The Not Mini Adults Podcast - “Pioneers for Children’s Healthcare and Wellbeing”
The Not Mini Adults Podcast - “Pioneers for Children’s Healthcare and Wellbeing”
Episode 32: 'PLAY SPECIALISTS WEEK' with Jo Pinney and Grace Welby
This week we are joined by Jo Pinney and Grace Welby who are both Play Specialists at the John Radcliffe Hospital in Oxford in the UK.
October 11th 2021 is the ‘Play In Hospital Week’ in association with the National Association of Hospital Play Specialists and this week’s guests successfully applied to launch the festivities so we are delighted that this podcast will be able to coincide with recogning the incredibly impotent role that Play Specialists have to making the lives of children and their parents that little bit more bearable whilst they are in hospital.
Jo Pinney is a Senior Health Play Specialist at the Oxford Children’s Hospital and has been a Health Play Specialist since 2001- even before there was a dedicated wing for the children’s hospital. Jo has worked in several different areas, with her current role as a senior HPS within E.N.T and Plastics outpatients where she has been since 2012.
Jo says that she ‘loves her role and find it especially rewarding when we have hooked or sucked an interesting find from a child’s ear or nose’.
Grace Welby is very special to Hannah and I as she was one of the pay specialists alongside Sam Mortlock. Grace has worked at Oxford Children’s Hospitals for 7 years, starting as a Play Assistant on an acute ward whilst training on the job & qualifying as a Health Play Specialist 5 years ago.
Grace says that “she very much enjoys her role as a Play Specialist, normalising the hospital environment for the patient & their families through play, having the time to interact & distract children from what can be a scary experience but seeing them smile is the most rewarding thing!”
Follow the Oxford Play Specialists on Instagram here.
Visit our shop here to purchase a copy of the Thinking of Oscar Cookbook - Made with Love or Face Coverings. THANK YOU!
Thinking of Oscar website and contact details can be found here.
Follow us on Twitter here or Instagram here.
Theme Music - ‘Mountain’
–
copyright Lisa Fitzgibbon 2000
Written & performed by Lisa Fitzgibbon,
Violin Jane Griffiths
Podcast editing - Right Royal Audio
Podcast artwork thanks to The Podcast Design Experts
Although it is very much about, as you say empowering the child. By them learning to trust us through providing something which is normal to them, which is playing. That can then lead to them cooperating in a situation where they feel uncomfortable. So if a child gets asked to go and have a blood test, if they've met us already, and then we have some time with that child. We can show them the equipment that's going to be used. Perhaps have a little practice with a teddy and do some roleplay, with the doctor's kit and teddy's and things. So it just then leads onto empowering the child to have the information that's needed in a way that's appropriate for them to understand. To then help them when they go into the treatment room and have those procedures done.
David:Hello, and welcome back to Episode 32 of the Not Mini Adults Podcast Pioneers for Children's Health Care and Well Being. Once again my name is David Cole and I'm joined by my wife Hannah and together we are the co founders of UK children's charity Thinking of Oscar. This week we are joined by Joe Pinney and Grace Welby, who are both play specialists at the John Radcliffe Hospital in Oxford in the UK. Now October the 11th 2021 is this play in hospital week in the UK in association with the National Association of Hospital Play Specialists and this week's guests successfully applied to launch the festivities at Oxford. So we're delighted that this podcast will be able to coincide with recognising the incredibly important role that play specialists have, to make in the lives of children, their parents that little bit more bearable whilst they're in hospital. Firstly, Joe Penny is a Senior Health Play Specialist at the Oxford Children's Hospital, and has been a health play specialist since 2001. Joe has worked in several different areas, with her current role being as a senior HPS within ENT and plastics outpatient, where she has been since 2012. Joe says that she loves her role and finds it especially rewarding when she has the opportunity to hook or suck an interesting find from a child's illness. Grace Welby is very special to Hannah and I, as she was one of the play specialists alongside her partner in crime, Sam Mortlock, who looked after Oscar whilst he was in hospital. Grace has worked at the Oxford Children's Hospital for seven years starting as a play assistant on an acute ward whilst training on the job and qualifying as a health play specialist five years ago. Grace says that she very much enjoys her role as a play specialist. normalising the hospital environment for the patients and their families through play. Having the time to interact and distract children from what can be a very scary experience. Seeing them smile is the most rewarding thing of all. We would like to apologise for some of the sound quality during the podcast. We recorded this with both Grace and Joe still in hospital and unfortunately, they were still having to wear their protective face masks, which muffles the sound a little bit. Once again, when we started the podcast. This was one of the conversations that we wanted to bring to you. Being able to share what we believe are some of the stories of the unsung heroes of paediatrics. Good morning Joe and Grace. Thank you so much for joining us on the Not Mini Adults Podcast. This has been a conversation that we've been wanting to have and make sure that we did have and highlight the incredible work that you both you and your colleagues to as play specialists. So thank you for being able to spare the time and to talk to us.
