Mimi Schultz’s detective name is Bubble 0-7. That’s because bubbles are her favorite work equipment. As a child life specialist, she turns kids’ toys into tools and medical procedures into child’s play.
In honor of Child Life Month in March, a display at Cook Children’s Hospital in Fort Worth asked “Where in the World is Child Life?,” a play on the 90s-era Carmen Sandiego game. Child life staff members each chose a detective name to accompany their photo and description in the display. The answer to the question for Schultz is the Cook Children’s Pediatric Specialties Clinic in Abilene.
Schultz, who has lived in Abilene for 20 years, is currently the area’s only child life specialist. Her role at the Abilene Cook Children’s clinic is to work with the psychosocial needs of children and adults in stressful or traumatic situations.
“I’m often called the ‘play lady,’” Schultz said. “Some might take offense to that, but I don’t because play is an integral part of the language of children. If I can use their language to create a better environment I’m happy to do that.”
Schultz began her career as a teacher in Louisville, Kentucky, but she didn’t enjoy being in the classroom setting. While volunteering at a local hospital, she met a child life specialist and realized that’s what she wanted to do. After an internship at Johns Hopkins Hospital, she took a job at Cincinnati Children’s Hospital and worked there for four years before moving to Abilene. She began working at the Cook Children’s clinic in 2008.
As a child life specialist in an outpatient clinic, her work is different than those in an inpatient setting at a hospital. Her hours are scheduled around when a doctor is in town having a clinic.
Schultz’s day begins by reviewing the list of patients for that day, doing a quick triage of the emotional and psychosocial needs that might accompany each patient, what procedures are scheduled, who is new to the clinic, who are the youngest patients developmentally, and then, based on those factors, determining who she needs to meet that day.
“I’m very fortunate here that I get to meet virtually every patient that comes to the clinic,” she said. “I wait with them in waiting room, and when they come back to the exam room, I go back first before nurses or physicians and try to prepare them for the visit. I tell them what will happen, ask if any of that is upsetting, use developmentally appropriate language and ask the parents if they have questions.”
Of course, some situations are more complicated than others, and Schultz tries to quickly identify what is needed for each patient and family.
“If I pick up on some psychosocial needs, sometimes I ask the parent, ‘By any chance did your child have vaccinations recently?’” Schultz said. “If a child has had their annual vaccine recently, they see a stethoscope, and it’s game over; they think they’re going to get another shot. So I try to set up an environment that is very different than primary care – through play, preparation and general education all the way around. Ultimately, my mission is to reduce stress or anxiety the whole family may be experiencing.”
As her choice of detective name reflects, bubbles are one of the most common tools in her stress-reduction kit. The spread of COVID-19 made bubble blowing by mouth too risky, so Schultz now uses battery operated bubble blowing apparatus, allowing her to lead a nervous patient back to the exam room via a bubble parade.
“I try to find out from parents what their child likes to play with,” Schultz said. “I can give them something to keep them occupied or play with them – inflatable balls or crayon markers to use on the exam table paper.”
Once back in the exam room, medical equipment and the usual office set up can feel intimidating to children, so Schultz finds way to change up their experience.
“Sometimes just the crunch of the paper on the exam table reminds them of a negative experience, so we can desensitize that by drawing on the exam paper or tearing it off and wadding it up and throwing it around,” she said.
Another tool of her trade is, well, actual medical tools. Schultz finds creative ways to demystify actual medical equipment.
“If I meet a two year old who has recently had an invasive procedure, I know we have a challenge,” Schultz said. “So I might bring in a doll or stuffed animal and a toy medical kit. I’ll have the child become familiar with the equipment in a non-threatening way. I give them control. They take my blood pressure and listen to my heart.Then I’ll introduce the real medical equipment, and they manipulate it and know what It looks like, so they have mastery over those things that in the past were quite frightening.”
The office environment and Schultz’s practices have, like most things, been affected by the coronavirus pandemic. She now wears personal protective equipment, including a mask and eyewear, which reduces her ability to use facial expression to connect with kids.
“Toddlers and preschoolers tend to be frightened of people in masks, so it’s hard to see how friendly people are because of the nonverbal communication that is lost. It’s made my job pretty challenging,” she said.
While the use of telemedicine has increased in recent months as providers seek to curb the spread of the virus, telemedicine was already a significant part of the Abilene Cook Children’s clinic to connect patients here with physicians in Fort Worth. The equipment allows for video conferencing and has medical equipment attached so that things like stethoscopes or otoscopes can be used in Abilene but viewed through a camera by a doctor in Fort Worth.
Schultz helps explain, normalize and even introduce an element of fun to such equipment for patients. But another part of her role is helping the general community understand what is available to them at the Abilene clinic and her role as a child life specialist.
“Should a primary care provider refer you to a pediatric specialist, there’s a possibility you don’t have to drive to Fort Worth for that,” Schultz said. “Some specialties have to have the initial visit in Fort Worth, but usually once that appointment has happened, then follow-ups can be done here. I encourage parents to ask if appointments can be scheduled at the clinic here; they don’t always have to take a whole day off work to drive out of town, and that can be really beneficial.”
The child life profession itself isn’t always fully understood, so Schultz finds opportunities to share about her passion and her career. She has also spoken to local groups to provide education about the work of a child life specialist and teaches a child life class at Abilene Christian University to students hoping to join the line of work. Sometimes there is educating to do even within the medical community.
“When I meet new staff who haven’t worked with a child life specialist, I always do a little education,” she said. “I tell them, ‘you may see me blowing bubbles or playing with dolls but what I’m doing is actually work.’ I’m fortunate to work with staff, nurses and physicians who understand how child life can help them. It does take some time, and in this day and age everyone is trying to get through as many appointments as they can, but they know their work will be more successful with a child life specialist involved.”
Becoming a child life specialist requires certain curriculum courses, one of which has to be taught by a certified child life specialist and includes certain curriculum. (Schultz sat on the committee to create those requirements and teaches a child life course in ACU’s Bachelor of Science in Child and Family Services program.) After completing curriculum requirements, it’s recommended that students complete a practicum for about 150 hours in order to help them obtain an internship, which is a 650- hour program. With the internship successfully completed, then applicants can sit for the child life certification exam.
“What’s most rewarding for me is when I play with a child in the room, so the physician can have the exam, and when it’s over the child cries because they don’t want to leave the doctor’s office,” Schultz said.
By Wendy Kilmer