Children and adolescents are a common sight in primary care, making up approximately 16% of all doctor’s visits (CDC, 2012a). Of those visits, approximately half were problem-focused visits (i.e., child comes in for an earache) and half were routine child checkups (CDC, 2012b). It is important that doctors, behavioral health specialists, and other healthcare providers are competent in relating to and communicating with children. One of the most effective ways to communicate and relate with children is through the use of play. Play can be defined as any fun or enjoyable activity that allows us to creatively express who we are (Association for Play Therapy, 2016) and is one of the primary means by which young children communicate (Landreth, 2012).
Why Play is Important in Primary Care Settings
Although play is as essential to our well-being as love and work are, it is often disregarded in primary care settings. This is understandable as play is generally seen as a time-consuming and non-directive process, two characteristics that seem almost incompatible to the fast-paced, provider-directed culture of primary care. As a medical family therapist who has seen first-hand the healing power of play, I have worked to figure out simple, yet creative ways that we can more effectively use play while working with children in primary care settings. Here are a couple of suggestions for behavioral health specialists or other healthcare providers who wish to use play in primary care.
● Paper with a blank gingerbread person
● Small box of crayons
1. Tell the child that the gingerbread person represents their body.
2. Ask the child to choose their favorite crayon.
3. Ask them to color or draw where in their body they feel pain or discomfort.
4. Ask them if they want to use another crayon or draw anything else on their gingerbread.
5. Ask them if they would like to draw what is going to make them feel better on the margins of their gingerbread person
6. Ask follow up questions on their drawing like, “Can you tell me what you drew? What is that you drew in the margins?” “I notice a lot of red. If you don’t mind me asking, did you choose red for a reason?”
7. Follow-up with parents if you have any additional questions.
Doctor's Toy Kit
● Doctor’s toy kit
● Smooth surface (table, chair, etc.)
1. Hold the bag up and tell the child that in the bag there are a few things that the doctor might use to make sure their body is feeling OK.
2. Spread the toys out on a smooth surface and ask the child if he or she would like to play.
3. Observe them play and reflect what you see: “You are using the stethoscope on mommy.”
4. After a few minutes, ask the child if it would be OK if you demonstrated what some of these toys are used for.
5. Demonstrate how the doctor might use these toys with the child. Observe and reflect on their reactions.
6. Ask them if they have any questions and let the family know the doctor will be in shortly.
● Mini-play dough
1. Ask the child to create what they believe is making them feel yucky or have pain.
2. Explore with the child what item they chose to create and why they chose that item.
3. Let them know that part of the doctor’s job is to help them get rid of the pain or yuckiness. In order to do this, though, sometimes this means having to do scary things like having a look in their mouth, their ears, or having a shot.
4. Let the child know that if they start to feel scared or stressed, they can smash or squeeze this play dough in any way they want to.
● Your favorite book on nutrition, exercise, or some other topic
1. Show the family that you have a book that you like to read to each child that comes in for their first visit with their doctor.
2. Ask the parents to look through the book to make sure they agree with everything presented.
3. Read the book out loud to the parent and child.
4. Ask the child follow-up questions about what they learned and how they feel they are doing with keeping their body healthy.
5. Set a goal with the family about eating healthier, exercising more, etc.
Drawing with Teenagers
● Plain white piece of paper
● Pencils or color pencils
1. Use traditional screening tools for family and individual struggles (i.e., family conflict, depression, etc.)
2. After discussing their results, tell them that many people feel more comfortable drawing how they feel or what they are struggling with then talking about it.
3. Ask them to draw the problem, the pain, or the struggle that has brought them into the clinic that day.
4. Validate and listen to their concerns.
5. Ask them what has helped them overcome this pain, problem, or struggle.
6. If willing, set a goal with them based on their answers from the previous step.
There are also many cell phone apps that can be used for self-care or for the management of difficult thoughts or emotions. Some of my favorites to use with patients are Breathe2Relax, PTSD Coach, or Bliss. If possible, download the app with the patient and practice one or two of the exercises together.
Tying it all Together
These strategies are, by no means, exhaustive. The strategies are endless! These are only a few, simple ways that we, as healthcare providers, could more fully use play in primary care. Remember, it is important that we do our best to learn the language of those whom we serve. And play is one of the primary languages of children!
David Haralson is a Ph.D. student in Medical Family Therapy at East Carolina University. For nearly four years he has worked as a bi-lingual medical family therapist in a variety of primary care settings. In particular, he enjoys helping families who struggle with substance misuse or other life-altering health conditions (such as cancer or MS). He often uses play therapy in his day-to-day work with children, adults, and their families. He is currently on the path to becoming a licensed marriage and family therapist and AAMFT approved supervisor.