HowFarHaveWeCome-1

How Far Have We Come?

ACLP Bulletin | Spring 2021 | VOL. 39 NO. 2

Cara Sisk, PhD, CCLS
Tennessee Technological University, Cookeville, TN

Kathryn Cantrell, PhD, CCLS
Texas Woman's University, Denton, TX

In the Summer 2007 Child Life Bulletin article “But is it a Field?,” Paul Thayer reflected on the first 25 years of the child life profession. A colleague had inquired about child life asking, “Is it a field of inquiry in addition to being a profession?” The question made Thayer take pause, before concluding that the profession had a long road ahead before it could also be a field of inquiry, a phrase used to indicate an area of research. Prior to 2007, child life was considered an applied science and relied on the profession’s anecdotal patient outcomes to inform the craft. The term “field” is often colloquially used to refer to any profession. Like Thayer, we take pause because, in an emerging evidenced-based profession, “field” more appropriately defines a field of inquiry that has the goal of producing new knowledge through research. This distinction is important to the profession’s growth as it informs our priorities as a community and the way we educate emerging child life specialists. Those of us eager to consider the profession a field of inquiry are focused on documenting our profession’s outcomes in a scientific manner to ensure our evidence-based practice is contributing to new knowledge. 

Thayer suggested that we could embrace both of our identities as an applied science and an emerging field of inquiry. He challenged readers to focus on both by making “equally impressive progress in the next 25 years toward becoming a leader in pediatric psychosocial research” (p. 3). Thayer (2007) outlined five goals for growing child life as a field of inquiry over the next 25 years:

  1. emphasis on research at all levels of education,
  2. graduate education that fosters leadership and academic
    skills,
  3. preparation of child life academic teachers,
  4. continued emphasis on evidence-based practice, and
  5. built-in time for research and professional development.
This paper will consider the progress made toward reaching each of these goals by 2032 and outline future steps for nurturing the growth of child life as a true field of inquiry.


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Examination of Our Progress
To start, we highlight evidence demonstrating child life’s collective pursuit of research since Thayer’s article. A paramount concept to comprehend in this discussion is the term child life, which is generalized when it actually encompasses four distinctly significant components: (a) the emerging academic discipline, (b) the field of inquiry referring to research, (c) the profession, and (d) the professional organization. Currently, most examples are housed in the professional association, because neither child life’s academic discipline or the field of inquiry is mature enough to sustain the profession’s research.

Emphasis on Research at all Levels of Education
Thayer’s (2007) first goal was to emphasize research in all levels of education. In addition to the efforts described in Table 1, child life specialists are conducting more research with their interdisciplinary teams, students, and academic partners. The certification requirement of one research course provides child life students foundational research knowledge. As they become professionals, they carry this foundation, as well as academic relationships, into their interdisciplinary settings. As will be discussed when we look at Thayer’s third goal, academic endorsement requires full time Certified Child Life Specialist (CCLS) faculty members to hold advanced degrees. This expertise ensures that child life students have a research resource and potential mentor at both the undergraduate and graduate level. Though more growth is needed, these efforts clearly support Thayer’s goal. 

Graduate Education that Fosters Leadership and Academic Skills
Thayer’s (2007) second goal focused on graduate education for child life students. At the time his article was published, there were far fewer child life academic programs, and students were entering the profession from a number of interdisciplinary backgrounds. Today’s certification requirements allow students to earn either an undergraduate or graduate degree, and the increase in child life-specific programs ensures that students have access to Thayer’s hope for education that fosters leadership and academic skills like research. The results of his vision can be seen in a number of outcomes. There is some data to suggest that research consumption amongst child life students is increasing. In 2019, 180 students (16% of the 1100 attendees) attended the Annual Child Life Conference, the most since the certification exam was offered at conference (email correspondence on 12/2/19 from R. Spencer, ACLP Director of Professional Development). Also, students at both the undergraduate and graduate level are engaging in scholarly writing projects that draw from their leadership and research knowledge. For example, in 2017, ACLP’s Bulletin student column was created, and we have seen students sharing their writing with the community in this outlet. Of the ten Beyond the Classroom articles published since the column’s inception, there has been a balance between bachelor’s and master’s student authors, suggesting mentorship for scholarly writing at both levels of child life education.

