International Journal of Science Annals, Vol. 4, No. 1, 2021 рrint ISSN: 2617-2682; online ISSN: 2707-3637; DOI:10.26697/ijsa LETTER TO THE EDITOR The Play Specialist in the Pediatric Healthcare: Evidence-Based Professionalism, Issues in Practice, and Training Across Different Countries Perasso G.1,2 1 University of Milano-Bicocca, Italy 2 Il Porto dei Piccoli Onlus, Italy Received: 25.03.2021; Accepted: 01.06.2021; Published: 30.06.2021 Keywords: Play, hospital, children, play specialist, training Copyright: © 2021 Perasso G. Published by Archives of International Journal of Science Annals DOI and UDC DOI https://doi.org/10.26697/ijsa.2021.1.7 UDC 159.9:615.851.8 Conflict of interests: The author declares that there is no conflict of interests Peer review: Double-blind review Source of support: This study did not receive any outside funding or support Information about Perasso Giulia – https://orcid.org/0000-0003-3265-3869; the author: ricerche@ilportodeipiccoli.org; Doctor of Philosophy in Psychology, Neuroscience, Data Science, Department of Psychology, University of Milano- Bicocca, Milan, Italy; Research Consultant, Porto dei Piccoli Onlus, Genoa, Italy. Dear Editor, For developmental psychologists, playing is a crucial “recreational therapist”. Nowadays, there is a great parameter to monitor children and adolescents’ physical, terminological fragmentation in describing all the emotional, cognitive, and executive development and professionals trained to support children during wellbeing. In the psychotherapy setting, play is a hospitalization through age-specific and diagnosis- promotor of positive therapeutic change because it allows specific play programs. Different countries adopt the child to express beliefs, memories, wishes, feelings, different labels to describe this role, which can be defined and subconscious contents, from a safe and indirect point by the keyword “Play Specialist” (Porto dei Piccoli, of view. Play is a fundamental human right during the 2021). Play Specialist intervention differs from Play whole life cycle, and it becomes even more important for Therapy because Play Therapy is a projective technique those children and adolescents who are hospitalized or practiced by psychotherapists in the light of a experiencing medical treatments at home (European psychoanalytical framework. Play Specialist’s Association for Children in Hospital, 1988). Entering a intervention, instead, can be summarized into two core- medical setting can elicit children’s and adolescents’ actions (Burns-Nader & Hernandez-Reif, 2014): distress on many levels (e.g., anxiety, depression, 1) medical play: using medical equipment and language hypochondria, acting out, externalizing, and internalizing to help the child to get used and not fear the medical problems) since their familiar routine is temporarily setting and procedures; 2) normative play: proposing disrupted. play activities to the child that are similar to play In the 1920s the nurses Florence Nightingale and activities he or she practices at home. This establishes a Florence Erikson were the first to intuit the power of play sense of continuity with the life before illness, and/or for hospitalized children: the pediatric patients who could offers distractions and imaginary escapes from reality. experience play sessions with a properly trained Noticeably, the Play Specialist can also offer to children professional were more adherent towards medical with chronic conditions (e.g., diabetes or disabilities) treatments (Francischinelli et al., 2012). Play can make experiential activities outside of the children’s comfort- the hospital experience enjoyable, or at least less zone, to increase their health-related responsibility and terrifying for the youngsters. Back then, many synonyms self-efficacy. were used to describe this role like “play-lady”, “puppet The aim of the study. To foster scientific community lady”, “play checkers”, “playing teacher”, and consideration about the Play Specialist role, paying 45 International Journal of Science Annals, Vol. 4, No. 1, 2021 рrint ISSN: 2617-2682; online ISSN: 2707-3637; DOI:10.26697/ijsa attention to the state of the art, the international field of overlapping with other professionals’ interventions like practice, the evidence supporting the effectiveness of the educational video gaming, pet therapy, art therapy; Play Specialist intervention, the main challenges, and the 3) Lack of recognition at a national and international everyday issue that these professionals have to face to level hinders the integration of the Play Specialist with gain proper integration in the national and international the hospital staff (Metzger et al., 2013). Frequently, healthcare system. doctors and nurses may exchange Play Specialists for This contribution presents two main elements: a literature volunteers or may improvise play activities for their review and a small-group survey. A review of the patients without having the proper training; literature (on a total of n=613 papers from Pubmed, 4) Lack of funds from national institutions represent Scopus, PsycArticles) has been conducted to describe the another crucial challenge for promoting the Play Play Specialist professionalism and the difficulties in the