Jo:Thank you. Pleasure to be on board.
Grace:Yeah, thank you very much.
David:Maybe we'll start if you could just tell us a little bit about how you've got to be a play specialist. Then I think we can go from there.
Jo:I was working in child care working in a daycare nursery and I saw the job advertised. I didn't really know much about it, to be honest, but I thought it sounded interesting. So arranged to have a visit to the hospital to have a look around. I was shown around the wards and the playrooms that were there at the time and then a couple of days later had an interview. Somehow I got the job and then absolutely fell in love with the job. Went on to do the training as I needed to further my qualification to continue and then have stayed for coming up for 20 years now. So I've been around for a good long time and have really enjoyed my time here and developed my role and moved into a senior role here. Very much part of the growing team that we have.
Grace:Yes, and I also started in childcare and it just so happened, one of the children that I used to keywork for. Their parent Emily, who is play specials here in A&E and always spoke to me and explained her job role and that's how I kind of heard about playing specialist and being in a hospital. We always joked that oh it wouldn't be amazing. If one day you come to work in hospital Grace. Well, here I am. I'm very fortunate to work with this amazing team. I started out as a play assistant. I was very fortunate that hospital funded me to do my junior animation degree. So I continued that degree during my workplace. So, Monday to Friday. I've been qualified for a few years now we've been in hospital for seven years. Not as long as Jo, but I'm sure many more years to come.
Hannah:Thank you. So perhaps you could describe for those listeners that haven't been as lucky to meet you before what the role involves. What a typical day might look or feel like.
Jo:For myself, I work in an outpatients department that sees children who are coming in. Perhaps for EMT related problems or for dressing changes, post having surgery. So these could be children that have already attended the children's hospital and need to be seen afterwards or perhaps before they have surgery going into the children's hospital. So very different situations. So for these families, I can sometimes go into the room whilst they're having the consultation. Perhaps if the child needs to have the doctor use an endoscope to look down their throat or have a good look up their nose, ahead of having surgery. For most children that's a really, really scary thing. So I can go in and try and do some distraction for them and talk them through the process and make it more bearable for them as they're doing that. Or if it's a child that's had surgery and perhaps they've got a dressing that needs to be removed and changed and redressed. Then again, I can go into the consulting room and support them through that procedure. Which can be quite scary for them, as the last time they would have been in hospital was when they were actually having their operation. So some children come back feeling quite scared and anxious about what's going to happen this time whilst they're awake rather than being under the general anaesthetic. So that could be really traumatising. But sometimes it works out really well and the children are very well distracted and usually leave with a great big smile on their face and ask me to blow more bubbles because they've enjoyed the experience so much, which is lovely.
Grace:Yes, and I work on a medical ward which specialises in respiratory and cardiac so quite a bit of a mix. A lot of our patients come through A&E. They may have infections or here for a long stay. So we're there to help support the child and their family through play. So we do lots of play on our ward. We have an lovely play room and lots of toys and activities that we can supply for the child be a tiger in the playroom or on a ward. This is all prepaid. So unfortunately, we've lost favouring, and lots of activities and stuff. But we also can do some preparation, the procedures that are happening for the child and distraction for those procedures, say a blood tests from Canada. Mentioned, you know, we're the masters of bubble blowing. So distract them from the procedure that they having done or the reason why they're in hospital,
Hannah:I will certainly come back to the distraction part of your job because I think that's a superpower. We were really curious about what life has been like for yourself and for the children and their families on the wards during the last 15 months or so. Because our memory was the one that you described originally, that we were there for a really short time with Oscar. But there was a playroom and there was an outside play space. He was like racing around on little vehicles, or you were doing some art with him. Just a real variety of normal day play activities for a child and we watched you think of different ideas for different age children as they were coming into the play space. But I know that our experience will not have been possible. So how have you managed to create a sense of play or to what degree has that been possible since the pandemic emerged.
