Mary Barkey Clinical Excellence Award
Purpose: The Child Life Council Mary Barkey Clinical Excellence Award is presented to
an individual child life specialist who has demonstrated exemplary child life care and a high
level of clinical skill. Each year, the Board of Directors will consider nominations and select one
recipient, with an award presentation at the CLC Annual Conference.
ELIGIBILITY & CRITERIA
Any Child Life Council member in good standing, who spends at least 75% of his or her work
hours serving in a direct clinical role, and meets the following criteria:
A.
Demonstrates the ability to work collaboratively with other health care team
disciplines in the delivery of patient care which results in positive outcomes for
patients
B.
Models exemplary practice of child life through critical thinking, inquiry, evaluation,
and a commitment to continuous improvement
C.
Demonstrates advanced competence and an ability to provide effective interventions
in a variety of situations
D.
Models child life practice and team behaviors that acknowledge and respect the
diversity of patients/families and members of the health care team
E.
Demonstrates strong professionalism and values-driven interactions that include
clear, supportive, boundaries-sensitive, and professional relationships with patients
and families
F.
Exercises sensitivity to the individual circumstances of patients/families and provides
supporting and nurturing care
G.
Embraces and models the core concepts of patient- and family-centered care
including information-sharing to support patient/family participation, collaboration
and involvement in their care
H.
Participates in the development and incorporation of evidence-based practice
I.
Mentors new child life specialists and students in developing child life competencies
and supporting the effective transition to professional practice
J.
Actively participates as a member of the Child Life Council
Mary Barkey Clinical Excellence Award
NOMINATION PROCESS
The application is limited to twelve pages and should consist of:
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Completed Nomination Form (due August 3, 2015)
Completed Endorsement Forms by two endorsers, both of whom must be CLC
members in good standing (due September 7, 2015)
A letter of support from a current or past employer’s department head or hospital
administration (due September 7, 2015)
Exemplars of the award criteria (due September 7, 2015)
A current resume must also be submitted with the completed
Each submission should include TWO completed Endorsement Forms, ONE Exemplar, a letter
of support from the nominee employer’s department or division head or hospital administration
AND a current resume must be attached. No present CLC Board member is eligible for
nomination.
In order to build/present a strong nomination for each candidate, nominators are asked
to provide specific behavioral examples in each section of the Exemplars form. The
Awards Committee will carefully examine the information provided in order to recommend the
strongest candidate for this award. Please refer to the Submission Tip Sheet for additional
guidance on completing the forms.
SELECTION PROCESS:
Each year following the final submission deadline, the Awards Committee will review all
complete award applications, and recommend a nominee to the CLC Board of Directors, who
will choose the award recipient. All nominees and the Primary Endorser will be notified of the
final decision by early January. The formal presentation of the Mary Barkey Clinical Excellence
Award will take place during the Annual Conference on Professional Issues.
Please contact awards@childlife.org with any additional questions about the award application
or selection process.
All initial nominations must be submitted no later than August 3, 2015. All complete
entries with supporting documentation are due no later than September 7, 2015.
Submissions must be sent to awards@childlife.org.
Mary Barkey Clinical Excellence Award
NOMINATION FORM
Please type your responses into this form, save with the award nominee’s first initial and last
name (example: EPlank-Nomination), and submit it via email to awards@childlife.org. Please
contact awards@childlife.org with any additional questions about the award application or
selection process. Your inquiry will be forwarded to the chairs of the Awards Committee. All
initial nominations must be submitted by August 3, 2015 in order to be considered.
Name of Nominee:
Place of Employment:
Title:
Agency Address:
City, State Zip
Country
Work Phone:
Home Phone:
Email:
Please provide a brief breakdown of the nominee’s clinical responsibilities to ensure that 75% of
her/his work hours are in a clinical role: (Please do not attach job description, but instead highlight
how her/his time is spent in the day)
Primary Endorser Contact Information:
Endorser Name:
Phone:
Email:
NOMINATIONS MUST BE SUBMITTED BY AUGUST 3, 2015
All supporting documentation (including endorsement forms, exemplars, employer letter
of support and a current resume) is due no later September 7, 2015.
Mary Barkey Clinical Excellence Award
NOMINATION ENDORSEMENT FORM (Primary Endorser)
Please type your responses into this form, save with the award nominee’s first initial and last
name (example: EPlank-EndorsementForm1) and submit it via email to awards@childlife.org.
Please contact awards@childlife.org with any additional questions about the award application
or selection process. All supporting materials will be forwarded to the Awards Committee. In
order for an award nomination to be eligible for consideration, all supporting
documentation must be submitted no later than September 7, 2015.
