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School Aged & Adolescent Burn Survivors

TEAM BRAVE
Team Brave was created to help patients re-enter the community following burn injuries and
surgeries. This group provides opportunities for socialization, learning, growth, facing fears
and new experiences. It is supported by members of the Boston Firefighters Burn Foundation
(BFFBF) who accompany a approximately 5-10 patients and Child Life Staff on outings into the
community.

Journal Excerpts Detailed Team Brave Events:

3/20/19
“This week I went on a Team Brave event to a paint studio where we took patients from
Shriners to meet with members of the Boston Firefighters Burn Foundation (BFFBF) for a few
hours of painting and fun! Team Brave was created to help patients re-enter the community
following burn injuries and surgeries. This group provides opportunities for socialization,
learning, growth, facing fears and trying something new. This group is predominantly for school
aged children and older and accommodates patients’ needs in order to promote maximum
participation, such as by providing a wheelchair accessible van. There are many benefits to
Team Brave events, particularly for children in Erikson’s Industry vs. Inferiority and Identity vs.
Role Confusion stages of development. During these stages, socialization is extremely
important to a child’s developing self-esteem and self-concept. Children and adolescents with
burn injuries often experience bullying. Depending on the environment and culture which they
were raised, they may also have experienced other forms of social rejection or discrimination.
One of our new patients named P is an 8 year old girl who grew up in an orphanage in
Swaziland and speaks Zulu. Before I met P I conducted research about Zulu culture, particularly
their views on disease and medicine. The Zulu culture is known for believing that illness and
misfortune are curses brought on by an angry spirit and that treatment and healing is largely
linked to magic and divination. I kept in mind Bronfenbrenner’s Ecological Systems Theory and
how P’s life experiences and interpersonal relationships might have been shaped by this
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cultural belief. We are all impacted by various macro systems, including culture and social
expectations. These larger belief systems affect smaller community social systems and as a
result the interpersonal social interactions among the community’s members.
P has suffered severe burn injuries to her face where she has lost an eye, ear and her
complete upper lip, leaving her teeth exposed. I considered the many ways that P’s injuries,
lack of treatment and the social and cultural context in which she was raised might have
impacted her past development, socialization opportunities and feelings of love and worth
especially considering that she is in the Industry vs. Inferiority stage. It was such a joy to be able
to sit with Piwa and see how much she enjoyed painting. By the end of the outing she really
seemed comfortable, and although she is currently struggling with maintaining social
boundaries, she had many positive interactions and was very outgoing with many of the fire
fighters and other children.
Within the context of the hospital, staff are used to seeing patients with facial
abnormalities, however because it is so “normal” within our daily work I sometimes forget what
patient’s daily experiences and struggles must be outside the hospital walls. I was made aware
of this when we were leaving the paint studio and a father and daughter were walking in, and I
saw the daughters expression when looking at P. Such a stunned reaction is expected for a
young child, but I cannot imagine the impact that such reactions must have on P, other patients
and their developing self-concepts.
An aspect of Team Brave that makes it especially unique when compared to other support
groups or social groups is the participation of members of the Boston fire department. Going
out in public settings truly requires bravery for many of our patients, and having the support of
doing things that may be new or scary with big strong fire fighters can be very empowering. All
of the fire fighters were prepared and unphased by the differences in appearance of some of
our patients and treated them just like any other kid.”

3/26/19
This week we had a Team Brave event to learn how to make pasta at Sur La Table. In our
group we had school aged patients who spoke mandarin, Spanish and English. Something that
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stood out to me this week was the importance of fostering peer relationships among school age
children and teen burn survivors. One particular group of girls who came on Team Brave all
spoke Mandarin. Based on the group’s continued play, conversations and overall engagement
with one another they appear to have been developing strong relationships throughout the
course of their treatments.
A school aged boy (A) was our only bilingual patient and we encouraged his interaction
with S, a girl who speaks Spanish and is a similar age. A had been adopted but was born in the
same city as S. This and their shared language, and burn injuries were unique and important
connections to be identified and celebrated. Rebecca made a point to note the similarities
these two shared and throughout the course of the event they began to interact more and
more. A key part of Team Brave is not only increasing patients' comfort levels and confidence
going into public settings but also promoting patients interactions with one another and the
development of relationships.
Thankfully severe burns are becoming less and less common. However, for some of our
patients it also means that their first interactions with other burn survivors might not be until
they get to Shriners. Peer relationships among burn survivors are extremely important to
foster, especially for children in Erikson's Industry vs. Inferiority and Identity vs. Role Confusion
stages of development. Within these stages, every child is undergoing changes in their bodies
and are developing a sense of identity, often based on social interactions and their abilities.
However, burn survivors often face additional challenges entering into these stages due to
social, psychological and physical challenges related to their burns. Shriners provides many
resources for patients and families to address some of these issues, including Psychology and
Child Life. However direct relationships with peers offers other forms of support that are very
important for children and teens within these stages of development.
A study I reviewed this week, entitled Community Integration after Burn Injuries, based on
their data concluded that burn survivors have “significant problems with integration into the
community” (Esselman, 2011, p.225). Additional challenges many burn survivors encounter
include the loss of normalcy, self-esteem, confidence, identity (compared to their pre-burn
appearance), loss of hope and feelings of safety. These common impacts on burn survivors are
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why social activities like Team Brave offer unique psycho-social benefits. Team Brave is a
reminder for our patients that they are not alone and that there are many other children and
teens out there just like them encountering the same struggles and challenges and who enjoy
and like the same things. It also provides a setting for them to bond over shared experiences,
and helps foster possible long-term supportive relationships among patients.
Even though patients will often be unable to continue to see one another after leaving
Shriners, many are able to remain in communication and continue to develop strong supportive
relationships in the future, frequently through supports provided through child life. One
example of this was seen on our last Team Brave event when an 11 year old named M
explained to me how Rebecca continues to support her relationship with another patient she
met at Shriners named F. Rebecca does this by arranging the exchange of M and F’s letters
which they leave for each other every time one of them is getting a surgery.
By reflecting on research and my experience going on Team Brave, I have been able to
practice the child life competency of evaluating Team Brave as a child life program. Team Brave
has proven to be a very effective re-integration program which promotes unity through shared
experiences and activities. Although A and S were not necessarily having conversations about
these larger issues, promoting interactions with other burn survivors helps individual's feel as
though they are not alone, and allows them to have interactions without as much thought
about their burns or what others think about their appearance.

4/17/19
This week our Team Brave outing was going on a duck boat tour of Boston. When
preparing for Team Brave we were mindful of what the duck boat outing would entail and any
adaptive measures that would need to be made in order to foster maximum participation. P is a
9 year old patient (with social delays) who is currently unable to drink out of a straw and will
not be able to blow or suck on anything because she is recovering from surgery on her lip. This
is relevant information to consider prior to our outing because it impacts P's ability to blow a
duck whistle. By considering this ahead of time and desiring to have her included and fully
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participate with the group as much as possible we collected alternatives to the whistle including
bubbles and shakers.
We gathered enough bubbles to be used by all of the patient’s in order to promote
inclusivity and unity within the group. Providing these alternatives not only for P but for other
children as well will help P feel less singled out and more included in the activity. Our goal was
to promote participation and peer interactions while also considering and making necessary
adaptions for all of the patients, which is particularly important for children within Erikson’s
Industry vs. Inferiority stage of development.