Child Life on Call Mobile Application

Children and families across the globe confront a wide variety of stressful and potentially traumatic events that may overwhelm their ability to cope. Some stressful events may include a chronic illness diagnosis, hospitalization, invasive medical procedure, or the death of a loved one. Parents may feel unsure of their ability to help their children to successfully understand and manage these experiences. Certified Child Life Specialists (CCLS) are trained professionals with expertise in helping children and families to understand their child’s illness, response to medical treatments, and support caregiving roles by promoting parent-child play sessions and sharing strategies for comforting or coaching their children (AAP, 2021). More broadly, CCLS collaborate with the entire interdisciplinary healthcare team to promote coping, enhance optimal development and well-being, and overall healthcare experience for children and families.

Research has shown that child life services are associated with improved quality, outcomes, and patient and family experiences (AAP, 2021). For example, an important element of a child life program is preparing children for surgery. A systematic review of preparation effectiveness concluded that children who were psychologically prepared for surgery experienced fewer negative symptoms than children who did not receive formal preparation (Koller, 2009). Some findings included a decrease in posttraumatic stress, lower levels of fear and anxiety, increased cooperative behaviors, and better long-term coping and adjustment to future medical experiences (Koller, 2009). Research has also evaluated child life programs, revealing that child life interventions resulted in less emotional distress, better overall coping during hospital stays, a better understanding of procedures, a more positive physical recovery, and enhanced posthospital adjustment for children (Wolfer, 1988). Overall, child life services and interventions have been documented to enhance children’s welfare during the challenging hospital experience. 

Unfortunately, CCLS services only see about one third of families that seek care in children’s hospitals due to a variety of reasons including non-clinical responsibilities, staffing issues, high patient ratios, little to no coverage on nights and weekends, and more. CCLS rarely provide services prior to a patient’s planned admission and never provide post-discharge support unless the patient is readmitted while a CCLS is on shift. This lack of access to child life services leaves many families left without all of the benefits that child life specialists provide. In addition, the profession lacks digital tools to support their efforts in the hospital and community setting to provide them with evidenced-based and on-demand resources, patient engagement tools which have the opportunity to make the CCLS more efficient at work. Furthermore, children with chronic illness like asthma or diabetes who would benefit from psychosocial support are never exposed to child life services if their treatment is managed by private practices.

We believe this gap in services can be mitigated with the implementation of the Child Life On Call (CLOC) mobile application for children and families in the hospital and community settings. This application was created over 2 years by CCLS with combined experience of over 50 years of clinical work, using evidence-based and trauma-informed resources designed specifically for parents to use as a resource, with the goal of helping parents to feel fully involved in their child’s care and empowered to make confident and informed decisions about their health. On this mobile application, parents have 24/7 access to learn specific ways to advocate for their child, coping plans to use with their child, guided meditations, and countless child life resources about ways to support children through challenging experiences. While we believe that a one-to-one support from a CCLS is still the most valuable resource, this mobile application can empower parents to continue confidently and competently supporting their child beyond hospitalization by providing access to a CCLS and invaluable resources and education specific to their child’s diagnosis and treatment.

The target population for this pilot project will be children and families who have received child life services in the hospital setting. These individuals will be provided information about the Child Life On Call application following their in-person services with a certified child life specialist (CCLS) in the hospital. This mobile application will allow CCLS to extend services beyond the short timeframe they are allotted with each patient due to high patient ratios and limited staffing.

We anticipate the use of the mobile application will help to empower parents to continue confidently and competently supporting their child beyond hospitalization by providing access to CCLS resources and education specific to their child’s diagnosis and treatment. Furthermore, we believe the equitable access of this application also provides a solution to underserved populations. 

Katie Taylor, the founder of Child Life on Call, spent over 2 years creating this application with the support of a team of CCLS with combined experience of over 50 years of clinical work. Additionally, application was developed by the use of evidence-based and trauma-informed resources designed specifically for parents to use as a resource, with the goal of helping parents to feel fully involved in their child’s care and empowered to make confident and informed decisions about their health. Prior to Katie devoting time to the development of the mobile application, she spent 10+ years as a certified child life specialist working in the hospital setting with children and families. It was also through these experiences that she developed an understanding of what services could be expanded upon to better serve the patients and families she was supporting.  