Name of Nominee: ___________________________________________________________
Endorser Name:
Place of Employment:
Title:
Agency Address:
City, State Zip:
Country:
Work Phone:
Home Phone:
Email:
Supportive information is required. Refer to criteria and supply exemplars for each (see
attached Exemplars of Criteria form). Be specific in describing exemplars in each area.
Application should include two completed Endorsement Forms by two endorsers.
ENDORSEMENT FORMS MUST BE SUBMITTED BY SEPTEMBER 7, 2015
Mary Barkey Clinical Excellence Award
NOMINATION ENDORSEMENT FORM (Secondary Endorser)
Please type your responses into this form, save with the award nominee’s first initial and last
name (example: EPlank-EndorsementForm2), and submit it via email to awards@childlife.org.
Please contact awards@childlife.org with any additional questions about the award application
or selection process. All supporting materials will be forwarded to the Awards Committee. In
order for an award nomination to be eligible for consideration, all supporting
documentation must be submitted no later than September 7, 2015.
Name of Nominee: ___________________________________________________________
Endorser Name:
Place of
Employment:
Title:
Agency Address:
City, State Zip:
Country:
Work Phone:
Home
Phone:
Email:
Supportive information is required. Refer to criteria and supply exemplars for each (see
attached Exemplars of Criteria form). Be specific in describing exemplars in each area.
Application should include two completed Endorsement Forms by two endorsers.
ENDORSEMENT FORMS MUST BE SUBMITTED BY SEPTEMBER 7, 2015
Mary Barkey Clinical Excellence Award
Exemplars of Criteria
Nominee:
Endorser:
A. Demonstrates the ability to work collaboratively with other health care team
disciplines in the delivery of patient care which results in positive outcomes for
patients. Please provide a minimum of two behavioral examples of how the nominee works
collaboratively with other health care team disciplines in the delivery of patient care, explain
how this behavior results in positive outcomes for patients and describe those outcomes.
[Type response here]
B. Models exemplary practice of child life through critical thinking, inquiry, evaluation,
and a commitment to continuous improvement. Please provide a minimum of two
behavioral examples of how the nominee models critical thinking, inquiry, evaluation and
commitment to continuous improvement.
[Type response here]
C. Demonstrates competence and an ability to provide effective interventions in a
variety of situations. Please provide a minimum of two examples of how the nominee
demonstrates expertise in specific areas of child life practice and describe effective,
evidence based interventions used by the nominee in a range of situations.
[Type response here]
D. Models child life practice and team behaviors that acknowledge and respect the
diversity of patients/families and members of the health care team. Please provide a
minimum of two behavioral examples of how the nominee models child life practice and
team behaviors that acknowledge and respect diversity.
[Type response here]
Mary Barkey Clinical Excellence Award
E. Demonstrates strong professionalism and values-driven interactions that include
clear, supportive, boundaries-sensitive, and professional relationships with patients
and families. Please describe the nominee’s strong professional values. Provide specific
examples of how the nominee’s values drive his/her interactions. Please include an example
that demonstrates the nominee's professional relationships with other members of the health
care team.
[Type response here]
F. Exercises sensitivity to the individual circumstances of patients/families and provides
supporting and nurturing care. Please describe behaviors that demonstrate sensitivity to
patient/family circumstances and provide supporting and nurturing care. What does the
nominee do? How does the child/family respond?
[Type response here]
G. Embraces and models the core concepts of family-centered care, including
information sharing to support patient/family participation, collaboration and
involvement in their care. Please provide a minimum of two behavioral examples which
demonstrate a patient- and family-centered care philosophy. How did the nominee share
information and support a family in participation and decision making? How does he/she
support families in their primary roles as caregivers, and supporters of their children and
their continued participation in their child’s care?
[Type response here]
H. Participates in the development and incorporation of evidenced-based practice.
Please provide a minimum of two behavioral examples that highlight the nominee's
contributions, which may include current or past participation in research or writing project,
or applying an evidence base in his/her practice. How has the nominee changed his/her
practice over time to include the use of strategies based on evidence?
[Type response here]
Mary Barkey Clinical Excellence Award
I.
Mentors new child life specialists and students in developing child life competencies
and supporting the effective transition to professional practice. Please provide a
minimum of two behavioral examples of how the nominee provides mentoring support to
new child life specialists and students. How does he/she help new child life specialists to
develop competence? How has that resulted in an effective transition to professional
practice for the student/new child life specialist?
[Type response here]
J. Actively participates as a member of the Child Life Council. Please explain how the
nominee engages with the Child Life Council. How does he/she use membership
resources? How does he/she contribute to the growth of the profession through committee
membership and work? What contributions has the nominee made to the profession overall?
[Type response here]