Every child is different, and a phone call to assess ways to support a patient’s coping can be helpful in adapting care to the unique needs of a child. This phone call not only helps you assess patient needs, but it is a private conversation with a caregiver where you can be honest about what to expect and allows the caregiver to ask questions or express concerns that they might be hesitant to bring up in front of the child. During a preadmission phone call, you can begin to plan what resources you might want to have available such as noise-cancelling headphones or other sensory adaptations. This information can also be helpful when evaluating a census and determining priorities for the day.

Preparation lowers fear and anxiety when provided in a developmentally appropriate way and is considered an important element of any child life program (American Academy of Pediatrics, 2021; Official Documents of the Child Life Council, 2011). By calling the family prior to admission, child life specialists can provide some developmentally appropriate preparation before the patient ever arrives at the hospital. Jaaniste et al. (2007) found that children benefit from preparation that starts about a week before their hospital visit. Over multiple studies, Bray et al. (2019; 2021) found that both children and caregivers wanted more preparation and information but didn’t seek out the answers to their questions for a variety of reasons, including not knowing where to look or whether the information they found would be applicable to their experiences. A preparation phone call gives CCLSs a chance to provide caregivers and patients with the information they may need to begin preparing for an admission or outpatient procedure. The preparation phone call has also been associated with success in MRI non-sedate programs. Fraser et al. (2019) considered that phone call assessment as the essential first step in a child’s participation in the non-sedate MRI program, and Durand et al. (2015) found that the phone call from a CCLS provided a significant reduction in the need for anesthesia for MRI patients.

The pre-admission phone call is also helpful for patients with developmental delays and special needs. Parents and caregivers are the experts on their children, and Taghizadeh et al. (2015) considered it ideal to talk to the caregivers before any procedure. In a study looking at the role of child life specialists in supporting patients with autism, partnering with the family was an essential part of the care provided by these CCLSs, especially when it came to reaching out prior to admission to individualize the care that the patient would receive (Fraatz et al., 2021). Following the individualized plan created prior to a pre-op visit was found to decrease the need for sedation in over 60% of patients with autism (Swartz et al., 2017). When a phone call is made before visiting the hospital, the child life specialist can provide guidance about stressors and address environmental factors that might be adjusted to make the hospital visit easier (McGee, 2003). By calling ahead, the CCLS can have detailed information before the day of the patient’s visit to accurately prioritize patient needs.

PREPARING TO MAKE A PHONE CALL

The first step is to gather the relevant information that you need to make the call, including the patient’s name, age, any pertinent diagnoses, reason for their upcoming hospital encounter, and their legal guardian’s name and phone number. I sometimes find it helpful to write down how I will introduce myself and what I will share with the caregiver prior to calling the family. I typically focus on my role in the department that the patient will be visiting and why I’m calling. For example, if the patient is going to have an MRI, I would say I’m calling because my role is to provide MRI preparation. If I’m calling because the patient has autism and will be visiting an outpatient clinic, then I would say I’m calling to learn more about their child’s needs and discuss ways to make their hospital visit as easy as possible. As you make more and more phone calls, you’ll find you become more comfortable, and gradually you won’t need the script when you call. If I’m looking to gather information, I will often print out a form with blank areas to fill in during our conversation.

MAKING THE PHONE CALL

When you call and someone answers, the first thing to confirm is that you are speaking to the patient’s legal guardian. When they confirm this, you can share who you are and why you are calling. If it’s a preparation phone call, then offer to share preparation materials and encourage the caregiver to have conversations with their child about what will happen during their procedure or admission. By providing accurate information, you are empowering the caregiver. This is also a time to clarify common misconceptions, such as that MRI contrast won’t make the child feel warm all over like the contrast used for a CT scan or that having an MRI with contrast means the child will need to have an IV. For individualized plans for patients with a development delay or special needs, it can be helpful to discuss the child’s likes and dislikes. This will give you information about how to adapt the environment and other ways to support their coping. During the conversation, caregivers might ask things that you don’t know the answer to. That’s okay – the important thing is that you’re giving them a space to share and ask those questions. Just tell them you don’t know but that you’ll figure out who to talk to and find
answers. Write down their questions and follow up with appropriate staff to address these, either during the family visit or in another phone call.

AFTER THE PHONE CALL

After the phone call, make sure you document the conversation. A phone call is an encounter with the patient’s caregiver, and you’ve either shared information with the family or gained information from them that would be helpful for the rest of the team to know. It’s essential that you document relevant information to provide continuity of care for your patients. You will also be able to use much of the information gained when planning for future appointments.

POTENTIAL OBSTACLES

Nothing is exempt from obstacles and roadblocks, and making phone calls is no exception. One concern that other staff might bring up is that caregivers won’t want yet another phone call on top of the scheduling and reminder calls they already receive. In my experience, caregivers are typically very appreciative of my phone call when they realize that it’s different from the arrival time reminders. Swartz et al. (2017) found that caregivers really appreciated when staff recognized that their child was unique and wanted to provide individualized support to the child. Because child life specialists are trained in family-centered care, the child life phone call is often a chance for parents to ask questions they might not have otherwise mentioned or may have forgotten to ask on an earlier phone call.