The rest of the team members, Katie Walker and Belinda Hammond, have experience as certified child life specialists working in hospital, in addition to, program evaluation research. These combination of skills will support the solution, as we hope to use systematic research endeavors to determine how and if the mobile application supports children and families beyond hospitalization.

This project is seeking financial support to better understand the outcomes associated with the implementation of the Child Life On Call mobile application in pediatric hospitals and community settings for parents of hospitalized children.

This project is seeking cultural and technical support. A barrier to the Child Life On Call mobile application is that it is only available in English and to reach underserved populations, translatable content is necessary.

Child Life on Call is the first mobile application created by a child life specialist to support children and families following in-person CCLS services in the hospital setting. This extension of services allows parents and children to continue receiving educational and therapeutic support that they may continue to need following hospitalization. We believe the implementation of this mobile application will enable CCLS to have a broader positive impact on the care team as well. 

Next Year Impact Goal:

Provide access to child life services through the Child Life On Call mobile application to 100% of families in 4 children’s hospitals in the United States.

In order to expand our ability to provide access to the Child Life on Call mobile application, we must provide evidence that the mobile application has a positive impact on children and families who use this service during and following their hospitalization experience. In order to determine the mobile applications impact, we will collect data from caregivers who have had an opportunity to use the mobile application during and following their child’s hospitalization.

Five Year Impact Goal:

Scale the Child Life On Call mobile app by 4 children’s hospitals each year reaching 20 hospitals by year 5. This will dramatically increase the access to vital healthcare education and support to families who seek medical care at a children’s hospital.

In order to expand the mobile application to other hospitals across the United States, we will utilize data from our research to publish in scholarly journal articles, present at conferences and hospitals, in addition to, continue advancing the mobile applications' content. We believe both continued research efforts to better understand the impact of the mobile application, in addition to, finding outlets to distribute information learned will allow for the growth of the mobile application to reach more children and families in hospitals across the United States. 

Currently, a pilot program has been launched at a hospital in the United States. We are actively collecting quantitative data from the certified child life specialists who are using the digital application in order to determine if the mobile application is making a positive and meaningful difference for the care team, and children and families who have access to it. With funding, we plan to perform more rigorous research methods to learn how this application is supporting children and families well-being, healthcare education, in addition to, potentially reducing inequity for underserved populations in healthcare. More specifically, we would like to collect data from the children and families who have had the opportunity to utilize the digital application during and following their hospitalization. 

With the implementation of this mobile application in pediatric hospitals across the United States, we hope to increase healthcare literacy, healthcare education accessibility, and child and family well-being during and following a hospitalization. Our target population for this mobile application is caregivers whose child has been hospitalized. We would like to collect qualitative and quantitative data during their child’s hospitalization, in addition to, following their child’s discharge from the hospital. More specifically, we would like to conduct interviews and collect survey data from the caregivers regarding their understanding of their medical experience, attitudes with their medical experience, and specific questions related to their experiences and changes following the use of the mobile application. We also believe other certified child life specialists and other healthcare professionals will be indirectly impacted by the implementation of the mobile application. Thus, we intend to collect survey data from this population to determine how the implementation of the mobile application influenced other individuals on the healthcare team.

Following the implementation of the mobile application, we believe the short-term outcomes will be related to increased healthcare literacy, healthcare support, knowledge, confidence, and well-being for caregivers whose child has been hospitalized. Long-term, we hope this mobile application will be accessible to all caregivers whose child has been hospitalized. Thus, hopefully mitigating the lack of resources and access to resources for underserved populations. Furthermore, we hope to continue building the mobile application to support children and families with different cultural and linguistic backgrounds. The continued expansion of this mobile application will allow for content that is culturally diverse, thus allowing us to best support all children and families who use it.

The core technology used as a solution in this project is the mobile application, Child Life on Call.

A portion of the team members are on faculty at Eastern Washington University in the Children's Studies department. Funds will be managed at the university level for the project.

As a white woman, I, Katie Taylor, recognize both my desire and obligation to provide equitable resources to all children and families in need, regardless of race, ethnicity, disability or any other cultural or physical characteristic. For this reason, the Child Life On Call mobile application has podcast episodes that directly tackle anti-racism in healthcare, and share stories from black and brown parents about how their healthcare experience is different from white people. The mobile application also consists of resources that promote conversations with children as it relates to race, racism, diversity and disability.

