Primary Outcome - Frequency 

� Used experts’ ratings to weight strategies: 

Red = Not Effective (0 pts) 

Yellow 

= Some/Mixed Support (1 pt) 

Green = Strong Support (2 pts) 

� Calculated a total score for each participant 

� e.g., hypnosis (2) + imagery (1) = 3 

� Total possible score �29 pts

Multiple Regression Analysis 

� To predict use of Empirically-Supported 

Treatments (criterion variable) 

� Predictor variables 

� age, US/Canada 

� certification, level of education 

� proportion of patients who are provided pain 

mgt. services, skill, knowledge 

Multiple Regression: Results 

Predictor Variable 

Step 1 

Beta p 

Age .050 .244 

US/Canada 

Step 2 

-.001 .977 

Certification .144 .001 

Education 

Step 3 

.077 .073 

Proportion .245 .000 

Skill .111 .049 

Knowledge .164 .003 

Note: Adjusted R2 =.185, F7,567 = 19.63, p < .001 

STRENGTHS 

Strengths & Weaknesses 

� North American sample 

� High response rate 

� suggests good external validity 

WEAKNESSES 

� Self-Report Measure 

� subjective 

� retrospective 

� Order of questionnaire 

Multiple Regression: Results 

Predictor Variable 

Step 1 

Beta p 

Age .050 .244 

US/Canada 

Step 2 

-.001 .977 

Certification .144 .001 

Education 

Step 3 

.077 .073 

Proportion .245 .000 

Skill .111 .049 

Knowledge .164 .003 

Note: Adjusted R2 =.185, F7,567 = 19.63, p < .001 

Take-Home Messages 

� CLS are involved in pain management 

� Several predictors of the use of evidence-based 

strategies 

� Goals should be to: 

� require certification 

� target knowledge & skill 

� Appropriate to more formally include CLS in 

pediatric pain teams 

Future Directions 

� Observational Research 

� What do CLS actually do in practice? 

� Is the comfort/reassurance CLS provide different than 

in the literature? 

� Research to assess future priorities as 

determined by CLS 

� Randomized Trials 

� e.g., therapeutic use of art/ play, medical play

Implications for Practice 

� Child life specialists are interested & 

motivated to learn more 

�? need for ongoing training opportunities 

for clinicians 

� Review of academic and internship training 

(MacLaren & Cohen, 2005) 

� training may be an effective method 

� implications for students and practicing prof. 

� some evidence for long-term effects 

Discussion 

� Multidisciplinary focus of pediatric pain 

management 

� Where are the boundaries? 

� Are there limits on what should be 

encouraged (e.g., CLS doing hypnosis?) 

� Are there positives to be gained? Are 

there negative consequences? 

�Questions? 

�Comments? 

Thank You! 

Implications for Practice 

� CLS use strategies that need further 

research to validate their use 

� Therapeutic play 

� Comforting and reassurance 

� Therapeutic use of art 

� Medical play 

� Positioning for comfort 

� Correlation between Certification and use 

of evidence based strategies 

Acknowledgments 

� Nancy Bandstra 

� Linda Skinner and the IWK Child Life staff 

� Dr. Christine Chambers 

� Pediatric Pain Experts 

� Marie-Claude Grégoire

The Role of Child Life in Pediatric Pain ... - Child Life Council

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