Academic endorsement helps institutions remain focused on the goal of fostering leadership and academic skills. With curriculum that specifically draws from the child life competencies, child life students enter the profession well-prepared to be leaders within their scope of practice. Too, the Certified Child Life Specialist faculty member must demonstrate how they remain informed of professional requirements in child life academics, internships, and certification to support students’ professional development. Because of this, child life students have leadership models who are knowledgeable of the profession’s evolving standards. In addition to offering child life courses required for certification and content relevant to child life practice, child life faculty in endorsed undergraduate academic programs must also guarantee students are academically advised and professionally mentored. This way, each student engaged in learning about child life has direct support for gaining academic skills.
 

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Preparation of Child Life Academic Teachers
Thayer’s third goal related to preparing child life academic teachers. The number of CCLSs teaching in child life academic programs has increased with the number of Certified Child Life Specialist faculty earning doctoral degrees. A review of the credentials of CCLS faculty teaching in the 65 university/college programs (80 degree programs: 51 undergraduate, 29 graduate) in the Child Life Academic Programs list on ACLP’s website showed that 11 faculty members earned PhDs, two faculty members possessed EdDs, and 37 held master’s degrees.

Recognizing the importance of Certified Child Life Specialist faculty leading child life academic programs, the ACLP’s Academic Endorsement standards require one full-time CCLS faculty member hold an advanced degree and have program oversight. The faculty member’s advanced degree and full-time dedication to the academic role offers professional credibility and bolsters quality child life education, which allows for long-term sustainability of all components of child life including the field of inquiry, the emerging academic discipline, the profession, and the professional organization. Too, the Child Life Certification Commission mandates faculty teaching the child life required topics of study hold the Certified Child Life Specialist credential and have fulfilled 4000 hours of paid work experience or minimum of two years teaching child life subject matter. This requirement ensures faculty have child life clinical practice experience to benefit students’ learning. Thayer’s goal of improving the preparation of child life academics is already well-developed, and we anticipate this goal will continue to develop as the profession sustains its popularity.

Continued Emphasis on Evidence-Based Practice
Child life, formerly an applied science, once relied on professionals’ training and anecdotal patient outcomes to inform the craft. After evidence-based practice was introduced to pediatric health care (Sackett et al., 1996), it became clear child life specialists, as health care professionals, must also be able to translate new knowledge into clinically useful forms that can be implemented across systems and measured in terms of meaningful impact on practice and health outcomes. Evidence-based practice requires collaboration between contributors to the field of inquiry and those practicing in the profession. Child life practitioners must have skills integrating research into practice, while researchers must understand the practitioner’s workload so they can propose realistically replicable research.

ACLP has made strides in supporting evidence-based practice since Thayer’s publication. In 2011, Jones and Bonjour published the evidence-based practice model for child life. Later, in 2016, smaller research and scholarship committees were combined into the Scientific Advancement of Professional Practice Committee, a large work group focusing on varied research initiatives. In 2017, the Child Life Professional Data Center (CLPDC) was launched to provide access to clinical data from programs across the globe. These initiatives are responses to the growth in research engagement amongst our community. Evidence of this engagement is also seen in ACLP’s growing Resource Library which provides access to a catalogue of empirical journal articles, books, websites, and organizations related to child life that have been curated by the association. Finally, an increase in research engagement amongst our community led to the decision to separate Child Life Focus from ACLP Bulletin and rename it as The Journal of Child Life: Psychosocial Theory and Practice.

While progress has been made, this goal needs more attention in order to adhere to the idea that a field contributes to a new knowledge base. Evidence-based practice is a bridge between our applied identity and the scientific world of health care. Sharing our evidence beyond the walls of child life will help to solidify our role as an important contributor to pediatric research with novel and innovative ideas.

