The Game That Heals!

Gloria Kriete Foundation in alliance with Fundación Niñez Primero

Over the past 18 years, the Gloria Kriete Foundation has impacted more than 3,200,000 Salvadorans in health, education, job training, community development, entrepreneurship, technology, innovation, and the environment.

One of the six programs financially supported by the Gloria de Kriete Foundation in partnership with the Fundación Niñez Primero is the "Gloria de Kriete" Ludoteca Naves Hospitalaria (Glora Kriete Hospital Playroom).

The Fundación La Niñez (FUNIPRI) was established as a non-profit organization in September 2002, with the primary goal of promoting the right to recreation for children in El Salvador.

Through play, the foundation encourages the physical, social, and emotional development of children, promotes the proper use of free time, and supports the prevention of social risks, primarily gangs or drugs.

FUNIPRI aims to contribute to the construction of a healthier, safer, and more peaceful society. To achieve this, they provide services through five types of ludotecas (Playrooms): Hospital, Mobile, Therapeutic, School, and Penitentiary.

The "Gloria de Kriete" Ludoteca Naves Hospitalaria (Gloria Kriete Hospital Playroom) was established in October 2005 at the Hospital Nacional de Niños Benjamín Bloom, the only public tertiary pediatric hospital in El Salvador.

 It is a pioneering model in Central America, based on therapeutic care through playful interventions aimed at children and adolescents hospitalized due to accidents, illnesses, and complications requiring medical studies. The work is complemented by a permanent training program provided to medical and nursing staff, among others. It has a multidisciplinary team of professionals who cover 13 medical specialties, focusing on emotional recovery, critical care, and palliative care.

Mental health remains a weak area in the care of pediatric patients with rare diseases, with very few personnel in public mental health systems able to respond to this need. In many hospitals, care remains primarily biologically focused. 

In El Salvador, in 2023, the Hospital de Niños Benjamín Bloom, the only tertiary pediatric care facility, officially attended to 10,981 patients diagnosed with conditions such as coagulation disorders, cancer (leukemias, lymphomas, and tumors or sarcomas), tubulointerstitial nephritis, cystic fibrosis, Tetralogy of Fallot, Arnold-Chiari syndrome, Meckel's diverticulum, renal diseases, systemic lupus erythematosus, stroke, Kawasaki disease, and Werdnig-Hoffmann disease, among others. Of these, 424 patients died in the hospital that year.

Poor mental health can amplify the effects of disease in pediatric patients and their families, potentially leading to treatment abandonment, school dropout, discrimination, emotional disturbances (low self-esteem, guilt, frustration, depression, anxiety, loss of life's meaning, suicidal behaviors), and rapid disease progression.

Common factors contributing to the problem include a shortage of mental health professionals trained in pediatric psychology and specialized in psychotherapeutic and social management of populations with complex diseases, limited health system budgets for mental health investment and hiring trained personnel, lack of programs aimed at mental health care, and a shortage of facilities and specialized professionals. Unfavorable social conditions, such as family disintegration and abandonment by one parent, further exacerbate the issue. These factors culminate in significant mental health problems within the pediatric health context in the country.

The increasing prevalence of mental disorders in children and adolescents requires an adequate response from the health system. Care centers must be equipped to address this growing demand by providing specialized personnel and resources to meet these needs.

Additionally, mental health disorders are much more frequent in individuals with rare diseases. It is estimated that 69% show symptoms compatible with depression and more than 80% experience stress and anxiety, far higher than the 17% in the general population.

Ludoteka Naves hospitalarias "Gloria Kriete" aims to address the lack of mental health care coverage in other hospital specialties where patients in delicate conditions are admitted, providing emotional support to caregivers from the admission of their family member until discharge or in cases where the patient passes away due to the severity of their condition.

Playful intervention involves the implementation of games and recreational resources that promote good mental health, emotional release, and adaptation to the hospital environment. The solution focuses on different areas: 

a) Hiring personnel.

b) Improving infrastructure.

c) Expanding care.

d) Providing recreational tools. 