Specialist as no-profit private institutions often support practice. Moreover, the core elements of the training this professionalism (Simonelli et al., 2014); across different nations in terms of the prerequisites, the 5) Difficulties in accessing the hospitals for Play duration of the training, the institutions promoting or Specialist during Covid-19 waves emerged. To respond certifying the training, and the study subjects are to the global crises without letting down families and discussed from an inclusive perspective. Thus, data from children, pioneering telematic adaptations of the Play n=9 international experts in the field are examined to Specialist intervention have been developed (Perasso et describe the state of the art over the Play Specialist’s al., 2020). training. Experts offer a detailed picture of the Play Specialist Literature offers a vast body of evidence supporting the formation at an international level. Data collected from Play Specialist’s intervention effectiveness in fostering the nine participants to Porto dei Piccoli’s international the hospitalized child’s wellbeing. Round Table (January 2021), reveal salient elements in Five key elements emerged: the Play Specialist formation. 1. The Play Specialist intervention improves the child’s Across different countries, heterogeneities and coping strategies, her/his positive emotions, and commonalities emerge: decreases anxiety and stress that may anticipate medical - the prerequisite of the training (e.g., a bachelor’s degree procedures (Gill, 2010; Ullan & Belver, 2019). in psychology or pedagogy) is required all over the 2. Children require less sedation for pain management: world; with the Play Specialist intervention, the child is more - the duration of the formation varies from courses of 200 capable of pain management at a behavioral, physical, hours to courses of 760 hours; cognitive, and complementary level (Bandstra et al., - considering the subjects of the Play Specialists’ study, 2008). the countries’ referents agree about offering formation on 3. The child is more adherent to the medical treatment: the child developmental milestones on a pediatric, since play intervention decreases negative emotions (e.g., psychological, pedagogical level, play-techniques, anxiety, stress, externalizing behaviors) the child is more family psychology, attachment psychology; collaborative towards medical staff (Gill, 2010). Once - as regards achieving a certification at the end of the achieved through medical play a major knowledge over training, a few countries still struggle to obtain her/his health and the healing process, the child institutional recognition for Play Specialists and proper experiences less power imbalance from the adults taking certification procedures. In fact, institutional certification care of her/him (e.g., family members, medical staff) is fundamental in providing evidence-based interventions (Bricher, 2000). and obtaining acknowledgment in the hospital context. 4. Play can be crucial in palliative care: through targeted The Play Specialist’s professionalism is essential to play activities the Play Specialist can help the child to advocate children’s right to play in the hospital context face and elaborate emotions connected to end-of-life and to promote her/his wellbeing by fostering coping, concepts (Lindqvist, 1974). treatment adherence, and counteracting negative 5. Time and economic savings for the hospitals: as emotions. Still, cross-countries differences at an supported by Metzger et al. (2013), the Play Specialist educational and institutional recognition level hinder the enhances patients’ compliance, requiring less anesthesia possibility to integrate the Play Specialists in national and for invasive medical procedures. This aspect is important international healthcare systems. For the future, the to spare sedation costs to the hospital, and also to spare exchange of best practice and research evidence among children from anesthesia and its potential collateral no-profit organizations, and public and private healthcare effects. stakeholders is vividly recommended to build a common Literature depicts the main challenges that the Play ground and finally overcome fragmentation. Specialists have to face all over the world. Five main domains emerge: References 1) Lack of standardized methods and measures to support Bandstra, N. F., Skinner, L., Leblanc, C., the practice (Goh et al., 2019) has hindered for a very Chambers, C. T., Hollon, E. C., Brennan, D., & long-time the possibility to create a common ground; Beaver, C. (2008). The role of child life in 2) Practice fragmentation across different countries arise pediatric pain management: A survey of child life problems in the practice as the core activities are often specialists. 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International Journal of Science Annals, 4(1), 45–47. https://doi.org/10.26697/ijsa.2021.1.7 The electronic version of this article is complete. It can be found online in the IJSA Archive https://ijsa.culturehealth.org/en/arhiv and in the KRPOCH Publishing Repository https://ekrpoch.culturehealth.org/handle/lib/71 This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (http://creativecommons.org/licenses/by/4.0/deed.en). 47