Jo:So we lost the play areas, unfortunately and had to support the children and their families purely at the bedside. So it made us go into the child, explaining who we were and what our role was and offering them some toys. But because of cleaning, infection control, we were unable to offer them as wide a variety of toys to what they could have had before. So we really have to think back to basics and think about what resources we could and couldn't use. Just simple things such as a book, we weren't able to give a child a book to read anymore because we couldn't clean all of the pages in the book. So they were gone. We had to give them colouring with pencils that were just a single use. So suddenly we were finding we were having to budget for lots of disposable toys. We were buying travel games such as Connect 4 and travel cluedo. Various games that were that were smaller and in a lot of respects, a lot more fiddly for the families sometimes to use. But we just had to constantly keep replenishing these things and say, okay, you can play with this whilst your here. Then when you're well, you get to take it home. So that was really quite frustrating that we couldnt bring the child away from their bed as well, for a change of scenery. Everything was happening at their bed, whether it was a procedure or play. They couldn't move to the balcony space, like you said, and have a bit of fresh air and a good run around. They couldn't come to the play room and see other children who were perhaps in a similar situation to them. So that was really quite a big challenge for a lot of us. Something that's still ongoing now, unfortunately. We've got used to it more. I guess the families are accepting that's how play is now. Lots of them, they didn't know any different to how things were before.
Hannah:Yeah, I guess you've learned a few tricks along the way of how to make the best of a limited situation.
Jo:Yeah, yeah, we've got to go back to thinking of just very basic. Let's quickly set up a game of hangman or something where, you know, before we would have given them a playstation or got them whatever they wanted. Suddenly, those resources aren't available. So there's been a lot of quick thinking on our feet as to what we can do with them.
Hannah:Sometimes over talking to folk over the last year or so there's been things that have changed that they wouldn't actually change back. So ways of working, for example, ways of collaborating. That things could happen more quickly during this time or something and perhaps some digital changes that meant that they would take elements of what had happened during this time and keep that. As we start to move out of this phase of pandemic. But I'm not sure that you're going to say the same. Is there anything that you would keep from this experience? Or were you just working through it with the children and their families, and it will be great when the playrooms are open?
Grace:I for one. You know, ready made packs for colouring and stuff. That's actually worked really well. Sometimes, you know as a play specialist, you have to do the background, things like photocopy lots of colouring and stuff. We've been quite organised, and we've got those packs ready to go, it's just a matter of picking them up and take them to the patients. I think those sorts of things we can see work well during this time. It's probably something that we might continue doing in different areas. But yes, I know that we will hope that one day, our role will come back to normal life. To work the play areas and the space for patients and their families.
Hannah:You made me think of something else. So as well, when you were talking about building trust with the families, because in the way that it worked previously. You would have been in the play area or children and their families would have seen you with other families or other children. Then they could, you know, when someone's just deciding whether to start talking to you or not, they'd like peak their head around the corner a little bit and make a decision about whether they're going to come to you. Whereas the way that it's had to work in the last, however long is. Then you've been going into their space straightaway. So that must have been a different set of skills that you intuitively developed to step into their space and build the trust in a different way.
Jo:Yeah, actually you've got to really sort of sell yourself at the bedside as it were. Make that quick relationship with the child and the parent. Obviously, we appreciate parents need a break as well. They might need to have 10, 15 minutes to go and get themselves some breakfast or go and have a shower or make phone calls to home to loved ones. So we've had to adapt to sort of selling our services, making sure that they understand what our role is. That we're not coming to do something medical at the bedside, but we are there to play and try and provide some normality for the child so that the parent can feel that they trust us to leave the child with us. Without the child becoming too upset. Once they disappear to do what they need to do.
David:Hannah's kind of intimated it, but Grace we obviously met when you were looking after Oscar when he was in hospital. We had no concept of play specialism or play specialists or anything along those lines, obviously, until we were actually put into that position. Jo, you said, parents that are now in that position with their children just have no kind of barometer to go by either. So whatever you're able to provide now is kind of it is what it is rather than kind of thinking about what it could have been before. I think it just kind of goes to show and maybe just discuss a little bit about the importance of giving parents that little bit of respite. So we've done a lot of conversations around play and the empowerment of children during that play. You know a lot of things done to a child as it were, whilst they're in hospital, in terms of procedures or operations or medicine or whatever. But actually, the ability for them to play and to allow them to do whatever it is that they want, that's a little bit of empowerment that they have, that they, I guess sadly, could potentially don't have as much of that at this point in time. But just maybe kind of reiterating or talking a little bit more about just how important the role of a play specialist is. For our listeners in other parts of the world, child life specialist is the other term that is widely used.
