Pediatric Care Volunteerism: Lessons from the COVID-19 Pandemic

Abstract

This article explores the deep impact of the COVID-19 pandemic on pediatric care volunteerism and specifically highlights the innovative responses and adaptations made by Project Sunshine, an international nonprofit organization headquartered in New York, NY. Prior to the pandemic, Project Sunshine's in-person volunteers played a critical role in providing comfort and support to hospitalized children and their families, bridging the gap between clinical treatment and patient satisfaction. However, COVID-19 brought unprecedented challenges to hospitals around the world, including widespread interruption of volunteer activities due to safety concerns and visitation restrictions. In response, Project Sunshine swiftly pivoted to virtual volunteering by launching TelePlay, an online playroom offering live interactive sessions between trained volunteers and pediatric patients. This approach addressed the immediate volunteering needs of patients during the pandemic and also extended support beyond traditional hospital settings, allowing Project Sunshine to reach children at home facing isolation and socialization challenges. Early pilot data is very encouraging: TelePlay participants were noted by their caregivers to be less anxious after a TelePlay session compared to before (p < 0.001). Additionally, the flexibility and accessibility of TelePlay have opened new avenues for volunteers to engage with their communities, transcending geographical barriers and accommodating varied schedules. As the healthcare landscape transitions back to in-person volunteerism, Project Sunshine embraces a hybrid model, offering both in-person and virtual volunteering opportunities. This flexible approach reflects the organization's commitment to helping shape the future of volunteerism to meet the evolving needs of pediatric patients and volunteers alike.

Volunteering Before COVID-19

The hospital can be a frightening environment for hospitalized children and their families. The people, the equipment, the loss of autonomy, the food—almost everything is different. There is information asymmetry, an entirely new (medical) language, and the fear of life-changing news. As a result, while healthcare personnel aim to heal, many children feel vulnerable and anxious with their clinical team. A trained volunteer, though, can provide comfort through non-clinical interactions, offering genuine connection to both patients and families in the form of a smiling face or a simple conversation. These volunteers can help restore a sense of normalcy, serving as a “vital [way] to bridge the gap between excellent clinical treatment and patient satisfaction by improving mood, providing hope and increasing adherence to treatments, ultimately culminating in better patient outcomes.” ¹

Further, the various ways that volunteers engage in developmentally appropriate play with hospitalized children likely serve therapeutic purposes as well. Indeed, evidence indicates that play has notable benefits for hospitalized children, including reduction of anxiety,^2,3 fear, ² and pain ³ ; enhanced self-expression^2,3; and increased knowledge of disease and treatment. ³ Dr. Gerald Loughlin, former Chair of the Department of Pediatrics at Weill Cornell Medicine and Pediatrician-in-Chief at NewYork-Presbyterian Komansky Children's Hospital, concurs: “It has become clear to me, after five decades in pediatrics, that for hospitalized children struggling with illness, play is an essential element of the success of any medical or surgical treatment plan.” (Dr. Loughlin is an unpaid member of Project Sunshine's Board of Directors.)

Project Sunshine, a nonprofit organization headquartered in New York, NY, has long understood the importance of play to pediatric patients and has boasted a well-developed and innovative approach to volunteer engagement for decades. Recruiting college students, corporate partners, and community volunteers alike, Project Sunshine has achieved international reach, serving more than 1.97 million patients and families since 2012.

The relationships and connections that volunteers offer to pediatric patients and their families are, indeed, indispensable to pediatric healthcare. As such, the widespread cessation of volunteer activities at the start of the COVID-19 pandemic marked a devastating loss for hospitalized pediatric patients and their families.

Virtual Volunteering During COVID-19

The global healthcare apparatus was affected by the COVID-19 pandemic at an unprecedented scale, forcing adaptation to myriad abrupt changes. Not only were hospitals and healthcare providers forced to adapt, but so, too, were patients and families around the world. News broadcasts included heartbreaking stories of families saying permanent goodbyes over video calls, and many patients—both those hospitalized with acute illnesses and those living with chronic conditions—felt intensely isolated and vulnerable. Hospitalized children were arguably among the most impacted, as many new visitor restrictions limited the number of family members (including caregivers) at the bedside, and volunteer prohibitions limited these patients’ ability to have reassuring and normalizing non-clinical interactions and experiences.

