Because it Takes More Than Medicine: The Use of Behavioral Economics in Pediatrics

by Caroyn Fung

Coauthors: Carolyn Schneiders Fung, CCLS, began her child life career at Duke University Medical in Durham, NC. In 2012, Carolyn was hired to work at Children’s National Medical Center becoming Hope for Henry’s first full-time, in-hospital child life specialist. She helped design Hope for Henry’s innovative patient incentive program—Hope for Henry’s Super Path to Super Duper Better. In 2016, Carolyn became Hope for Henry’s National Program Director, overseeing program innovation and expansion, including developing Hope for Henry’s Super Rewards for Super Kids, is used in hospitals nationwide to improve medical adherence. Carolyn has presented at conferences across the country and formerly led the Hope for Henry iCAN chapter.

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Advances in medicine have led to vastly improved survival rates for once-life-threatening pediatric illnesses. But every year, more than 6 million children are hospitalized in the United States. Although designed to have positive physical effects, many medical interventions are painful and upsetting for children, often causing short- and long-term psychological distress. In fact, the incidence of emotional problems resulting from hospital experiences has been reported from 10% to 30% for severe psychological distress to as much as 90% for slight emotional upset. The combination of physical and psychological distress can cause healthcare-induced trauma and lead to challenges like procedural delays or cancellations, missed dosages of critical medications, and flat-out refusal to seek follow-up care.

Using the efficacy of behavioral economics, an approach to understanding decision-making and behavior that integrates behavioral science with economic principles, specifically in the form of Hope for Henry’s Super Rewards for Super Kids program, in improving pediatric patient anxiety, coping skills, adherence, and overall patient experience – our key drivers – as a means of improving safety before and during 17 common medical procedures. addresses the connection between children’s psychological well-being and their ability to heal. By employing a behavioral economics approach to medical adherence, children and adolescents are rewarded for navigating all the steps necessary to successfully complete procedures that can be painful and stress-inducing, such as proton beam therapy, MRI, or PICC line and NG tube placement. With the aid of a colorful game board and removable stickers that feature superheroes undergoing each of the relevant procedural steps, patients can map out what they need to do to – recognizing the completion of each step with an “I Did It!” sticker. Post-procedure, the patient has a completed game board and the opportunity to pick a gift from the rewards cart, both of which serve as tangible mementos of the patient’s accomplishment.

Certified Child Life Specialists (CCLS), employed by 36 participating healthcare facilities, and trained in Hope for Henry’s Super Rewards for Super Kids, entered deidentified data from 1,877 patient encounters into a password-protected online database based on their subjective observations course of eight months (January 1, 2022 – August 31, 2022). CCLS assessed each child receiving support for the included procedures based on age, past experiences in the hospital, understanding of why they are there and what’s going to happen to them, and expressions of fear and anxiety. CCLS offered the program to every child they believed would benefit based on that assessment.

The reported outcomes indicate that procedure adherence was improved in 88% of patients, with an overall patient experience improvement in 95% of patients. Anxiety reduction was observed in 86% of patients, and an improvement in coping skills was observed in 87%. For patients assessed for sedation for MRI, avoidance of sedation was attributed to SRSK intervention in 68% of patients. Findings suggest that behavioral economics can effectively improve health outcomes for pediatric patients undergoing medical procedures.