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Q&A with Child Life Specialist Angela Franceschi

Angela Franceschi, Child Life specialist (CLS) started her career in Child Life 12 years ago at Children's Hospital Boston as an intern. After working as a temporary employee for over a year, Angela was hired as the CLS for a surgical/orthopedic unit and also provided coverage to the medical/surgical ICU. She spent seven years on these units before she decided it was time for a change. Three years ago she moved to Radiology where she works with children undergoing radiological procedures. In recent years, Children's has added additional Child Life specialists to the ambulatory programs. Read more to find out why they are critical pieces of the care team and how their responsibilities and experiences differ from the Child Life specialists on the inpatient units.

What made you want to pursue a career in Child Life?
I was going to school to be a teacher, but I took the advice of my college counselor and volunteered my entire summer at Children's as part of the Child Life department. I knew within the first week that this was the job I was destined to do.

As you learned more about Child Life, what made you stick with it?
The Child Life field is both diverse and unique. I work with patients in all age ranges, from infancy to the early 20s, and the severity of their illnesses varies. It can be dealing with the short-term recovery of a patient who just had minor surgery or the long-term challenges of a patient overcoming a significant debilitating injury.

Working with the family is also a huge component of the job; it's not just about the patients.

What is the best part about working with families?
It adds a whole different dimension. No one knows a child better than his or her parent, which is beneficial when helping a child through the hospital experience. Working with a family member also allows you to support another person through the process.

It's a privilege to be part of a family's life when they are going through a crisis and it's rewarding when you feel like you've helped or supported them.

What are your day-to-day responsibilities?
I am devoted to children undergoing voiding cystourethrograms (VCUG), a test that primarily tests children for urinary reflux, but also detects other urinary abnormalities. I work with eight to 12 patients and their families each morning. In the afternoon I am busy with Child Life and Radiology departmental responsibilities and spend a great deal of time on the phone. I call all families coming in for a VCUG prior to their test date. There are a lot of misconceptions about VCUG's, and because it is an invasive procedure parents are often anxious and have many questions. I am responsible for explaining the test to the parents, alleviating their fears and helping them with the appropriate language to explain the test to their child. The day of the VCUG, I prepare the child, ease anxiety and am present during the procedure to provide support and distraction techniques. A lot of hospitals sedate children undergoing the procedure, but our goal is to use no sedation. The technologists, radiologists and I work closely together to ensure success for all of our families. I also work along side physicians in training to help them learn age-appropriate practices.

Why do you think it's important for Radiology to have a CLS?
Within Radiology, children are exposed to a variety of tests and procedures and are often unfamiliar with what will be happening. This uncertainty can easily become fear and anxiety. Preparation is crucial ñ kids need to know what to expect. It's my job to help make each experience for a child and family a positive one.

What types of things do you do to help children through these procedures?
If a patient is scared, he may start crying or screaming, and this automatically gets the parent nervous because they assume something is painful. Coping and distraction techniques such as bubbles, playing DVDs or video games, reading books, singing and playing with interactive toys are all extremely helpful in engaging the child and taking his focus off the actual procedure. These techniques also help parents realize the child is crying because they are scared and anxious and not necessarily in pain.

How does working with outpatients differ from working with inpatients?
Play is the basis of Child Life, and most outpatient programs, including mine, don't have playrooms. I do however, still have the opportunity to incorporate play when preparing patients for their tests. Outpatient also differs in that you have the opportunity to meet a wide variety of patients each day. One of the most important things about my job ñ inpatient or outpatient - is showing someone you care about them, whether it is the patient or the parent, and although I have a shorter time to do that it, it can be done just as easily.

How do Child Life specialists work together?
Even though each of us has an expertise in a different area, based on the departments we work in, we are constantly collaborating. We do this through the patients we work with, the committees/organizations we serve on, the presentations we give, etc. Myra Fox, director of Child Life Services, has always made sure we develop mutually respectful relationships since each of us is a resource to another person on the team.

What would you consider a success?
Honestly, the best thing I can hear is thank you. It can come from a member of the team I work alongside or from a 2-year-old who cried and screamed through an entire procedure, but looked back and smiled as he walked out the door.

What are some of the biggest challenges for Child Life specialists?
It can be very chaotic and overwhelming. For inpatients, one minute you might be helping a sibling say goodbye to their brother or sister for the last time, and the next minute you might need to bring birthday balloons to another patient. Similarly, for outpatients in Radiology, you may have visibly upset parents with a newborn that has life-threatening problems and the next minute you have to switch to a lighter tone to help a bubbly 5-year-old through a procedure.

What's a little known fact about Child life specialists?
Not many people realize that 95 percent of our staff have master's degrees and a child life certification we have to keep up with, including renewing our professional development hours.

How do you think Child Life is unique at Children's?
Child Life specialists at Children's are integrated as an essential part of the care team and our work is valued and respected. We are fortunate to have one of the largest Child Life programs and it continues to grow. CLSs at Children's have the ability to work seamlessly with many different types of care providers and are exposed to countless learning opportunities.