Build in Time for Research and Professional Development
Finally, Thayer recommended a goal of building in time for research and professional development in clinical settings. In the 2019 ACLP member survey, a lack of time was cited as the greatest barrier for not submitting writing, whether scholarly or research, to the ACLP Bulletin or Child Life Focus. Anecdotally, more clinical child life departments are protecting time for specialists to consume and conduct research; however, we need to see specific data on how this is being funded and what those roles specifically entail. Since Thayer’s publication, we are seeing an increase in child life-related publications by child life specialists in pediatric journals, implying there is more time to devote to research efforts (Boles et al., 2020). Again, this needs to be documented and program leaders need to share how these projects are supported by their health care institutions.

ACLP donor partnerships that emphasize evidence-based practice also help support efforts to prioritize research. From 2012-2014 ACLP was cumulatively awarded $1 million from Disney Citizenship to support multiple play initiatives, including a national survey on play and two studies examining the economic value of child life interventions in hospital settings. These grants enabled child life authors to take protected time from their clinical duties and focus on conducting and disseminating (Grissom et al., 2015) their research. But because child life is a small profession, we cannot depend on grant funding for each research endeavor. As such, child life academic and clinical research partnerships are essential for boosting our emerging academic discipline and improving feasibility since academics can relieve research burden. This synergy improves the speed and ease of conducting clinical research and provides students access to clinical samples for learning.

Hopes for the Future of Child Life
Evidence suggests we are making progress toward meeting Thayer’s goals for 2032. Efforts by the professional organization such as academic endorsement and the launch of The Journal of Child Life: Psychosocial Theory and Practice highlight the profession’s undergraduate or graduate degree, and the increase in child life-specific programs ensures that students have access to Thayer’s hope for education that fosters leadership and academic skills like research. The results of his vision can be seen in a number of outcomes. There is some data to suggest that research consumption amongst child life students is increasing. In 2019, 180 students (16% of the 1100 attendees) attended the Annual Child Life Conference, the most since the certification exam was offered at conference (email correspondence on 12/2/19 from R. Spencer, ACLP Director of Professional Development). Also, students at both the undergraduate and graduate level are engaging in scholarly writing projects that draw from their leadership and research knowledge. For example, in 2017, ACLP’s Bulletin student column was created, and we have seen students sharing their writing with the community in this outlet. Of the ten Beyond the Classroom articles published since the column’s inception, there has been a balance between bachelor’s and master’s student authors, suggesting mentorship for scholarly writing at both levels of child life education.

Academic endorsement helps institutions remain focused on the goal of fostering leadership and academic skills. With curriculum that specifically draws from the child life competencies, child life students enter the profession well-prepared to be leaders within their scope of practice. Too, the Certified Child Life Specialist faculty member must demonstrate how they remain informed of professional requirements in child life academics, internships, and certification to support students’ professional development. Because of this, child life students have leadership models who are knowledgeable of the profession’s evolving standards. In addition to offering child life courses required for certification and content relevant to child life practice, child life faculty in endorsed undergraduate academic programs must also guarantee students are academically advised and professionally mentored. This way, each student engaged in learning about child life has direct support for gaining academic skills.

The Academic Discipline of Child Life
Child life is emerging as an academic discipline as the field of inquiry continues to grow, providing evidence that the child life profession’s scope of practice has value. This necessitates an increase in research literacy amongst the community responsible for maintaining this data. Child life academic programs continue to work toward enhancing their clinical research training so more students contribute to the field of inquiry. Emphasizing practical, clinical research methods offers students a foundation of skills to use in their future practice. When they enter the profession, they bring with them knowledge of how to contribute to a field of inquiry as well as relationships with academic mentors. Because the academic discipline is only emerging, it is essential that these relationships between clinical child life specialists and academic mentors are well nourished so the momentum for collaboration pushes us closer towards Thayer’s vision.




