Janis Yoshikawa is a senior Child Life specialist and art therapist at Children’s Hospital & Research Center Oakland. Her work illustrates the difference an independent children’s hospital can make in a child’s healing process.
Janis understands that play is more than mere distraction for kids. It’s also a means of expression, and Janis knows how to use it to help children get better.
In the following interview, Janis explains what she does and how it helps kids get through some challenging times.
Q: Tell us what you do here at Children’s.
A: I help children cope with medical procedures and emotional upset. I became very interested in looking at the concept of play, and what it means to children in terms of symbolic communication. Children really can show you an experience of what it’s like to live in their world. Because children are not equipped to verbalize their feelings they use more nonverbal communication to express themselves, often through play.
With the medical play we provide, children experience a sense of mastery by sometimes reenacting the procedural event. As we help or guide that process along, we also listen for their misperceptions, for what they’re thinking and feeling.
Q: Can you give me an example of how you helped a child prepare for a procedure by using medical play?
A: One example is an 8-year-old, an outpatient. He was very afraid of the MRI machine. Apparently at the age of 2 or 3 he had very unpleasant experiences (with an MRI) at another facility. He said the two things that scared him the most were the noise and having to lie perfectly still. He was also fearful about the magnets breaking out of the machine.
I talked about the procedure with him, and told him the machine wasn’t going to touch him, that the magnets were not going to hurt him or break out of the machine.
With the help of my husband, I constructed a model MRI. I went to Home Depot and we got these fluorescent lamp covers as part of what covers him, and I went to Kentucky Fried Chicken and got buckets and I made a miniature (MRI). And we could fit a doll in it.
Q: He was able to reenact the process of getting in the MRI by placing a doll in (the model) you and your husband built?
A: Right. I went to the MRI facility and had them tape-record the sound; it’s a very loud noise, it has this thumping sound, and a jackhammer sound. It was also important for him to get familiar with the sound of the machine.
He would take the doll and put it into the machine and he would practice, with the sound from the tape recording. It helped him develop a sense of rehearsal over the fears of the event, which was very, very important for him. And it provided a level of control as well as a sense of mastery over something he’d really been afraid of since he was 2 or 3 years old.
Later I got an unexpected phone call at work and the boy said, “You know what, Janis, I really did well with the procedure.” And he was so proud.
I think a lot of healing is also making caring visible; it’s not about the information, it’s about the trust and the relationship you have with the patient and their family.
Q: Going back to a point that you made earlier, could you give us an example of how you were able to help a child coping and healing using nonverbal techniques?
A: There was a 3- or 4-year-old Laotian boy who got hit by a car. He sustained a fracture of his left leg. He was referred to Child Life because his mother reported he was having one or two nightmares a night. He was also sleeping more with his mother, and he was very fearful; every time he saw a car coming, he would cling to his mother. The mother spoke English, but he didn’t understand much English. I really had to rely more on my ability to nonverbally communicate with him. By the fifth session I decided to bring out some toy cars and a hospital and an ambulance, and I also brought out this town carpet that you can put the cars on. It has streets and things like this.
So, not surprisingly, he reenacted the accident, knocking down the Lego people, they were being knocked down several times. I thought he would use the ambulance to take these little people back into the hospital.
I was observing this and I also had construction paper and pens and pencils and things, so I decided to model the concept of a stop sign. I took a tongue depressor and made a little red circle, taped it onto the tongue depressor and modeled the whole idea of how the car should have stopped.
Well, he took such interest that he made multiple stop signs.
But what was so amazing was that he took the stop sign and took charge of the play. As an oncoming car came along he would take that stop sign and say the word stop to all the oncoming play cars.
He really began to realize that the car that struck him should have stopped. This was an important breakthrough. Later I learned that the intervention helped reduce his nightmares. I’m not sure of the exact time, but eventually all of his nightmares were gone and his mother reported that he was not exhibiting any fears of crossing the street anymore.