How a children’s hospital set up an on-campus daycare in 72 hours during COVID-19

Rocking babies to sleep, logging kids onto Zoom school lessons, and coloring with preschoolers – these activities were all in a day’s work for CHOC Children’s child life team as they ran a pop-up on-campus daycare center for children of hospital staff during the COVID-19 emergency this spring.

“It brought me back to my early days as a parent,” says Amber Chavez, a special programs coordinator for the Cherese Mari Laulhere Child Life Department.

That the child life department could ultimately be tasked with setting up on-campus childcare for hospital staff in the event of a large-scale disaster or crisis was well-known among the team. They had long planned for that possibility, stocking up bins of activities and supplies carefully marked by age group – just in case.

So, when schools in Orange County, Calif., began closing on-campus instruction in mid-March, the team sprang into action immediately.

A survey conducted through CHOC’s emergency communication system revealed that nearly 600 staff and physicians did not have backup childcare. Then, the child life team, in collaboration with executive leadership and other departments, scurried over the weekend to establish an on-campus daycare for physicians and staff who directly support patient care and throughput and had no other childcare options.

A child life specialist sits with two children enrolled in CHOC's on-campus daycare for staff.
Child Life Specialist Peggy Mok with a CHOC staff member’s child

Just in time

Within 72 hours of receiving notices of school campus closures, the center had an emergency operating license, and was open and available in a conference center of the main hospital campus.

In addition to a robust programming schedule, the compound featured a space for naps, a play area, computer stations for school-aged children, a diaper-changing area, and anything that could possibly be needed to care for children of a wide age range while their parents worked in the hospital.

“CHOC providing these services was heaven-sent,” says Dr. Sonia Morales, a hematology/oncology fellow who enrolled her daughter. “It made a very stressful time less stressful. There is no greater feeling than having your child squeal with excitement when she’s being dropped off.”

The team quickly established a schedule and routine – and support from many other hospital departments was critical.

Older children would get checked-in, their backpacks placed in a cubby and any upcoming Zoom class appointments set as an alarm on a phone. After enjoying breakfast provided by food services, the children could play video games for a bit sometimes – to their delight – broadcast on the center’s large screen. A team of CHOC physical therapists would come by twice daily to lead the kids of all ages through activities and movement exercises.

“We tried our best to support the kids through this difficult time as well,” says Eric Mammen, the child life department’s creative arts supervisor, who helped develop the daycare’s schedule and oversee day-to-day operations. “We also helped with homework when needed and I had to learn how to do elementary math and English again. I admit I had to use Google a few times helping the kids with their homework.”

CHOC's conference center is transformed into an on-campus daycare center
The conference center at CHOC Children’s Hospital converted into a daycare center

A true collaboration

The project was truly a collaboration between many departments across the health system, including environmental services, food services, legal services, patient care services, human resources, information systems, plant operations, regulatory, safety and security, and volunteer services.

And the result was a daycare center that provided wonderful care, structure and fun – not to mention peace of mind for many CHOC working parents who could rest assured their children were safe and happy while they supported patients. 

Little Diego Valencia had never been in daycare before he came to CHOC’s center, says his mother, Jamie, a nurse in the recovery center.

“He will remember all of them forever,” she says. “Without child life’s kind hearts, I would not have been able to work. It was easy to leave Diego in their care because they took such good care of him.”

Being able to check on and nurse her young daughter has been a relief for Dr. Bhavita Patel, a hematology/oncology fellow.

“I cannot say enough about the phenomenal child life staff taking care of our children,” she says. “Bless them for their diligence and flexibility during this time. It takes a village, and they have quickly become a crucial part of mine. My anxiety and overall mental health have improved drastically as a result.”

A child life specialist sits with two children enrolled in CHOC's on-campus daycare for staff.
Special Programs Coordinator Amber Chavez and two young charges

An exercise in agility

Running the center was also an exercise in agility for the child life department, requiring the team to quickly adapt and make changes to meet evolving needs.

The compound’s layout and schedules were adjusted occasionally when needed. Child life specialists made quick dashes to a nearby drug store for nightlights after noticing the windowless conference center was too dark for little ones to nap without fear. Plant operations were called in after realizing an overhead page could thwart a half hour’s work to rock a baby to sleep.