Strengthening a team of specialists is essential to cover the total demand for mental health in the pediatric hospital of El Salvador.

Mental health care for patients and caregivers during hospitalization is crucial to prevent future relapses and provide support during invasive procedures, such as amputations or surgeries where the patient's organs may be exposed as part of the treatment.

The innovation of this work focuses on using a mix of playful therapeutic tools that adapt to the particular needs of each patient, considering their illness, medical condition, and emotional state, while also taking into account their caregiver and medical staff.

Our core activities within the hospital are:

• Therapeutic Play Care sessions: Therapeutic play care sessions directed at healthcare personnel (1-hour class).
• Play Care Sessions for Caregivers: Play care sessions for caregivers (30-minute sessions).
• Psychological Support: One-on-one psychological support for patients in critical health conditions or end-of-life stages.
• Healthcare Personnel Training: Training for healthcare personnel (Workshops or curricular classes that are part of the training for hospital staff being trained as specialists. Two classes and three workshops are conducted monthly).
• Mental Health Workshops for Caregivers: Mental health workshops for patient caregivers (six workshops per month based on demand).

Our target population consists of pediatric patients from newborns to twenty-one years old with rare diseases who do not receive emotional support, nor do their families. They lack the spaces and conditions to engage in age-appropriate mental health activities, are limited in social interaction, and are separated from their meaningful and everyday contexts. The impact of their solution is primarily directed at the patients, secondly at the caregivers, and thirdly at the healthcare teams.

Patients: The program promotes good mental and emotional health, attachment and cooperation with treatment, adaptation to the hospital environment, and adaptation to their health condition, thereby improving their quality of life in the hospital context.

Caregivers: It enhances their understanding of the disease, provides emotional relief, psychoeducation, and improves communication with the treatment team.

Healthcare teams: It strengthens communication skills, promotes interdisciplinary and holistic care, and fosters a healthy and efficient relationship between patients, caregivers, and the treatment team.

The solution addresses the need for emotional support through playful intervention, delivered by a trained team equipped with the necessary infrastructure and recreational tools. This approach supports the recovery process, complements medical treatment, and provides support tools for caregivers and medical staff.

¡We want to grow and expand!

Our Ludoteca NAVES Hospitalarias program was established in 2005 thanks to Gloria Kriete Foundation at the Hospital Nacional Pediátrico Benjamín Bloom, initially providing playful interventions and mental health care in Orthopedics and Oncology, attended by two professionals. The positive impact on patients, caregivers, and healthcare personnel quickly became evident. Since then, more professionals have joined the team, allowing us to expand our services and even extend the project to other national hospitals: Hospital San Rafael (2017) and Hospital San Juan de Dios in Santa Ana (2018).

Currently, we provide services in 13 hospital specialties, covering an estimated 75% of the hospital attendance capacity. This expansion is also made possible by our permanent program of volunteers and social service students, which has been consolidated throughout our history. 

Our team has been trained in various areas of playful and hospital care, including pediatric palliative care, humanized care, timely stimulation, and art therapy, among others. Additionally, we have formalized our relationships with the hospitals through agreements and contracts for the implementation of playful interventions in hospital settings.

Our experience in playful approaches in hospital environments positions us as pioneers at the regional level. The total population benefited (2005-2023) so far are close to 150,000 Salvadoreans. 

In brief, our greatest achievements so far are:

• Systematization, Writing, and Launch of the Book "The Healing Play": Luanched in 2023, the book is a compilation of 18 years of experience in hospital play intervention.

• Infrastructure Adaptation: Modifying the operational space to facilitate the project's implementation within the pediatric hospital. Including a proper place for caregivers to process bad news. 

• Development of Volunteer Student Cohorts: Developing four cohorts of volunteer students who completed the specialized diploma in play intervention for children and adolescents. Annually, we work with approximately 517 volunteers.

• Committee Membership: We are members of the committees for palliative care, breastfeeding, humanized care, mental health, and the specialist training unit for intensive care at Bloom Hospital (a connection that is difficult to achieve; the hospital sees us as part of their holistic care approach).

