Remain in your Scope

“She is asking again for you, Allie. The doctor has already seen her and she doesn’t need anything else for today, but she won’t leave until you two get to talk.”

As I entered the room, the 17 year-old patient’s mom quickly dismissed herself. “This is your time to talk. I will let you two have some privacy.” She clutched her pursed and hustled out the door.

This had become a frequent part of the patient’s visit: port access, blood count, physical exam, and then talk to me for a thirty minute “session” (as her family would refer to it) to process how she was feeling surrounding hair loss, peers, and school re-entry to name a few.

It was about the third or fourth “session” when I felt the need to clarify something to the patient and family: I am not a counselor. I am a Certified Child Life Specialist. And yes, I care about her and can help address the psychosocial aspects of the hospital and situations surrounding treatment, but I am not able to offer clinical counseling or therapy. I had begun to notice that my conversations with this teenage patient began to surround around deeper issues: self-esteem, anxiety, and feelings of depression. Furthermore, I had noticed that the patient became increasingly more dependent on me to “fix her” and to guide how she should handle these deeper issues.

I find that oftentimes with the teenage population especially, sometimes the role of child life and the role of counseling can look similar. Instead of the obvious child life service of distraction during a procedure, my time may be spent with a teen instead processing friendship dynamics that occurred over the weekend or being a listening ear as they vent frustrations of their parent’s hovering nature ever since they were diagnosed. Very quickly these conversations can look very close to counseling or therapy sessions.

“Our role as child life specialists is often to focus on the immediate task at hand”

Why is it so important for a child life specialist to remain in their scope of practice? For several reasons! Namely, imagine if you needed brain surgery and your family practice doctor nominated herself for the job!

• We remain in our scope to ensure the emotional safety and well-being of our patients and families. Since I am not trained in how to support patients or families facing an addiction or an abusive relationship, I could quickly mislead them in attempting to provide services. It is necessary to not put ourselves in a position where more harm can be done than good. (Side note: some child life specialists do have certain trainings like disaster relief, for example, that they can offer in addition to their child life trainings during those specific and unique needs as a way to still remain in their scope).
• We remain in our scope to maintain the integrity of our profession. The ACLP highlights the role of a child life specialist in their mission, vision and values, and we must stay true to that and to the certification we have received.
• We remain in our scope as one of the many parts that can care and support patients and families. When in doubt, refer them to other trained professionals who can also support the patient and family throughout their injury, illness or treatment. Child life specialists are not (hopefully!) the only trained professionals who can provide psychosocial care.

So what are some of the red flags? How do we know when we have crossed over the boundary from CCLS to counselor or to even social worker?

For me personally, I try to consider the following to help me discern if I am remaining in my scope of practice:

–Red Flag #1- the topics of conversation. Are the emotional needs expressed related to the healthcare setting and medical experience (the ACLP defines the mission of child life services as supporting the needs related to “illness, injury or treatment.”)

–Red Flag #2- the frequency of visits. Is the patient and family relying on the child life specialist to provide frequent “emotional support sessions”? Has this reliance become an unhealthy dependability on child life? Our goal should be to empower the patient and family in their coping to the point where they don’t need child life every single visit and feel the confidence and possess the tools to cope on their own.

–Red Flag #3- the mental health of the patient. Of course child life specialists can provide services to the young adolescent who just presented to the ER for suicidal ideation. And of course child life specialists should never shy away from working with a patient for his IV start even if he has severe bipolar disorder. However, as soon as a mental health condition is expressed, that is a great reminder to make sure additional trained mental health professionals are involved to support the patient in more in-depth psychosocial ways. Our role as child life specialists in these scenarios is often to focus on the immediate task at hand rather than dissecting their mental health condition.

What other red flags do you have that help keep you in your scope? And I will conclude with this final question…