As a team, we also value the human-centered solutions that uphold the principles of diversity, equity, and inclusion. The mobile application was created as an inclusive technology that would allow for equity, fairness, and eliminate potential systematic barriers that marginalized groups may experience in the hospital setting. Aside from this work, Dr. Katie Walker and Dr. Belinda Hammond are child life faculty at Eastern Washington University. Last year we created and implemented a diversity course into our child life undergraduate and graduate academic curriculum. Additionally, Drs. Katie and Belinda are currently supporting HBCU and HSI universities develop child life academic programming at their institution. Although these are projects separate from this current proposal, these examples do demonstrate the action-based commitment these members have towards supporting diversity, equity, and inclusion.

CHILD LIFE ON CALL, LLC

Business Plan

March 28, 2022

Executive Summary

Child Life On Call, LLC (CLOC) is an online child life services platform for every child and family facing a health issue. It has pioneered a user-focused care model that leverages technology and education to empower parents and caregivers as they and their children cope with challenging life and medical experiences.

Certified Child Life Specialists (CCLS) who provide evidenced-based support are typically found in children’s hospital settings. These clinicians provide psychosocial support to educate and empower children and families facing acute and chronic healthcare experiences.

Children’s hospitals, providers and research studies have found that child life specialists are effective at reducing anxiety and promoting coping strategies. CCLS’ services lead to informed families enabling them to have more effective engagement with nursing staff and providers (Health Heroes) leading to improved patient satisfaction, increased patient engagement and reduced overall operational costs through reduced reliance on sedation and procedure delays caused by parent or child anxiety.

Today, Child Life Services are limited by the number of CCLS staff and their availability when a child or family is in the facility. Studies show that for most facilities using CCLS staff that the typical CCLS only sees 6-12 patients per 8-hour shift; typically, CCLS staff are used on day shifts primarily, with less coverage on weekends and night shifts.1 This CCLS to patient ratio leaves many children and families unseen and unsupported by Child Life Services. Finally, access to Child Life Services ends upon discharge from the hospital.

CLOC Goals and Solutions

There are limited tools to support the efficiency of CCLS’ work. Child Life On Call is the first platform that has developed solutions to tackle these challenges and expand Child Life Services to more families in and out of the hospital.

1. Expand Access to Child Life Services Virtually
   1. Child Life On Call has developed a mobile application (APP). A user-focused tool designed to leverage technology to serve and educate parents, children and clinicians. “Users” include parents and caregivers, children 6 and up, CLS staff and Health Heroes.
   2. The APP offers children and families “tele-health” services with Certified Child Life Specialists through a HIPAA-compliant communication platform, Twilio.
   3. The APP was successfully launched at Inova Children’s Hospital in Fairfax, Virginia in January 2022.
2. Improve CLS Staff Productivity and Touch More Patients
   1. The CLOC APP has digital tools for ready access to the CCLS. Instead of each CCLS spending time collecting resources in multiple places, the APP has resources embedded, so that the CCLS and the family will have those at their fingertips.
   2. The APP has links to evidence-based resources to help children and families cope with various conditions so that when the CCLS has consulted with the family, the family can review these resources at their convenience as often as they desire.
   3. By enabling the CCLS to educate and inform the family and leave them with the APP as a resource, the CCLS can meet and support 10-25% additional families. Further, the rest of the care team has access to the APP and can use it as a resource when child life is unavailable.
3. Leverage Community through Podcast and Social Media
   1. Parents feel isolated when their child is sick. Child Life On Call is a podcast that interviews parents of children with an illness or medical condition and gives them a safe place to share their experiences with each other and Health Heroes. The production of informative and community-building podcast episodes that engage parents in a conversation that enables them to share their journey in the treatment of their child’s care. As of March 2022, over 112 interviews have been published covering a wide range of health care diagnoses from infant heart disease, cancer and congenital anomalies, to more common conditions such as diabetes, respiratory illnesses and sickle cell disease. The podcast has over 100,000 downloads and has an active social media presence attracting over 6,000 cumulative loyal followers. Multiple undergraduate and graduate level academic programs and clinical training programs use the Child Life On Call podcast as part of their curriculum.2
4. Child Life On Call Professional Development Platform
   1.  Web-based continuing education to support CCLS pursuit of continuing education and re-certification. Modules are available for purchase in single or multiple modules as well as a monthly subscription.