The Ludoteca NAVES Hospitalarias program innovatively addresses the lack of mental health care for pediatric patients by integrating playful interventions into their treatment. This approach not only supports emotional recovery but also enhances the overall hospital experience for children, their caregivers, and healthcare staff. 

By fostering a holistic environment, the program can inspire broader adoption of therapeutic play in other healthcare settings. This model can shift the market towards more comprehensive care, emphasizing mental and emotional well-being alongside traditional medical treatment.

We are a playful intervention program with a unique methodology in the country and the Central American region, developing a playful care project in a tertiary-level hospital to address the mental health of patients and caregivers. Our systematic methodology includes impact measurement, care protocols, and constant learning, making it replicable in other countries.

¡We cover 75% of the target population and we want to cover 100% of the hospital needs!

With our proposal, we aim to achieve 100% coverage at the NNBB hospital by enhancing care through continuous process improvement, expanding facilities, hiring staff, and re-equipping. This would serve as the catalyst for our proposal, benefiting more children and adolescents with rare diseases.

We are applying for this award with the primary goal of benefiting pediatric patients and their caregivers by improving their quality of life, regardless of their disease diagnosis, during hospitalization, which can range from one day to several months in some cases.

As an organization that works and collaborates with donors, it is important to ensure financial stability and sustainability. Winning this award would provide the capital injection needed to expand our programs to achieve 100% coverage for patients with rare diseases. This would help us promote mental health, a culturally and socially undervalued topic. All of this would positively impact the lives of pediatric patients with rare diseases and their families.

Specifically, we will use the funds for three objectives:

1. Office Adaptation: To adapt the central offices for the team of volunteers we are training through our initiative (40% of the received budget). ¡We need more space, we have managed to have more than 500 volunteers per year!

2. Hiring Specialists: Hiring two specialist therapists in play intervention for patients with rare diseases for three years to expand our technical capacity (40% of the budget).

3. Technology Integration: Incorporation of technological tools in our play interventions (20% of the budget). This includes purchasing virtual reality or augmented reality devices that could be used in play sessions.

Since 2005, we have worked at the Hospital Nacional de Niños de El Salvador, the only one of its kind in the country. The project has been led by the executive director, with the support of competent professionals specialized in pediatric palliative care, timely stimulation, clinical psychology, laughter therapy, pediatric psychology, psychosocial care for patients with coagulation disorders, and psychological care for critically ill patients. Professionals operate under a general plan, adapting interventions to the patients' conditions and characteristics.

Our close proximity to beneficiaries results in a high level of acceptance and satisfaction with our emotional psychological care. Our team is recognized as a reference in mental health and pediatric patient care.

The design, management, and implementation of our program are based on the needs of our beneficiaries, ensuring timely, holistic, and effective psycho-emotional care. As program leaders, we have facilitated the creation of video and illustrative resources to aid in understanding and adapting to diseases, making information more comprehensible for our beneficiaries.

It is worth highlighting that the three greatest strengths of the team are:

1. Highly Trained Staff: The team participates annually in various congresses, receives certifications, and constantly updates their knowledge in the specialties we address, including the play aspect.

2. Personal, Human, and Ethical Commitment: The team is deeply committed to our mission on a personal, human, and ethical level.

3. Emotional Intelligence and Resilience: The team has accumulated emotional intelligence and resilience over the years, which is essential for fostering the mental health of our patients.

4. Strong Connections: We have established strong connections with hospital members, allowing us to integrate into care units as an integral part of patient treatment.

General Impact goal for next year:

Increase the emotional and mental health support coverage for pediatric patients in the Hospital Nacional de Niños Benjamín Bloom up to 100% of target population

Specific goals

Objective 1: Implement playful and therapeutic sessions to promote treatment adherence, grief management, and care for critical patients. Success Indicator: Conduct 15,000 playful interventions for the mental health of pediatric patients. Attend to 7,000 hospitalized patients.

Objective 2: Provide training for doctors and nurses at HNNBB in best practices for humanized care and mental health. 

