Power of Play Study

Two weeks before their child's next hospital visit, Qualtrics surveys will be sent to participants' parent/guardian to capture baseline values of the dependent variables, demographic characteristics, and illness severity information. During the scheduled hospital visit, a member of the study team will be present to administer the SuperTee intervention. The child will receive their SuperTee, will be given time to play with it freely, and then will be guided through an imaginal exercise to encourage them to begin to embody their character. Following the intervention, participants' parents will receive bi-weekly text messages sent via the Mosio platform reminding them to encourage their child to wear their SuperTee. After 6 weeks, a follow-up survey will be sent to capture change on the dependent variables, feedback on the SuperTee (from parent and child), and frequency of use. After an additional 6 weeks, parents will complete a survey version of the dependent variables one final time.

The intervention will utilize the SuperTee medical garment. Each garment, in addition to being Magnetic Resonance Imaging safe and medically accessible, is designed to encourage children to embody an inspiring character, with options including a ballerina, a space commander, and Marvel superhero characters (Spiderman, Captain America, and Captain Marvel). These medical garments, which are donated to hospitals by the Fair Fight Foundation, are a relatively low-cost, portable, and easy to implement intervention for children who are undergoing a hospitalization.

This arm is the same as the Intervention arm, except they will have a delayed start to receiving the SuperTee intervention.

The intervention will utilize the SuperTee medical garment. Each garment, in addition to being Magnetic Resonance Imaging safe and medically accessible, is designed to encourage children to embody an inspiring character, with options including a ballerina, a space commander, and Marvel superhero characters (Spiderman, Captain America, and Captain Marvel). These medical garments, which are donated to hospitals by the Fair Fight Foundation, are a relatively low-cost, portable, and easy to implement intervention for children who are undergoing a hospitalization.

Parents will be asked to describe if a series of statements "never," "sometimes," "often," or "always" describe their child. Example items include "my child worries about things" and "my child is scared of the dark." This scale generates a sum score; participants' sum scores from different time points will be compared. Sum scores can range from 0 (low anxiety/better outcome) to 114 (high anxiety/worse outcome).

Parents will be asked to describe how frequently their child uses a number of both positive and negative coping strategies, with response options comprising "never," "sometimes," or "a lot." All coping strategies are asked about within three different contexts: in general, when saying goodbye, and when the child has to do something that they do not want to do. Positive coping strategies include "spend a lot of time with a good friend" and "ask a teacher for help." Negative example coping strategies, which are reverse-coded, include "keep feelings to self/not show how he/she feels" and "get stomach aches or headaches." A sum-score will also be generated from this scale; participants' sum scores from different time points will be compared. Sum scores can range from 0 (weaker parent-reported coping skills/worse outcome) to 174 (stronger parent-reported coping skills/better outcome).

Parents will be asked to describe if a series of statements "never," "sometimes," "often," or "always" describe their child. Example items include "my child worries about things" and "my child is scared of the dark." This scale generates a sum score; participants' sum scores from different time points will be compared. Sum scores can range from 0 (low anxiety/better outcome) to 114 (high anxiety/worse outcome).

Because no existing developmentally appropriate measure of psychological distancing was identified, to investigate the proposed mechanism, the study team has created an exploratory quantitative measure asking parents to report on how much their child engages in various psychological distancing behaviors when facing a difficult medical situation. For example, one item asks: "When my child is facing a difficult medical situation, they look at the situation from the outside and separate themselves from what is happening." The study team has written several items to help establish the reliability of this measure, all of which will be endorsed on a 4-point scale. An average score on the items of this scale will be created for each participant. Thus, average scores on this scale will range between 0-4 , with higher scores corresponding to higher parent-reported psychological distancing.

The study team has also created a measure to gauge parent and child reactions to the SuperTee medical garment. Parents will be asked to respond to 8 items measured on a 4-point scale, such as "My child wanted to wear the SuperTee during their hospital visit." An average score on the items of this scale will be created for each participant. Thus, average scores on this scale will range between 0-4 , with higher scores corresponding to higher parent-reported satisfaction with SuperTee. Parents will also be asked to report, on average, how many days per week their child wore their SuperTee. Parents will be asked to reply to one open-ended item ("Please use this space to write anything that you would like for our team to know about your child's experience using SuperTee"). Parents will also be instructed to ask their children four open-ended questions (e.g., "What did you pretend when you wore your SuperTee?") and will be asked to type their child's responses to these questions.