Caring for Kids Emotional Wellbeing

Sala’s specialists partner with medical providers to reduce anxiety, fear, and pain that children may experience during care

When children experience chronic and complex health conditions, these young patients and their family members often grapple with depression, stress, or anxiety brought about by the challenging medical journey.

But there’s plenty of hope and help available. Thanks in large part to generous support from charitable donors, Sala Institute for Child and Family Centered Care offers many programs that wrap around each child and family member across Hassenfeld Children’s Hospital at NYU Langone to foster their emotional wellbeing and build resiliency.

To learn more about these efforts, Sala Institute E-News recently spoke with three leaders: Mary Pat Gallagher, MD, director of the Robert I. Grossman, MD, and Elisabeth J. Cohen, MD, Pediatric Diabetes Center; Becky Lois, PhD, co-director of the KiDS of NYU Foundation Integrated Behavioral Health Program, part of Sala Institute; and Chris Brown, director of Therapeutic Recreation, Child Life & Creative Arts Therapies, part of Sala Institute.

 

What is integrated behavioral health (IBH)? How does it help families?

Dr. Lois: IBH combines medical and behavioral health within one setting. When children and their families walk into a medical space and are asked about their physical and emotional wellbeing, it really helps to improve mental health access—and decrease mental health stigma—by presenting a holistic model of care aimed at normalizing conversations about the need for support as an essential part of medical care.

To start, we huddle with the care team to make sure that we really understand the whole picture of what's going on with each family and what the child's needs may be. Then we talk with the family directly about what's going on. We share how we work and our model of care, and the different ways that we can support them. Families come to experience their IBH and medical specialists as a unified team supporting their emotional and physical health, with both being equally important and interrelated.

 

What are some of the signs that you see when a child or family may benefit from resiliency-building programs like IBH?

Dr. Gallagher: To a certain extent, everyone benefits from behavioral health and resiliency supports. We proactively provide these services to all kids at the Pediatric Diabetes Center—but some families might have an increased need. Different tools help families identify these needs for themselves. For instance, in every interaction, we use a stress thermometer, which is a visual way that families and children tell us if they're in the green, calm zone, or if they’re feeling really stressed out: “in the red zone.” In addition, we have developed screening pathways with IBH to identify anxiety symptoms, depression symptoms, and suicidal thoughts or plans. When we do identify additional needs, we might ask for psychology, psychiatry, or social work to help us with those needs.

In the Pediatric Diabetes Center, needles and some uncomfortable procedures are common—and even those that are not too uncomfortable are very frightening to both children and families. Trying to help families cope with that is very important, and I don't know what we would do without our child life specialists.

Tell us more about how child life specialists contribute to emotional wellbeing.

Ms. Brown: Child life specialists are part of an interdisciplinary team. Along with our art therapists, music therapists, and drama therapists, we all share a common goal: To reduce the anxiety, fear, social isolation, and pain that are sometimes associated with healthcare.

We do that by providing positive experiences to counterbalance and counteract these common negative experiences. Those include using play, art, music, and education on various topics such as what is diabetes or what is an MRI. We support kids through medical procedures that they're awake for, and we have school teachers, artists-in-residence, and pet therapy dogs—favorites of staff and patients alike. There's really something for everyone, every age, every interest, and preference, and we try to match our services with what kids really want and need in that moment.

Therapy dogs are some of our most popular volunteers on Sala Institute’s Child Life team. These furry friends help reduce stress and bring a feeling of home into the hospital.

How do you decide what combination of child life services to provide to children and families?

Ms. Brown: We work very closely with the medical team, as well as the patient and family themselves, to do formal assessments. Our screening tool helps us identify which kids need some support in coping, but we really want to begin by hearing what families think they need, and we make sure they understand what's available.

So much of it is individualized. If we have a dog on site today, we find out if they like dogs before bringing a dog around. Some kids express themselves really well through art, or writing, or others through music. We try to match those services up in the way that will be the most useful. We huddle every morning to see how different patients are doing and compare notes on what’s working and what else we might offer, evaluating as we go. We constantly ask, is that the right approach? Are we getting the outcomes that the patient needs?

 

How does Sala Institute provide consistent support to children when they move from inpatient to outpatient settings and back again?

Dr. Lois: Knowing that many of our patients are constantly moving and shifting between outpatient care and inpatient care, we have staff embedded in these different settings. Over the past few years, we’ve designed our program to ensure close collaboration and communication between the teams to ensure coordinated care for these kids and their families.

For example, a wonderful 10-year-old girl was here for a longer period of time because she was awaiting a heart transplant. She ended up getting all of our services—from the therapy dog to lots of art therapy with her mom. Our multidisciplinary psychosocial team came together to meet all of her needs throughout the long hospitalization, then continued to follow her when she transitioned to outpatient care. This young patient knows her team and she’s engaged with the resources designed to support her. This really helps children and families not to feel siloed or like they are starting over when they transition between care venues. It takes an intentional plan with lots of communication and coordination behind the scenes, but it’s really improved and optimized the way we deliver care to families.

Charitable gifts of every size make Sala Institute’s programs possible. We invite you to learn more about how you can support initiatives that strengthen children and families’ emotional health.