Value Proposition

The Child Life On Call APP will radically change the patient experience and Child Life Services by being the first Child Life Services technology platform. The APP will enable child life services to reach more patients thereby reducing patient and family anxiety, increasing patient engagement scores and deepening patient loyalty (estimates are that fewer than 50% of children/families are engaged by CCLS on a daily basis). The APP provides tools directly to patients, parents and Health Heroes by providing a trove of resources for children and their families to better inform and support them, leading to better health outcomes.

With the goal in mind to expand and optimize this easy-to-use APP to support children and families during their health care journey, the APP will increase the number of pediatric patients who are exposed to Child Life Services, therefore increasing patient loyalty and engagement at a lower cost per contact. The CLOC APP will be first to market and, with over 46,000 lines of code, difficult to match for years ahead.

The Market

CCLS are employed in over 80% of children’s hospitals and many other large pediatric hospital units in urban areas, according to our experience and industry observers. Typically, the ‘reach’ of Child Life Services in a hospital is limited by the number of CCLS staff employed, the shifts worked and the hospital units to which they are assigned.

Child Life On Call is the first online platform of its kind. The platform includes educational and communication tools specifically designed to support Child Life Specialists, Health Heroes, families and children.

CCLS are considered an integral part of the multidisciplinary team and are designed for “patient support.” Due to this, their services are not billable and staff/department expenses are incorporated into hospital overhead, much like social work. As a result, the expansion of Child Life Services occurs only when the hospital can afford to expand the number of paid staff. For example, a hospital with 25 CCLS improves their patient contact by 4% (8 families per day) with one additional FTE; the CLOC APP will improve patient contact by 10-25% (20-50 families per day) at a cost 1-1.5 FTE.

There are approximately 250 children’s hospitals, including stand-alone, dedicated children’s hospitals as well as children’s hospitals that are incorporated into larger health systems serving both children and adults. CLOC believes that each of these institutions is a potential and likely user of the CLOC APP. The reach of the CLOC APP, however, does not end with children’s hospitals alone and has the ability to support any healthcare facility that serves children, including pediatrician private practices, outpatient clinics, surgery centers, urgent cares, NICUs and schools.

The CLOC APP

The APP was developed over 18 months with design and collaboration from eight child life specialists who have aggregate 50 years of experience in over 10 different children’s hospital settings. The APP presents four user experiences

• the parent user
• the child user (via the parent)
• the “health hero” user
• the CCLS user

The APP connects users to prepared resources and support organizations, offers education through on-demand videos and content, Child Life On Call podcast episodes, and virtual appointments with Certified Child Life Specialists.

With user-minded functionality at the forefront of the app, all resources are inventoried in an easily accessible library with keyword search function. The APP builds on the framework that parent-focused self-care is mandatory when acting as a caregiver, thus uniquely produced tools to help parents, kids and the health care team de-stress including guided breathing and meditation.

In an effort to encourage both the patient and parent to engage in their healthcare experience, the APP offers prompted journaling features, drag and drop “coping plans” for kids, features with thought provoking prompts and hospital specific maps, photos and engaging bios of the hospital’s Health Heroes, as hospitals desire.

Organization and Management

Child Life On Call, LLC is a two-member LLC including Katie Taylor, CCLS, Founder and CEO and Jim Donovan, MPH, Chief Strategy Officer (CSO).

The CLOC management team will consist of the following key positions, in addition to the CEO and CSO:

• Chief Operating Officer will oversee client/hospital partnerships, account management and implementations, and content creation and quality control.
  • Following the deployment of the fifth installation, regional leaders will be hired to provide sales and account management reporting to the COO.
• Director of Finance
• Director of Marketing
• Director of Accounts and Sales
• Director of Product Management (app, podcast, PDU platform)
• Director of IT

In addition, the Child Life On Call Advisory Panel will advise CLOC and review new content, deployment strategies and quality through quarterly reviews. Members of the Panel will represent a diverse and high caliber membership and will include:

• Academic Chair of Children’s Studies
  • Eastern Washington University Director Confirmed[1] 
• 1-2 Child Life Administrators from top children’s hospitals
• Pediatric Physician Entrepreneur
  • Pediatric Emergency Medicine Physician Confirmed
• 1-2 Parents who have experienced a challenging health care journey with a child[2] 
  • Sickle Cell Disease Parent Confirmed
  • Autism, ADHD Parent Confirmed
• 1-2 CEOs from adjacent community organizations/foundations
  • Childhood Cancer Organization Confirmed

Launch of the CLOC APP

The APP launched during Q4 2021 with a focused pilot to establish proof points for nationwide roll-out in 2022 and beyond. CLOC leadership is in discussions with large children’s hospitals in Texas, California and Virginia.