While already a close-knit team, the child life team grew more bonded after the experience.

“It wasn’t easy, but we grew stronger as a department and team,” Amber says. “We lifted each other up when times were tough, and we laughed in times of need.”

Earlier this month, the center’s operations transitioned to a national childcare chain. And though the child life team has transitioned back to their more typical work, the team might be feeling a touch of separation anxiety.

“The child life staff bonded with the children and they looked forward to seeing everyone,” Eric says. “I think it is safe to say that we will all look at the Wade Center a little differently now.”

Learn more about the CHOC Children’s Cherese Mari Laulhere Child Life Department.

Music therapy in a mental health setting

Music therapy has been part of CHOC Children’s specialized therapeutic programming for more than 10 years. The program has grown recently, due to increased awareness of its effectiveness and a rising need among CHOC patients. We sat down with Kevin Budd, a board-certified music therapist in CHOC’s Mental Health Inpatient Center, to discuss the benefits of music therapy in an inpatient psychiatric setting.

Q: What comprises music therapy as a practice?


A: Music therapy is the clinical, evidence-based use of musical interventions to accomplish individualized goals. This occurs within a therapeutic relationship between a credentialed professional who has completed an approved music therapy program and a patient. During music therapy, we address physical, psychological, cognitive and/or social functioning challenges for patients of all ages. Essentially, music is the tool that helps support a patient’s non-musical need.

Q: How does music therapy support clinical goals?

A: A patient’s clinical goal is the starting point for determining which musical intervention will be most effective. In the Center, these goals could include: mood regulation, self-expression, self-esteem, anxiety, interpersonal effectiveness, treatment motivation, positive coping skills and others. There’s no one-size-fits-all treatment when it comes to music therapy and mental health. We might work towards a patient’s goals several different ways, such as through focused music listening, songwriting, song discussion, group instrument playing, music and relaxation, singing and more.

Music therapists rely on assessment, treatment planning and evaluation to determine whether a patient’s current music therapy methods are meeting their needs. Without treatment goals, there could be no effective music therapy.

Q: What is an example of using music therapy to address a clinical goal?


A: If a patient’s clinical goal is to increase identification of positive coping skills, we might work on lyric analysis within the patient’s preferred style of song. We could discuss triggers, resilience and negative life situations in the song. After this discussion, we could rewrite the chorus of the song, including identification of a negative situation and a positive coping skill to help address it. The patients can then be encouraged to share what they created—by singing, spoken word or other creative means.

Within this exercise, not only has the patient used a creative medium to identify a negative situation and how to cope with it; they have also built confidence after completing and sharing their creation, felt more connected with others in the group by being vulnerable and feeling validated, improved their mood and increased their treatment motivation.

Q: What kind of impact have you seen in mental health patients who have participated in music therapy?


A: Sometimes it’s hard for patients to verbalize past trauma or express their struggles. But with music therapy, they can discuss a song that relates to their current situation—whether it is bullying, family problems, hopelessness, anxiety or another stressor. During this process, patients may be able to process and verbalize more, since the lyrics are an easier gateway for expression.

During group ukulele playing, patients who have difficulty with interpersonal relationships can cohesively and successfully play music together in a positive, supportive space without the need to talk. They can work on distress tolerance and problem-solving skills while persevering through a challenging task—and by the end, they have improved self-esteem.

In any setting, music instantly affects our bodies—mentally, physically and behaviorally. It’s amazing how one musical intervention can address multiple goals.

Q: What is unique about music therapy in an inpatient psychiatric facility?


A: Music therapy can look different in the inpatient psychiatric setting than in other areas of the hospital. Within the Center, goals for music therapy are focused on combatting the reasons why a patient is admitted—these could include suicidal ideation, depression, anxiety or other factors keeping a patient from participating in a healthy way in daily life. The goal of the MHIC is to stabilize these patients and provide them with as many resources as possible to cope with their mental health challenges.

Music therapy does just that and provides opportunities for patients to learn, process, practice and discover new skills through tailored music interventions. The MHIC offers opportunities for a diverse group of kids and teens to express themselves in a supportive, safe and validating environment. Individual music therapy sessions are available to patients in the Center who need additional one-on-one support to complement their other treatment.