Jo:Yeah. Although it is very much about as you say, empowering the child and by them learning to trust us through providing something, which is normal to them, which is play. That can then lead to them cooperating in a situation where they feel uncomfortable. So if a child gets asked to go and have a blood test. If they've met us already and then we have some time with that child, we can show them the equipment that's going to be used perhaps a little practice with a with a teddy and do some roleplay with tdoctor's kit and teddy's and things. So it just then leads on to empowering the child to having the information that's needed in a way that's appropriate for them to understand to then help them when they go into the treatment room and have those procedures done.
Hannah:That's a really important point that you've made and we've had other conversations about this because in a hospital setting it might well be that many of the conversations will go above the child's head especially when it's a younger child. Maybe one of the roles that you play is around that direct communication to the child using language that they understand. I think that those of us that are parents of young children and you'll know this very well as well as it's always a mistake to underestimate how much they're understanding. I think Oscar had a really good, you know, level of understanding what was going on and he was not quite a year old but you know certainly from then through to early toddlerdem they're usually quite smart humans. So being able to fill in the gaps for them and help them have some kind of an idea of the processes that are happening or the procedures that are taking place is important as well. You talked about the blowing bubbles and you were half joking with it but we've also had conversations about when we first started looking at VR which was still I know that it's in use in hospitals already. But we were looking at different methods of distracting children and one of the points that became very clear was at a younger age it's really hard to beat a 30 pence bottle of bubbles. Can you just talk more about what the impact of whether it's bubbles or singing songs or all of the tricks that you have up your sleeve? What's the impact on a child that may start off in that section feeling quite nervous. If we're talking about something like taking a blood test. How do you go through from that being very traumatic to potentially much easier for the child to handle
Grace:Making it thats little bit more fun. If you were to imagine going for a blood test we would always make sure that they meet us first. Going to immediately start with a list of activities. So although, you know, they need to get the cream off and stuff if we can interact them with the bubbles we can get them more focused on that side and the fun side and the destraction of why we are there for them. Sometimes you can then put that into a little game. There's so much you can do. Our bad boys you can count the bubbles and pop the bubbles and see where the big bubbles are and follow the little bubbles and you can in between all the little process that needs to be done with the blood test. You can make it into quite a fun game and you know you win quite a lot of little ones over. Sometimes the challenge is a challenge that bubbles wont work on some patients. Yes and again we've seen in you know you can have so many nursery rhymes and songs that you can provide for the patient and if they can see that you're there for that side of things and actually everything is going to be okay. If you can focus on me and you know the parent that's in there and normally it's a successful procedure for them. They're not so nervous if they have to come again or visit for bloodtests. We were red polo tops in the hospital so we are known as a fun place to be. So once they hear they can kind of have that reassurance that this might be okay. I've met somebody before like this and we had fun playing with bubbles and you know, we can do bubbles again or we can change activity. So watching something on YouTube or reading in my book.
David:That's an interesting point Grace. Over the course of both of your careers, lots of things have changed. We talk quite a bit on this podcast around technology and bringing innovation into child health. I know you're looking at some of those things and have experienced some of those things. Can you talk about how you think the technology can actually either hopefully benefit what you're trying to do, and certainly, you know, from a child and parents perspective. But there's also I guess, potentially some adverse sides to that as well.
Jo:Yeah, technology's moving really well. It can really benefit us in the hospital setting. One of the most basic things that we use here is that when we're preparing a child for coming in the theatre, we filmed the process. So people can access that on YouTube and have a look at the hospital setting and the anaesthetic room before they come in and have the procedure done. So that's one aspect of technology. Then also, we're using technology to distract the child and just make things feel normal. So at the bedside, they could be playing with some game console that keeps them distracted and do something that they would be normally doing if they were at home. Then also, we're looking at moving on to different technology, such as looking into the VR headsets. To engage the children in a different immersive way to distract them from what's happening in the situation in the hospital. That's quite a fast sort of new thing that we're learning and trying to catch up. To find out a bit more about. We're also very lucky that there's a company that have put together a simulation of an MRI machine as well. So we have that as an app on our iPads. So if we're preparing children for going for an MRI, we can help them to visualise what that's going to look like. To hear what it's going to look like as well, because the machine does make a noise, which they really wouldn't have heard before in the outside environment. So it's good for them to experience that and get used to that before they go into the machine and be expected to lie there still for a long period of time. So there's lots of different technological things that we're able to use.