Project Sunshine understood that while the landscape of pediatric healthcare volunteerism had suddenly changed, the needs were as pronounced as ever. After witnessing how rapidly virtual platforms were widely adopted for education, business, and more, Project Sunshine pivoted and similarly began providing its volunteering services virtually. For an organization founded on the premise of promoting healing through play and connection, ingenuity was required to create a program that would deliver similar benefits through a virtual medium.

Project Sunshine quickly decided that delivering this benefit would require live “face-to-face” interaction between patients and volunteers. Once aligned on this foundational premise, it became clear that a virtual platform featuring real-time play may actually offer some unique advantages over in-person volunteering. For many children, internet-based games are familiar, and digital ways of connecting with friends are comforting. Further, for pediatric inpatients who are immunocompromised, who face mobility challenges, or who experience in-person encounters with new people as stressful, virtual volunteer interaction may be preferable. For volunteers, virtual programming may afford geographic and scheduling flexibility that could allow for more robust participation across more locations. This, in turn, could help better match volunteering supply and demand at different hospitals at different times, ultimately benefitting volunteers as well as patients.

The culmination of Project Sunshine's reflection and planning was TelePlay, an online playroom with age-appropriate activities where children can play structured games together under the supervision of a trained volunteer. To date, more than 5000 volunteers have spent nearly 6800 hours leading TelePlay sessions, reaching close to 12,300 children and families.

Recognizing that COVID-induced isolation was creating socialization and developmental challenges for children at home in addition to those in the hospital, Project Sunshine expanded TelePlay access beyond the inpatient setting through partnerships with nonprofits and support groups that serve patients with specific illnesses. Early (unpublished) data is very encouraging: TelePlay participants were noted by their caregivers to be less anxious after a TelePlay session compared to before (p < 0.001 on a 5-point Likert anxiety scale as analyzed through paired t-testing).

Early in the pandemic, TelePlay emerged as an accessible technology that could support the well-being of not only hospitalized pediatric patients but also children more broadly. In so doing, it created an opportunity for volunteers to continue to engage with their communities even when social and governmental restrictions were in place. TelePlay therefore represents an innovation in both the healthcare and the nonprofit landscapes.

The Return to In-Person Volunteering

While the benefits inherent in virtual volunteering are multifold, the tangibility of in-person interaction remains sought after by many patients and volunteers. Unfortunately, we have observed that the pandemic dismantled much of the hospital infrastructure (e.g., credentialing and training) required for in-person volunteers; that many hospitals are still restoring those processes to their pre-pandemic capacities; and that many service organizations lost much of their volunteer pipelines, which will take time to reconstruct.

With that reality, however, comes the opportunity of a hybrid model to allow for engagement at all levels. As such, Project Sunshine is now offering both in-person and virtual volunteers to its hospital partners around the country. While opportunity abounds, implementing volunteering paradigms that are technologically, operationally, and financially distinct poses challenges to nonprofit organizations and their staffs. However, as Project Sunshine volunteer Dana Covey concludes, these in-person and virtual modalities work together to “serve the same goal,” so Project Sunshine is committed to scaling both.

Having learned from our early, unpublished data (see above) that TelePlay seems to reduce anxiety in participants, Project Sunshine's future plans for TelePlay include targeting patient populations experiencing anxiety on account of their condition (or the social isolation it induces). Though our pilot results were limited by the small subset of TelePlay participants it reflected, our illness-specific nonprofit partners are enthusiastic about the opportunity the program offers their children and families. We hope future TelePlay evaluations will feature a more robust response rate to allow for enhanced generalizability of our findings.

Whitney Namm Pollack, Project Sunshine's Chief Executive Officer, recognizes that the pandemic created “a unique catalyst for expansion and innovation that we could have never imagined.” Indeed, it is likely that the landscape of volunteering has permanently changed. The purpose and heart of volunteering remain the same, but how that manifests in the post-COVID world will continue to evolve. Project Sunshine plans to play a pivotal leadership role in defining and exploring the future of volunteerism.