Q: Why did you want to become a music therapist? Why a mental health setting specifically?


A: I’ve gone through my own mental health challenges throughout my life, and I always found that music validated my journey. Music helped me distract myself and process my feelings. Music met me where I was in the moment and gave me hope. It also gave me a platform to express myself in ways I didn’t know how to otherwise.

When considering career paths, I wanted to find a way to harness the role music had played in my life in a therapeutic way. After receiving my undergraduate degree in music, I developed a special interest where psychology and music intersect—the space where music therapy truly breathes. I pursued my graduate degree in music therapy and then became a board-certified music therapist.

I feel humbled and fulfilled to be able to support kids and teens at CHOC with the tool of music. By creating an authentic therapeutic alliance, I can support them through a harsh and challenging time in their lives. I am thrilled to be on the front lines of the music therapy program at CHOC Children’s, and I look forward to supporting its growth and success in treating pediatric patients.

Learn about Specialized Therapeutic Programs at CHOC

CHOC Children’s Photograph Selected for National Photo Exhibit Showcasing the Work of Children’s Hospitals

A photograph depicting a young patient in CHOC Children’s neonatal intensive care unit (NICU) participating in a music therapy session has earned a spot in a national photo exhibit showcasing how children’s hospitals help kids thrive.

The biennial Children’s Hospitals Photo Exhibit, the result of a national competition administered by the Children’s Hospital Association (CHA), curates 50 photographs selected by a panel of distinguished judges including renowned photographer and author Anne Geddes.

CHOC’s winning photo in the Children’s Hospitals Photo Exhibit administered by the Children’s Hospital Association (CHA)

In CHOC’s winning photo illustrates the power of music therapy, which helped the patient, Olivia, manage pain, self-soothe and express herself. Olivia, who spent the first seven months of her life in the NICU, became more relaxed every time she worked with CHOC music therapist Brie Mattioli.

“Music promotes a sense of positivity, peace and normalcy in the room,” Brie says. “It wasn’t the nursery [her parents] planned to bring their baby home to, but it provides a sense of normalcy to families.”

The exhibit of 50 winning photographs was curated by a panel of distinguished judges including renowned photographer and author Anne Geddes. Showcasing the ways children’s hospitals help all children thrive, the online exhibit includes stories behind the photos, allowing viewers to read first-hand accounts from patients, parents, doctors and other healthcare providers.

Tamara Wroclawsky’s photograph was chosen from more than 370 images submitted by nearly 60 children’s hospitals across the country.

Joining Geddes on the judging panel were Sandy Adams, photo journalist and officer, The Exposure Group; Lily Francesca Alt, photo director, PARENTS magazine; Lori Epstein, photo director, National Geographic Kids Books; and Eric Gapsch, graphic designer, CHA.

View the online exhibit at www.childrenshospitals.org/photos.

5 Tips on Connecting with Your Pediatric Patients

In recognition of Child Life Month, we are highlighting the Cherese Mari Laulhere Child Life Department at CHOC Children’s, a critical partner to physicians and an essential part of the multidisciplinary team at CHOC ensuring the continuity of care.

We spoke to Brianne Ortiz, child life clinical educator, who shared the following ways in which physicians can better connect with their patients:

