Abstract
Research supports the essential nature of play as directly impactful of children's overall development and wellbeing. However, the meaning of play, play materials, and access to play are not uniform across cultures or communities. Biopsychosocial factors such as development, health, mental health, trauma, racism, gender, gender identity, family structure, socioeconomics, geography, and religion influence how and why children play within their daily lives. Children in healthcare settings can face additional obstacles to play engagement thereby minimizing the therapeutic and healing impact of play. This chapter seeks to highlight the need for healthcare providers, particularly play specialists, to improve their understanding of biopsychosocial factors to promote more thorough assessments of patient coping, facilitate beneficial play engagements, and address areas of intrinsic bias in pursuit of optimal outcomes and well-being for children in healthcare settings whether hospitals, community clinics, hospice, or residential care.
TopIntroduction
Scientific advances in medical care continue to improve pediatric healthcare outcomes. However, due to globalization and an increase in medical tourism, emigration, and a growing migrant work force (Chambers, 2015; World Health Organization, n.d.), medical professionals and healthcare systems continue to face challenges in providing optimal care to multicultural patients and families. As the world continues to become more diverse it creates challenges with defining exactly what culture is so we can address its unique features and impact within the healthcare experience for children and families. Culture, one of many biopsychosocial factors that influence play, shapes how children utilize and engage in play as well as how clinicians interpret a child’s play as normative, adaptive, or maladaptive. Research on play has spanned many decades and in that time family systems, lifestyles and technology have changed as well. Current literature regarding biopsychosocial influences on play are often a static commentary on a specific feature within a unique context such as race or gender. Research which investigates the synergistic impact of biopsychosocial influences on children’s engagement in and use of play would greatly advance our understanding of play specifically (Roopnarine, 2011), but also enhance the Play Specialists ability to assess and provide more appropriate play interventions to hospitalized children. Assessing the coping and play-based behaviors of hospitalized children through only one biopsychosocial lens may lead to inaccurate assessments and inadequate interventions as it fails to consider multiple possible truths being communicated through play.
The authors offer the following discussion of globally applicable biopsychosocial factors of play, a spider’s web with many reciprocal and interdependent parts, to represent how each child may present their own unique mix of influencing factors and with differing levels of influence. Further, the role of intrinsic bias on clinical assessment as well as a child’s experiences with play both inside and outside the healthcare setting will be explored. Additionally, we offer a case discussion to showcase the need for more inclusive assessments, play interventions and research. Lastly, the authors provide a brief synopsis of clinically relevant considerations to promote more thoughtful play engagements for hospitalized children.