Child Life in Action

in a PICU Up!TMprogram with Kelsey Mora, CCLS, LPC

by Yvonne Kassimatis | June 30, 2020

Kelsey giving Dr. Sapna Kudchadkar, the developer of the PICU Up!^TM program, a tour of the play spaces that promote mobility.

"Illness does not mean stillness."

Kelsey Mora, CCLS, LPC, is the sole child life specialist, from a child life program of 14, assigned full time to the pediatric intensive care unit (PICU) at Advocate Children's Hospital in Park Ridge, Illinois.

Kelsey has been fortunate to have the opportunity to participate in the planning and implementation of the ground-breaking PICU Up!^TM program at the hospital. The PICU Up! program, which promotes early mobilization and rehabilitation for pediatric ICU patients was developed by Dr. Sapna Kudchadkar at the Johns Hopkins Children's Center. The basis of PICU Up! is "Illness does not mean stillness." Preliminary research at Johns Hopkins indicates that structured activity and mobility is safe, feasible, and may have benefits for short- and long-term outcomes of critically ill children.

Dr. Deanna Behrens, an attending physician, is the lead investigator for Advocate Children's Hospital's participation in the multicenter PICU Up! trial, and procured the grant that facilitated bringing equipment and resources to optimize successful implementation of the program. The teams involved in the implementation of the program include child life, creative arts therapies, physicians, nursing, respiratory therapy, physical/occupational/speech therapy, and research. "We are so proud of the culture change in our PICU while implementing PICU Up! It is a true interdisciplinary project, and one of the benefits has been strengthening the relationships between each discipline. Our Child Life and Creative Arts Therapies team members, championed by Kelsey Mora, have been critical members from the beginning. They have made art, composed songs, and created innovative material such as schedules and communicative devices that is integral to the success of the project. Additionally, the team actively involves the parents. They are truly an invaluable part of the team." - Deanna Behrens, MD

One of the criteria of PICU Up! is that occupational and physical therapy have to be consulted on a patient's third day in the PICU. Since implementing PICU Up!, child life has started to be consulted earlier in a patient's experience. Amazingly, sometimes the recovery phase is started even while the child is still in critical condition. The education and preparation may start while the patient is sedated and intubated.

The kids in the program are less sedated, more alert, and more interactive. They start to declare their preference for their level of sedation. They want to be awake, they want to be read to, they want to actively participate in their recovery. The kids are out of their cribs, playing on floor mats, going for walks - having mobility experiences. Patients in the program tend to get better so much faster. They extubate sooner, meet recovery goals earlier, and often don't need inpatient rehabilitation.

Kelsey has been instrumental in educating parents on the importance of creating mobility experiences as soon as possible. Most families have been excited by the program's success in reducing the use of sedatives, shortening sedation wean times, and having calmer kids with non-pharmacological interventions.

Once the pandemic started, room visits were limited due to PPE shortages. Give-away toys replaced re-use toys. Caregivers at bedside were limited to one. Volunteers were eliminated. Despite all these changes, the PICU Up!program continues to be successful.

As the pandemic rages on, Kelsey has started to see children with the inflammation symptoms of COVID-19. One young patient who was in very critical condition and who was a participant in the PICU Up! program, had a full recovery. She was able to go directly home without the need of inpatient rehabilitation. Watch the heart-warming video of her discharge from the pediatric unit as the child life team and other medical staff cheer her on. 4-year-old Amelia Goes Home

"We are so proud of the culture change in our PICU while implementing PICU Up! It is a true interdisciplinary project, and one of the benefits has been strengthening the relationships between each discipline. Our Child Life and Creative Arts Therapies team members, championed by Kelsey Mora, have been critical members from the beginning."

Team members representing child life, music therapy, physical therapy, speech therapy, and occupational therapy attended a presentation by Dr. Behrens and collaborated to implement the PICU Up! program.

Kelsey with Ryan, an occupational therapist on the PICU Up! implementation team.

Kelsey with two other child life specialists and a PICU physician who brings a holiday train annually to the unit. Several children were able to get out of their room and ride the train around the unit.

See more Child Life in Action.

Child Life in Action

in a PICU Up!TM program with Kelsey Mora, CCLS, LPC

Child Life Profession

in a PICU Up!TMprogram with Kelsey Mora, CCLS, LPC