Wrap-Around Care: Shriners Children’s Avoids the Risks of Superficial Treatment

This is part two of a three-part series about the specialized wrap-around care provided to all patients at Shriners Children's. To read part one, clickhere.

In the absence of the wrap-around care that Shriners Children's provides all patients, a child might heal partially but not completely from the ordeal. "Surgery is a source of acute stress or trauma for children and families," said Krystal Vermillion, MOT, OTR/L, a staff therapist at Shriners Children's Greenville, referencing a systematic review and metanalysis published in 2021 that reported that 16% of children who undergo surgery and 23% of parents will meet criteria for post-traumatic stress disorder (PTSD).

"This can have long-term negative effects on well-being that last well into adulthood," she said. "In the absence of wrap-around care, we cannot identify those children most at risk and attempt to intervene."

Emphasizing that "every interaction a person has within the healthcare setting has the potential to help or hinder health and healing," Vermillion champions a trauma-informed approach to wrap-around care. It "entails practicing cultural humility and being able to identify and respond to the signs and symptoms of trauma to avoid re-traumatization, build trust and improve communication between patients and providers."

Helene Freni-Rogers, recreational therapy manager at Shriners Children's Hawai`i, agreed that treatment needs to go beyond skin deep because incomplete care can yield long-term problems. "A child might have their physical conditions addressed, but they might have issues with coping and pain and emotional concerns," she said. "Their coping mechanisms might not be strong and this, in turn, could impact their long-term healing and might even have a negative impact on how they view healthcare."

A lack of wrap-around care could lead to other consequences, too, such as a longer recovery time, an unwillingness to accept treatment, and a lack of confidence or will to persevere, said Kerry Marini, M.Ed, CTC, coordinator of education and transition at Shriners Children's Northern California. Ultimately, a patient may be "unwilling to return to their community as a positive and productive member of society."

Marini's focus, the school and community re-entry program, ensures that inpatients don't fall behind during their hospital stays, and then prepares teachers and peers for the patient's return to school so that it's handled with care and tact. "Students return to their school environment or community falling right into place as if they were on campus or in the classroom all along," she said. "It helps to give the student a sense of belonging, empowerment and acceptance."

During his recovery, Fausaga embraced the personalized care offered at Shriners Children's Hawai`i. For example, although he was in considerable pain, he avoided pain medicine and opted for an "energy" or "biofield" therapy known as healing touch. He also participated in the music therapy program and learned, appropriately enough for his location, how to play the ukulele. Such therapy is believed to help improve mood and regulate emotions.

The recreational therapy team kept him fully engaged, Freni-Rogers said, and leaned into the fact that Fausaga was older than most patients at Shriners Children's Hawai`i. "Fausaga is a teen, and, sometimes, it's challenging for a teenager or young adult to be in a 'children's' hospital," she said. "Because of this, we look at the patient's strengths. In this case, Fausaga was strong, independent, resilient, has strong family values, has an infectious smile and laugh and was musically talented. With such strengths, we had Fausaga be a mentor and role model to his peers."

The kids were naturally drawn to him, and he often played with the younger patients and supported them like a big brother - a role that came easily to Fausaga as one of eight brothers. "He naturally made everyone around him feel welcomed. During various activities, he would make it fun and made everyone laugh with him," Freni-Rogers said. "This allowed him to feel good about himself and can boost one's self-esteem."