David:I guess, children, you know, certainly our children are very much due to the pandemic, as much as anything, had a lot more time with technology, with tablets, doing all their schooling online and all this kind of stuff. So actually, it's becoming more prevalent and children growing up today are going to expect certain things, I guess, in terms of just communication or distraction. Wherever they are, whether it's in hospital or at home, or at school, or whatever it might be. So I guess trying to keep up from that point of view is a challenge, but also exciting in terms of some of the additional research and opportunities that it could bring.
Grace:Fortunately, you've donated us a magic card here, so during the last 15 months or so we haven't been able to use it as much. But pre that it's been such a big change for the patients and their families. It's just something different that we can take their attention. They have that half an hour of lots of fun and the magic carpet is attractive laws and the children are able to interact with the kitchen say they're from fisheries and water and feed from their hand, to playing a football game. Thats been a real big help. We hope to get it back out and use it with our patients.
Hannah:Okay, one of the other questions we had for you was around career paths. So you've described how you both come into the profession that you're in. But is there a typical career path for being a play specialist and the questions posed to you really because to do with some of the listeners out there if there's somebody that was mulling over wanting to be a play specialist. Then what might they expect and and where could they go then?
Grace:Yeah, sure. So to become a play specialist is a two year foundation degree. Wescott and North Worcestershire are the places in the Uk that take on the course. Also, within that you also have to do the academic side of things, you have to find a two hour placement. So for the life of me, I was very fortunate that I was already at the play system. So I could do the course alongside my job but a lot of my friends from university, they dont necessarily work in a hospital at the time. So they would have to go you know, find a hospital that was happy to take on them as a student to continue the two hours, 200 hours, sorry, placements.
Jo:It was different for me because the foundation degree hadn't started when I got it but you do basically need a childcare qualification first of all and then go on to do the junior foundation degree.
David:This podcast is going to be going out during a very special week in the UK. Which is the play in hospital week. So I think I'm right in saying that you guys have submitted some ideas and you've actually been awarded the hospital to actually open it up or start it. So tell us a bit about that.
Jo:So play in hospital week happens every year and it's a celebration of children being able to play in hospital. This year we were able to submit some ideas, as to how we could launch play in hospital week. So we were very fortunate to have been chosen as the launch hospital. So we basically sent through some ideas about what we're going to do to promote the role of play in hospital, different videos that we're planning on putting together which will explain a day in the life of what a play specialist does. Some poems that we've had written about us, and lots of different ideas of things, which we plan to do. The people that looked at what we submitted, decided that we had a good plan and decided to use us to launch it, which is really exciting.
David:Fantastic. So what does that mean, in terms of the launch? Will there be lots of press and social media and what have you around it?
Grace:Yeh
Jo:Absolutely So there'll be a press release in the local newspapers and from within the hospital here on their social media sites. So that will really promote our role around the hospital for people that don't necessarily come into contact with children and play specialists. So they'll find out a bit more about what we do. The also, we've got our own soc What sort of things we've got lined up for the week ahead? al media, which we launched abo t a year ago, actually. So we' l put lots of things onto our social media to explain a bit more about what we're about,
Grace:We've planned lots of activities for the children to do throughout the week. Like Jo said, earlier, we're hoping to video one or two of our play specialists within two different departments in the hospital. Just so people can get a little insight as to what our play specialists get up to during one day, you know. Just read awareness of play specialists and what we do in our role within the hospital. We're going to do that by playing lots of display boards within our wards and hopefully, a little one out in the main foyer of the children's hospital. Just so people can see and have a little read and just to focus it on how we've changed our role through the pandemic, and made that difference to the children and been able to continue our role as play specialist from keeping that smile on children's faces in this past year.
Hannah:It strikes me that one of the benefits of the events and yourselves being the launch hospital is thinking about it from parent's point of view. But if a parents hasn't had the opportunity to experience the benefit of a play specialist role. Then I think it would really allay some concerns about, you know, the experience that their child would get whilst they were in hospital care. In terms of the other benefits, you know, what do you you want to get out of the week?