  1. Greet the patient first and let them know they are important to you. It’s natural to address the caregiver first, but ultimately you need the patient’s buy-in for compliance and a valued relationship with the family.  After introductions, explain your job in a way that your patient understands. If you are going to listen to your patient’s lungs, show her your stethoscope first.  Let the child touch it and have her practice taking big deep breaths.  Listen to the caregiver’s lungs first and then tell the child it is time to listen to her lungs.  Always tell a child what you are going to do before you approach the patient.  Language and delivery is powerful and giving basic and honest information in a non-threatening manner goes a long way.
  1. Do your homework. Patients will be more cooperative and trusting if you find something in common with them.  Ask non-medical questions to find out what makes them happy.  Be in touch with what various age groups enjoy right now (Mickey Mouse Clubhouse, Minecraft, the Lego Batman movie, Snapchat, Spotify, Taylor Swift and Shawn Mendes, for example). If your patient is more reserved, remember that communication is multifaceted; patients may warm up to you based on your facial expressions, tone of voice, if you’re eye level with them, if you’re friendly and keep them in involved in the exam or check-up.  You may not even speak the same language as your patient, but all children understand the language of play.  At the end of your appointment, take notes about what your patient enjoys, so when you see them again you have something to talk about and they’ll feel special because you remembered what is unique to them!
  1. Offer choices and utilize positioning for comfort. Even young children have preferences and like to feel included. When you are checking a patient’s tympanic temperature, ask the patient which ear she prefers.  The power to choose provides feelings of control and autonomy and allows the child to anticipate what is ahead.  Positioning for comfort helps children feel more secure and less vulnerable.  Sitting in an upright position is always more desirable than lying down.  If a child needs help holding still, ask the caregiver to assist the child during an invasive procedure.  If a patient can sit on her mother’s lap during an IV start, the child will have positive support from a person she trusts rather than a negative restraint from a stranger.  A sense of dignity and respect is earned when patients feel more comfortable and less helpless.
  1. Let your professional guard down. Take off your doctor cap for a few minutes and tell a silly joke, help build a Lego car, make pizza out of Play-Doh or have a lunchtime dance party.  This will foster a safe place for families and make you more approachable.  Your clinical expertise will be apparent by the medical treatment you provide; however, being relatable and understanding will convey a human connection.
  1. Less is more. Unfamiliar faces can be intimidating, so only allow for medical personnel who are absolutely necessary in the patient’s room during an exam. If an invasive procedure is scheduled, designate one person who has a calm tone of voice to speak to the patient. Several people speaking and giving directions at the same time may feel chaotic and can cause more anxiety for the child. Having age appropriate distraction items available can also help decrease anxiety. If you have a toddler who is afraid of the blood pressure cuff, ask her caregiver to blow bubbles while staff obtains her blood pressure. Nursery rhymes, counting and interactive toys with sounds and lights, work well for distracting young children. I Spy books, cell phone apps, belly breathing and conversation are better ways to engage older children during stressful situations.

 Learn more about the child life experts and services at CHOC.

The Cherese Mari Laulhere Foundation Donates $5 Million to CHOC 

The Cherese Mari Laulhere Foundation, whose mission is to provide funding and support to charitable organizations that enrich the lives of children and families, has donated $5 million to endow the child life department at CHOC Children’s Hospital.  In recognition of the foundation’s generosity and to honor the memory of Cherese, the department will be named The Cherese Mari Laulhere Child Life Department.

Cherese is remembered by many for her compassion, sincerity and zest for life.  An elementary school assignment revealed her dream for peace.  As she matured, she continued to nurture that vision by focusing her attention on causes that improved the lives of others, especially children.  A bus accident in India tragically ended Cherese’s life when she was 21 years old, but her family and friends make sure her dream lives on through the work of the foundation they created in her name.

CHOC Children’s President and CEO Kimberly Chavalas Cripe, left, with Larry and Chris Laulhere.

“Our donation is truly a gift from Cherese, who was committed to making a difference in people’s lives.  Supporting CHOC’s child life department and the inspiring ways its specialists and programs positively impact patients and families each and every day is a wonderful tribute to our daughter and her dream to make the world a better place for children,” says Cherese’s parents, Chris and Larry Laulhere.

The Cherese Mari Laulhere Child Life Department at CHOC Children’s Hospital offers comprehensive education and support services to help normalize the hospital experience for patients and their families.  From pre-surgery preparation and therapeutic medical play to developmental stimulation and specialized programs, such as art and music therapy, the department addresses the unique needs of children who are facing the most challenging moments in their young lives.

“We are incredibly grateful to the Cherese Mari Laulhere Foundation for their generous support of our child life department, which is committed to transforming the hospital experience for our patients and their families.  Our child life specialists and programs, such as art and music therapy, play crucial roles in our patients’ healing and recovery, helping them focus on what’s most important: their childhood,” explains CHOC President and CEO Kimberly Chavalas Cripe. “Hearing of Cherese’s kind and giving spirit, particularly where children were concerned, we are especially touched by this gift and proud to honor her memory by naming the department the Cherese Mari Laulhere Child Life Department.”

For more information about Cherese and for photos, visit www.cherese.org.