Success Indicator: Conduct 45 training workshops for healthcare personnel, benefiting 500 Salvadorans, including medical staff and nurses.

Our 5 year plan

Extend Permanent Care: Extend permanent care to the specialties of Infectiology, Intermediate Care, Emergency, and the Dengue Unit, adding up to 5000 attentions per year to our work.

Hiring of Professionals: Hire two trained professionals to meet the demand for care in the missing specialties, particularly for rare diseases.

Training Program: Train 120 students on therapeutic play intervention for children and adolescents.

Infrastructure Expansion: Expand the infrastructure to provide an adequate space for the project's operations.

Key important specific indicators

-Percentage of patients showing improved mental health indicators (measured through pre- and post-intervention assessments).

-Increase in treatment adherence rates among patients involved in the program.

-Decrease in instances of emotional disturbances (such as anxiety, depression) among patients

-Improvement in overall health and quality of life for patients and their families, measured through follow-up surveys and health outcomes.

The theory of change for the Ludoteka Naves Hospitalarias "Gloria Kriete" project posits that implementing playful interventions, hiring specialized personnel, improving infrastructure, expanding care, and providing recreational tools will enhance emotional support and adaptation to the hospital environment for pediatric patients and their caregivers. This, in turn, is expected to lead to improved mental health, reduced emotional disturbances, higher treatment adherence, and better overall health and quality of life for the patients and their families.

In simple terms our theory of change is built in the following way:

Inputs

• Funding for hiring specialized personnel.
• Budget for improving hospital infrastructure.
• Grants for program expansion and development.
• Trained mental health professionals (psychologists, therapists).
• Volunteers and social service students.
• Recreational tools and equipment for therapeutic play.
• Educational and training materials for staff and caregivers.
• Data collection systems for monitoring and evaluation.
• Research and evidence-based practices in pediatric mental health.
• Training programs and workshops for staff and caregivers.

Activities:

• Therapeutic Play Care: Therapeutic play care directed at healthcare personnel (1-hour class).
• Psychological Support: Psychological support for patients in critical health conditions or end-of-life stages.
• Healthcare Personnel Training: Training for healthcare personnel.
• Mental Health Workshops: Mental health workshops for patient caregivers.

Outputs:

• Hire Specialized Personnel: Bringing in trained professionals to provide care.
• Improve Infrastructure: Upgrading facilities to better support mental health activities.
• Expand Care: Increasing the reach and capacity of the program.
• Provide Recreational Tools: Supplying necessary materials for therapeutic play.

Short-term Outcomes:

• Enhanced Emotional Support: Immediate emotional benefits for patients and caregivers.
• Better Adaptation to Hospital Environment: Helping children adjust to being in the hospital.

Long-term Outcomes:

• Improved Mental Health: Sustained mental health improvements for patients.
• Reduced Emotional Disturbances: Lower instances of negative emotional effects.
• Higher Treatment Adherence: Increased cooperation with treatment plans.
• Better Overall Health and Quality of Life: Comprehensive improvement in the well-being of patients and their families.

The team consists of 13 people (10 psychologists, 2 physiotherapists, and 1 sanitation worker) who work full-time, 8 hours a day, Monday to Friday. Additionally, there is a permanent internship program with 3 young trainees.

Our staff enjoys being part of our team. We have a team with a cumulative longevity in the program equivalent to 127 years. On average, staff members complete a cycle of 9.76 years within the organization.

 There is also a social service and volunteer program that brings an average of 40 young people per day to carry out playful interventions and mental health care at the hospital. We work with approx. 500 volunteers per year!

Currently, we have been working on our program for 19 years, during which we have updated, innovated, and modified our interventions to meet the needs of our beneficiaries and incorporate new strategies and tools. Over the years, this work has included studying rare diseases to ensure our interventions are impactful within that context.

Our team is composed of diverse professionals from various backgrounds and beliefs, fostering inclusion and respect for individual differences. We have rules and regulations to govern and manage risk behaviors, including PEAS-UN and operational manuals, and an internal regulation promoting peaceful and cordial coexistence. Our facilities are designed to ensure comfort and functionality according to the needs of our team. The program involves 9 women and 4 men.