But even if they want the call, families might not have time to talk. I always check when they first answer if they can talk at that time, and if not, I’ll inquire as to whether another time might be better. Sometimes email is easier for families, especially if you’re sending information, so this could be another option for the caregiver that doesn’t have time to talk. You can also shorten your information to what’s most relevant to the patient and family.

When you call, you won’t always reach the guardian. When you leave a voicemail, do not say the patient’s name as that is a HIPAA violation. I typically say I’m calling from the hospital name to speak with you about your child’s appointment, and then I briefly mention why I’m calling and how that’s different from other calls before leaving a call back number. If the family does not speak English, I would encourage utilizing your hospital’s interpreting services to reach out to these families.

As child life specialists, time is at a premium, so it’s natural for this to be a concern when considering adding phone calls to your to-do list. Depending on the nature of the call, it can be as quick as 10-15 minutes. Another helpful trick that I’ve found is calling a week in advance for the first call. This gives some wiggle room if you get busy with direct clinical work. It can be hard to prioritize a phone call when there is a patient on your unit needing support now, so planning can allow for you to make important prioritization decisions while also calling caregivers.

A preparation phone call can also shorten inperson preparation time later and potentially decrease the need for direct procedural support. Sometimes the phone call will give you a chance to assess whether a patient needs child life support or will cope well independently, freeing up your time to focus on another patient’s needs during their visit. By calling to assess a child’s coping and sensory preferences, you can also proactively adjust the environment and set the child up for success to avoid the need for future de-escalation.

It can feel overwhelming trying to figure out how to start the process of making phone calls and identifying what kind of information to obtain or discuss. But the content of the phone call is something you’re already trained to do; the only difference is that it’s on the phone instead of in person. You know how to assess patients and families and what kind of information you’re looking at during your assessment. You know how to prepare patients using developmentally appropriate terms. You know what kinds of questions to ask a caregiver prior to the procedure to make it as successful as possible. The phone call might be new to you, but the support you’re providing isn’t.

References

Bray, L., Appleton, V., & Sharpe, A. (2019). ‘If I knew what was going to happen, it wouldn’t worry me so much’: Children’s, parents’ and health professionals’ perspectives on information for children undergoing a procedure. Journal of Child Health Care, 23(4), 626–638. https://doi.org/10.1177/1367493519870654

Bray, L., Appleton, V., & Sharpe, A. (2021). ‘We should have been told what would happen’: Children’s and parents’ procedural knowledge levels and information seeking behaviours when coming to hospital for a planned procedure. Journal of Child Health Care, 26(1), 96–109. https://doi.org/10.1177/13674935211000929

Child Life Council. (2011). Official documents of the Child Life Council.

Durand, D. J., Young, M., Nagy, P., Tekes, A., & Huisman, T. A. (2015). Mandatory child life consultation and its impact on pediatric MRI workflow in an academic medical center. Journal of the American College of Radiology, 12(6), 594–598. https://doi.org/10.1016/j.jacr.2014.12.015

Fraatz, E., & Durand, T. M. (2021). Meeting the needs of children with autism spectrum disorder and their families in hospital settings: the perspectives of certified child life specialists and nurses. The Journal of Child Life: Psychosocial Theory and Practice, 2(2). https://doi.org/10.55591/001c.27703

Fraser, C., Gray, S. B., & Boles, J. (2019). Patient awake while scanned: program to reduce the need for anesthesia In pediatric MRI. Pediatric Nursing, 45(6), 283–288

Jaaniste, T., Hayes, B., & von Baeyer, C. L. (2007). Providing children with information about forthcoming medical procedures: A review and synthesis. Clinical Psychology: Science and Practice, 14(2), 124–143. https://doi.org/10.1111/j.1468-2850.2007.00072.x

McGee, K. (2003). The role of a child life specialist in a pediatric radiology department. Pediatric Radiology, 33(7), 467–474. https://doi.org/10.1007/s00247-003-0900-2

Romito, B., Jewell, J., Jackson, M., Ernst, K., Hill, V., Hsu, B., Lam, V., Mauro-Small, M., & Vinocur, C.(2021). Child life services. Pediatrics, 147(1). https://doi.org/10.1542/peds.2020-040261

Swartz, J. S., Amos, K. E., Brindas, M., Girling, L. G., & Ruth Graham, M. (2017). Benefits of an individualized perioperative plan for children with autism spectrum disorder. Pediatric Anesthesia, 27(8), 856–862. https://doi.org/10.1111/pan.13189

Taghizadeh, N., Davidson, A., Williams, K., & Story, D. (2015). Autism spectrum disorder (ASD) and its perioperative management. Pediatric Anesthesia, 25(11), 1076–1084. https://doi.org/10.1111/pan.12732

Turner, J. C., & Fralic, J. (2009). Making explicit the implicit: child life specialists talk about their assessment process. Child & Youth Care Forum, 38(1), 39–54. https://doi.org/10.1007/s10566-009-9066-x