Jo:I think it's just reaffirming to other professionals what we do. People might just sometimes see that we're we're the fun people who are bringing paints to the children's beds to make a mess or just arriving with a whole array of bubbles and other bits in our hands that we're going to entertain people with. The roll is actually far more than than that. It's been proven that we can aid recovery and encourage children to take part in procedures which they wouldn't necessarily be willing to do. But if we can bring a bit of fun and distraction into it, then they allow those things to happen. So I think it's just promoting the more seriousness behind the fun side of what we do as well.
David:The week specifically is, for anyone listening to this, hopefully during that week, which is the beginning the 11th of October 2021. So I think everyone hopefully will be able to look out for not only the media and press that you guys are putting out, but just everyone that's putting things out across the UK, across the country. But of course, as we've discussed previously, we may call you play specialists in the UK, but in other parts of the world there are child life specialists and who are doing a very similar or if not identical job. So it's a good shout out for everyone. I think
Jo:Hopefully it might encourage other people to think about joining the role if its something they haven't heard of before. They've got an interest in working with children, it might be that they think, oh, let's find out a little bit more let's do an internet search to find out how to become a play specialists and possibly that it might be a way into the role for some people.
David:Lets just cover that just to make sure that people understand if they are listening and as you say, Jo, and that could be interested. What are the steps that they would need to potentially take in order to become a play specialist.
Grace:Yeah to have three years experience of working within childcare and education. Maybe a little bit of experience within either the nursery or the hospital itself would also be quite good. You apply through the Association of Health Play Specialism and there's a few areas within the UK that take on the degree. It's a foundational degree in health play specialism. It's one day a week alongside work experience, or your job role of getting the hours in to show that you able to continue this role and get the experience needed for it. It's a two year course. Then once once you've done your two years, you're qualified as a play specialist to then hopefully get a job within one of the hospitals.
David:Then there's a registration with the HPSET. Can you just tell us a little bit about what that is specifically.
Jo:So they are the people that provide us with the registration, so they're the ones that look at our portfolios every three years to make sure that we're still putting in the practice that we should be, and still learning and developing. You obviously get a whole lot of training and information initially from the course in those two years and whilst you're initially doing your workplace placement as well. But we need to with HPSET keep up to date portfolio to show that we're learning and,keeping up to date with all of the information that's out there, as we can develop our skills.
David:Fantastic and we'll make sure that we've got links to the Healthcare Play Specialist ducation Trust. Also I thin, to your social media as well and I guess if anyone's got a y questions, then they can eithe go to the trust or I guess, i deed yourselves and maybe as any questions about becoming a play specialist?
Jo:Yeah, absolutely.
David:So first of all, thank you so much, because obviously, I feel like we've taken you away from from the patients. So we really appreciate you coming on. We hope that the conversation has given some, I guess, clarity to our listeners about what it is that a play specialist does, but also the importance of those activities. We really hope in the not too distant future, that you're actually able to get back and do all of the things that I guess you enjoy doing. But you know, are really important to the children whilst they're being looked after in hospital care. The final question that we tend to ask all of our, everybody that comes onto the podcast is, if you could change one thing, if you had you had a magic wand, which seems apt in the roles that you do. if you could wave a magic wand and change one thing within child health, what would that be?
Grace:It is important that we have a lot of play specialists. We can run Monday to Friday, no magic wand needed and we would probably be okay. We need play specialists seven days a week covering full time days, saying morning, afternoon and evening. Everyone who loves to talk, we're talking A&E and everywhere else. We hope everyone has that experience with a play specialist and is able to have that positive impact from us and make that experience that little bit better.
Hannah:Thank you, Joe and Grace. Thank you very much indeed for joining us today on the Not Mini Adults Podcast. We really appreciate your time. It's been great chatting with you.
Jo:Thank you.
Grace:Yes, thank you very much.
David:Thank you so much to Jo and Grace for joining us on this week's Not Mini Adults Podcast and we wish everybody celebrating play in hospital week all the fun and joy and laughter that hopefully will come with it. Next week we will be talking about adverse childhood experiences and we are delighted to welcome Sarah Mariecos who is the executive director of Ace Research Network. If you'd like to do any pre reading then please look out for Dr. Nadine Burke Harris's book Toxic Childhood Stress. Thank you so much for listening to the Not Mini Adults Podcast. We really hope that you're enjoying it and if you are then please do leave us a review. We hope that you will be able to join us again next week.