Defining Play in the Healthcare Setting: A UK Perspective

Introduction

Over the course of the past 60 years, the endorsement of therapeutic play and play-based services has enriched the healthcare experience of children, young people and their families in the UK and around the globe (Association of Child Life Professionals, 2022; National Association of Health Play Specialists [NAHPS], n.d.; Perasso et al., 2021). The descriptor therapeutic is used here to refer to play that is beneficial to health in that it helps to heal, to restore, or to promote health and therapeutic play will be used throughout the chapter to refer to play-based services in hospitals and other healthcare settings in the UK. The generic term therapeutic play has been adopted in preference to healthcare play specialism (the descriptor in current use in the UK) for greater fluency and sense-making by an international readership. It is not to be confused with play therapy which derives from the psychotherapeutic tradition and is a treatment modality which focuses on a child’s internal conflicts and their expression in daily life and relationships (American Psychological Association, 2022).

Numerous studies testify to the benefits of therapeutic play for children in hospital in terms of establishing trust (Godino-Iáñez et al., 2021; Li et al., 2016), meeting developmental needs (Nijhof et al., 2018), assessing psycho-social needs (Burns-Nader & Hernandez-Reif, 2016), and reducing negative emotional behaviors (Williams et al., 2021), all of which are summarized in a policy statement on Child Life Services issued by the American Academy of Pediatrics (2021). Hospitalization for illness or injury in childhood may be experienced as traumatic (Murray et al., 2008) which can impede recovery (Moss et al., 2019) and lead to ongoing psychosocial difficulties (Meentken et al., 2021). There is evidence that engagement with therapeutic play can ameliorate the impact of trauma (Godino-Iáñez et al., 2021) by promoting health literacy (Koukourikos et al., 2015) and as a medium for self-expression and emotional release (Witt et al., 2019).

The actual and potential contribution of therapeutic play is susceptible to being overlooked or undermined due to the ambiguity surrounding play as a concept (Sutton-Smith, 2009), and to the paucity of hard evidence to support its therapeutic benefits (Cho & Choi, 2021). This tendency to discount the unique contribution made by therapeutic play to the pediatric healthcare experience can be attributed, at least in part, to the dearth of statistical evidence of its positive impact on clinical outcomes (Kennedy, 2010; Perasso, 2021) which is a constitutive requirement of the Evidence Based Practice model which predominates clinical research (Nevo & Slonim-Nevo, 2011).

The premise underlying this chapter is that the benefits of therapeutic play may be more effectively demonstrated using the parallel concept of Evidence Informed Practice, which integrates evidence from a wider range of sources (empirical evidence, case studies and clinical insights) and which draws on the collective experience of both professionals and service-users (Nevo & Slonim-Nevo, 2011). Therapeutic play practice is as much an art as it is a clinical activity and, as in the case of other therapeutic disciplines, “the wisdom appropriate to it is practical wisdom rather than that of scientific rationality” (Nevo & Slonim-Nevo, 2011, p. 1178).