Subject(s)
Exanthema , Infant, Premature, Diseases , Exanthema/etiology , Humans , Infant , Infant, Newborn , Infant, PrematureABSTRACT
BACKGROUND: Children undergoing procedures in pediatric health care facilities and their families have been shown to benefit from psychosocial services and interventions such as those provided by a Certified Child Life Specialist (CCLS). The comprehensive impact of a CCLS in a pediatric imaging department is well recognized anecdotally but has not been examined in a prospective or randomized controlled fashion. OBJECTIVE: We prospectively assessed the impact of a CCLS on parent satisfaction, staff satisfaction, child satisfaction, and parent and staff perceptions of child pain and distress in a pediatric imaging department. MATERIALS AND METHODS: Eligible children between 1 and 12 years of age (n = 137) presenting to the pediatric imaging department for an imaging procedure were randomly assigned to an intervention or control arm. Those assigned to the intervention received the comprehensive services of a CCLS. The control group received standard of care, which did not include any child life services. Quantitative measures of satisfaction and perception of child pain and distress were assessed by parents and staff using a written 5-point Likert scale questionnaire after the imaging procedure. Children 4 and older were asked to answer 3 questions on a 3-point scale. RESULTS: Statistically significant differences between the intervention and control groups were found in 19 out of 24 measures. Parents in the intervention group indicated higher satisfaction and a lower perception of their child's pain and distress. Staff in the intervention group indicated greater child cooperation and a lower perception of the child's pain and distress. Children in the intervention group indicated a better overall experience and less fear than those in the control group. CONCLUSION: Child life specialists have a quantifiably positive impact on the care of children in imaging departments. Measures of parent satisfaction, staff satisfaction, child satisfaction, child pain and child distress are shown to be positively impacted by the services of a CCLS. These results have significant implications for hospitals striving to increase satisfaction, decrease costs and improve quality of care. In a health care landscape that is changing quickly and increasingly focused on the cost of care, future research should assess whether the core tenants of the child life profession support and contribute quantifiably to high-quality, cost-effective practices in health care.
Subject(s)
Child Health Services/organization & administration , Child, Hospitalized/psychology , Diagnostic Imaging/psychology , Pain/prevention & control , Parents/psychology , Patient Satisfaction , Stress, Psychological/prevention & control , Child , Child, Preschool , Female , Humans , Infant , Male , New York , Pain/psychology , Pediatrics/organization & administration , Stress, Psychological/psychologyABSTRACT
OBJECTIVES: Both insecure attachment style and early maladaptive schemas have been associated with mental health difficulties. This study aimed to investigate how schemas relate to attachment style classification in mental health service users. A further aim was to investigate the nature of the relationship between psychological distress, common psychological difficulties, and attachment style. METHOD: Participants were 72 people in contact with mental health services who completed the short form of Young's schema questionnaire, a measure identifying their attachment style (experience of close relationships), and the clinical outcomes in routine evaluation (CORE; Evans et al., 1998) outcome measure. RESULTS: Overall, 81% of the participants had an insecure attachment style. The fearful group were the most distressed across several domains of the CORE, followed by the preoccupied group. Schemas differed significantly according to attachment style grouping, with the fearful group possessing the greatest degree of maladaptive schemas, followed by the preoccupied group. Discriminant function analysis identified differing patterns of schemas associated with attachment style. CONCLUSIONS: The results supported the relevance of both attachment style and maladaptive schemas to individuals with mental health difficulties. Importantly, several aspects of the individuals' symptoms and difficulties and their schemas were meaningfully related to their adult attachment style. Limitations included the small number of dismissing individuals identified, the problems of self-report in this area, and the absence of information about the quality of participants' current relationships.
