Assisted Play as Part of Psychosocial Support at KHC

Objective

The role of Assisted Play is especially important when a child is more vulnerable through illness
or disability. Play in children can improve general mental well-being, facilitate emotional regulation
and strengthen social competencies and adaptation skills. By, advancing their play can help children to cope with stressors, such as managing pain and emotional stress deriving from cancer disease. Providing time and opportunity for children to play should not be overlooked in clinical settings. At New Hope Children’s hostel at KHC (Kawempe Home Care), we try/aim to increase and improve children’s play by providing assisted play sessions and age–appropriate play equipment as part of our psychosocial support.

Method

New Hope Children’s Hostel hosts poor and vulnerable children from upcountry who
receive cancer treatment at UCI, but cannot be accommodated at Mulago Hospital due to limited capacity. At New Hope Children’s Hostel children with different capacities to play are admitted for care. The social worker and counsellor observe children’s play in order to identify children, who show little play, isolated play, repetitive behaviours and aggressive play, as these behaviours are indicators of impaired child mental well-being. In our daily play sessions, guided by our psychosocial staff, vulnerable children are assisted in their play, according to their needs. Beyond, guided games for different age groups help children to build positive relationships with peers. Age – appropriate equipment is available throughout play sessions and continuously assessable for children and caretakers. This includes different board – games, dolls, bicycles, footballs and table tennis. The hostel’s psychosocial care is evaluated with the Palliative Outcome Scale (POS-C; APCA, 2012) (2).
POS-C is a standardized tool to assess the disease-related quality of life and track possible changes over time for children and their caretakers in palliative care settings, also capturing children’s motivation to play and emotional state through 3 standardized items. At KHC, assessment with POS-C is accomplished at four visits within a child’s stay, with the first interview upon admission and repetition after every two weeks. Further, a total of 10 qualitative interviews were conducted with children from ages 10 to 15 about how play has helped them cope with their cancer disease and treatment.

Results

Descriptive analysis using average scores of 86 complete filled POS – C questionnaires
suggests that children’s psychosocial well-being improved throughout their stay at KHC, indicated by reduced crying and increased happiness and motivation to play. In interviews, children report that play has given them happiness and helped them to make friends, find distractions and limit negative
thoughts. Also, the play has helped them to stay physically active and to feel less sick. Older children reported finding less distraction from negative thoughts through play than younger children.

Conclusion & Future Directions

Our analysis shows general positive outcomes of the psychosocial care provided by KHC and supports the general notion that play is important for children in palliative care. For future monitoring, KHC aims to improve the observation of children’s play as well as the evaluation of our assisted play sessions through the introduction of specialized standardized tools. Further, we aim to provide more specialized and age – appropriate play equipment for clinical settings, such as therapeutic board games.