The pilot will initially support hospital staff as the APP’s most dynamic user with the ability to progress and engage additional hospital staff and patients/families during the final 30 days of the 90-day pilot. The pilot will measure:

• Ease of use by hospital staff
• Ability to offer Child Life Services to more patients per day
• Patient/family engagement through the APP
• Feedback from hospital staff and families
• Long-term benefits, such as reduced costs due to diminishing patient/family anxiety during pre- and post-hospital stay engagement and overall patient satisfaction metrics will be measured over time.

Sales Process

During the first year, contracts with hospitals will be driven by the CEO and CSO using both virtual and in-person meetings. It is expected that the sales cycle may vary depending upon other hospital priorities and the time from initial meeting until contractual agreement and launch will range from 3-12 months. During 2022, CLOC intends to contract with up to three hospitals in addition to the pilot site(s), and one-two contracts per quarter in 2023.

Beyond 2022, the Sales team will be expanded to include one CCLS and one sales professional, supported by the CEO, COO and CSO.

Risks and Challenges anticipated                                                           

Risks and Challenges : Results from Pilot as of 3/28/2022

CCLS staff find APP hard to use : Identified few issues and corrected with APP modifications and/or training

Hospital support staff adoption and use : RN use of hospital systems may impede adoption; we have deployed tablet based CLOC app at nurse stations as a successful resolution

Family engagement : Develop new user video and Chat functionality to support new users –TBD

Hospital budget issues : Develop data and sales tools that demonstrate cost-effectiveness – TBD

COVID pandemic constraints : Since APP is passive and encourages remote use, pandemic may encourage adoption – TBD 

Ease of download from app stores : APP is designed for iOS and Android; technical glitches have been minimal

Family adoption and use of the APP : Up to 25% use is anticipated during the hospital stay, 15% post discharge diminishing after 90 days  -- Parent pilot commencing in Q2

Pricing Strategy – preliminary

CLOC APP will be priced to align with the size of the facility serving children or other institutional users as well as whether certain features are included. These added features include virtual sessions made by CLOC CCLS employees on behalf of the hospital. The base contract will be $120,000 per year for mid-sized 150-200 bed children’s hospital.

Pro Forma and 5-year projections

2022

Hospitals: 3-4

APP Revenue: $150,000

Operating Costs: $200,000

Profit (Loss): $(50,000)

Staff (FTE): 3

2023

Hospitals: 7-9

APP Revenue: $450,000

Operating Costs: $450,000

Profit (Loss): $0

Staff (FTE): 5

2024

Hospitals: 12-15

APP Revenue: $1,200,000

Operating Costs: $1,200,000

Profit (Loss): $0

Staff (FTE): 19

2025

Hospitals: 18-22

APP Revenue: $2,000,000

Operating Costs: $1,600,000

Profit (Loss): $400,000

Staff (FTE): 14

Future Development Opportunities

• Partnering with Eastern Washington University to conduct Research on efficacy of virtual child life services
• Align with survey entity to expand post discharge engagement
• Expand to more rural and general hospitals that serve children but do not have CCLS staff
• Expand to outpatient pediatric practices
• Adding marketing partnerships with vendors seeking to reach pediatric patient families

Potential Threats and Opportunities

• HIPAA
• CERNER, EPIC etc interfaces
• Potential alliance with EPIC, CERNER, other EMR systems

Endnotes

1. Child Life Services Barbara Romito, Jennifer Jewell, Meredith Jackson, AAP COMMITTEE ON HOSPITAL CARE; ASSOCIATION OF CHILD LIFE PROFESSIONALS. Pediatrics Jan 2021, 147 (1) e2020040261; DOI: 10.1542/peds. 2020-040261
2. George Mason University, Eastern Washington University, University of Georgia, American University, Iowa State University, Texas State University, Arizona State University

The Child Life On Call app will be priced to align with the size of the facility serving children or other institutional users as well as whether certain features are included. These added features include virtual sessions made by CLOC CCLS employees on behalf of the hospital. The base contract will be $120,000 per year for mid-sized 150-200 bed children’s hospital.

The Child Life On Call app has raised $175,000 in a pre-seed round of funding, and secured 2-3 year contract with Inova Children’s Hospital post-pilot at a minimum payment of $8,000 per month.