Collaborators have opportunities for academic training funded by the organization, support for attending conferences and technical update sessions, and spaces for self-care both within and outside the institution, promoting professional growth.

We create opportunities for students with physical disabilities or specific health conditions (hemophilia, transplant recipients, functional affective disorders) to complete their social hours and promote gender equality without discrimination.

Social Business Model Canvas for Hospital Bloom Naves Hospitalarias "The game that heals"

Key Resources

• People: Highly trained staff, including psychologists, therapists, and volunteers.
• Finance: Grants, donations, revenue from book sales, training services, and event organization.
• Access: Partnerships with hospitals and health institutions that allow us to carry on our mission.

Key Activities

• Therapeutic play 1:1 interventions for pediatric patients.
• Psychological support for patients and caregivers.
• Training healthcare personnel.
• Organizing academic and training events for other interested stakeholders.

Type of Intervention

• Workshops: For caregivers and healthcare personnel.
• Sessions: Therapeutic play care and psychological support.
• Products: "The Healing Play" book and training materials for other academic activities.

Partners + Key Stakeholders

• Partners: Hospitals (e.g., Benjamín Bloom Hospital, Hospital San Rafael, Hospital de Santa Ana), health ministries, and 03educational institutions like local universities.
• Stakeholders: Donors, volunteers, healthcare professionals, patient families.

Segments

• Beneficiaries: 
  • Pediatric Children admitted to the National Children's Hospital Benjamín Bloom with rare diseases
  • Caregivers of admitted patients
  • Healthcare personnel of the hospital
• Costumer: Health providers and institutions, and organizations needing training services to incorporate our approach to their own therapeutical insight.

Value Proposition

• Beneficiary value proposition:
  • Improve mental health and emotional well-being of pediatric patients and their caregivers through an innovative and playful holistic approach.
    • Impact Measures: Number of patients and caregivers served, mental health improvements, feedback from beneficiaries.

• Customer Value Proposition: The development of the play methodology that we have implemented in our projects has been supported and shared through the creation of various books and manuals, which develop standardized protocols and techniques for the implementation of this methodology by other users. 

Channels

• Direct Engagement: In-hospital interventions, workshops, and training sessions.
• Online: Book sales through Amazon, virtual training programs, and webinars.
• Events: Academic conferences and training workshops.

Cost Structure

• Major Expenditure Areas: Salaries for staff, training materials, event organization, infrastructure adaptation, and technological tools.
• Scaling Costs: Increased staff and resources to cover more hospital specialties and patients.

Revenue

• Sources:
  • 70% from privately owned sources and grants and donations.
  • 30% from book sales and training services.

Surplus

• Investment Plans: Reinvest in expanding services by hiring specialized team members, improving infrastructure, and acquiring new therapeutic tools and technologies.

As an organization and professionals, we have extensive experience in project formulation, management, and implementation. With 22 years of experience, we have worked with local organizations such as Fundación Gloria Kriete, Fundación Lolo, Fundación Rafael Meza Ayau, Phenix Tower, the Ministry of Health, and the Ministry of Education, as well as international organizations like USAID, UNICEF, and Irish Aid.

One of our fundamental pillars is transparency in fund management and effective accountability to our donors. As part of our sustainability plan, we sell services to donor organizations or fund managers and create joint work agreements where project execution includes a margin for our organization's operation. Additionally, we develop academic activities, such as conferences and professional update sessions, and create and sell resources like books and playful materials. Another strategy we have used is offering training services to various entities.

We are venturing into other income-generating methodologies:

1. Book Sales: Selling our book "The Healing Play," which is currently available on Amazon.

2. Training Services: Offering training services based on the accumulated knowledge of our team to other organizations and institutions that serve patients with similar profiles.

3. Event Organization: Organizing academic and training events, such as the organization of the 1st Mental Health Congress.

Our book is on amazon!

Our 1st congress organized for this year.