We encourage practicing child life specialists to tap into their natural curiosities observing, wondering, questioning, and assessing with research structure to support our field of inquiry. A future hope would be for clinical program child life leaders to have support to provide their teams research training and protected time to conduct research.
The Profession of Child Life
A primary hope for the future of the child life profession is that we continue to passionately and professionally serve children and families experiencing stressful life events. Increasing diverse perspectives will enhance the research produced that informs practice. The profession’s focus on diversity, equity, and inclusion will bolster our research as diversity of practitioners and educators within research are all needed to achieve the highest level of professional quality. We also noted one area of growth is Thayer’s fourth goal of promoting evidence-based practice. As a profession, we can support the evidence-based practice skills of our colleagues, trainees, and selves by accessing professional development that translates research into practice, teaches us how to consume research, and encourages us to disseminate our work outside of the child life silo.

The Professional Organization of Child Life
ACLP supports the child life profession by providing a structure for credentialing, access to evidence-based practice recommendations, a code of ethics, and resources for peer connection. The Journal of Child Life: Psychosocial Theory and Practice is an example of an ACLP resource designed to support child life’s field of inquiry. By emphasizing interdisciplinary collaboration and peer-review, the publication establishes itself as a vehicle for sharing the latest inquiry on pediatric psychosocial care. However, this publication is primarily accessible to ACLP members and not searchable on scientific databases such as PyschInfo or Google Scholar. In order to share our work with others in pediatrics, a future hope for our profession is to continue seeing more child life specialists publishing outside of our professional organization in interdiscinplinary journals and collaborating with other pediatric providers to produce research that will advance our field of inquiry.

Conclusion
In 2007, Paul Thayer was asked two important questions: “How does child life develop a new body of knowledge?” and “Is child life a field of inquiry in addition to being a profession?” These questions compelled us to consider how far child life has come in the past 13 years. Coincidentally, it is a mid-point progress report to Thayer’s question: “Can we make equally impressive progress in the next 25 years toward becoming a leader in pediatric psychosocial research?” (2007, p. 3). As summarized above, it appears child life has made progress as a field of inquiry impacting the emerging academic discipline, profession, and professional organization.

Child life’s current challenge is to continue making positive contributions in each area of our collective identity as we pursue research that benefits not only our field of inquiry, but especially the children and families we serve. Helping people is the primary motivating factor that drives child life professionals to provide best practices in psychosocial care, advocate for changes to create optimal health care experiences, and face challenges that promote professional development. Translation of these clinical elements into motivations that fuel child life research is pivotal for all aspects of child life to thrive. Let’s not wait another 25 years, but focus to accelerate our progress in building a child lifespecific body of knowledge within the next ten years. With this goal in mind, child life professionals must ask themselves, “How can I contribute to building child life’s field of inquiry through research?”


REFERENCES:

Association of Child Life Professionals (2019). Vision, mission, and values. https://www.childlife.org/about-aclp/purpose-mission-values

Boles, J. C., Fraser, C., Bennett, K., Jones, M., Dunbar, J., Woodburn, A., Gill, M. A., Duplechain, A., Munn, E. K., and Hoskins, K. (2020). The value of certified child life specialists: Direct and downstream optimization of pediatric patient and family outcomes. www.childlife.org

Grissom, S., Mandrell, B., Browne, E., Boles, J., Bailey, K., Cantrell, K., Kennedy, A., Lekhy, C., & Yuan, Y. (2015). The impact of play-based procedural preparation and support intervention for children undergoing cranial radiation for treatment of a central nervous system tumor. Supportive Care in Cancer, 24(6), 2421-2127.

Jones, E., and Bonjour, A. (2016). Step 1: Assess practice need. ACLP Bulletin, 34(4), 26.

Sackett, D. L., Rosenberg, W. M., Mur Gray, J. A., Haynes, R. B., & Richardson, W. S. (1996). Evidence based medicine: What it is and what it isn’t. BMJ, 312, 71-72.

Sisk, C., and Burn-Nader, S. (2020). The 411 of child life in higher education. ACLP Bulletin, 28(2), 22–25.

Thayer, P. (2007). But is it a field? Child Life Council Bulletin, 25(3), 3.

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