Professional Identity as Reflected in Scope of Practice

ACLP Bulletin | Summer 2018 | VOL. 36 NO. 3

Kathleen McCue, MA. LSW, CCLS
Scope of Practice! It’s a phrase we use frequently in child life. But do we really know what it means? And more importantly, do we all agree on the meaning? When establishing a scope of practice for any profession, minimum educational or training requirements, populations to be served, and specific services to be provided are all included. Often professions look for what is unique and different about their services in order to clarify identity and separate themselves from other professions.

In the most generic sense, scope of practice is defined as “The range of responsibility – e.g., types of patients or caseload and practice guidelines that determine the boundaries within which a physician, or other professional, practices” (Scope of practice, n.d., para. 1). According to the Federation of State Medical Boards (2005), scope of practice is the: 

Definition of the rules, the regulations and the boundaries within which a fully qualified practitioner with substantial and appropriate training, knowledge, and experience may practice in a field of medicine or surgery, or other specifically defined field. Such practice is also governed by requirements for continuing education and professional accountability. (Federation of State Medical Boards, 2005, p. 19)

This definition was established to be applied to any licensed healthcare professional. However, since child life is not licensed in any state or country, it is unclear whether this definition is legally applicable to child life.

It is not surprising that we would use the phrase “scope of practice” when discussing the parameters of child life. The phrase was initiated in the healthcare field. In 2009, the National Council of State Boards of Nursing (NCSBN) published an overview of the history and issues that have arisen through the use of the concept of scope of practice. In their document, the NCSBN states, “physicians were the first health professionals to obtain legislative recognition and protection of their practice authority” (NCSBN, 2009, p. 5). As other professions were established in the field of medicine, the scope of their practice was often defined early in their history, again to distinguish the services of a nurse, a physical therapist, or a radiology technician from those of a doctor. Since child life began its existence in healthcare, the establishment of a scope of practice was a natural defining step in the development of the profession.

It is true that the public benefits from scope of practice standards, which hold any profession responsible to practice within their own areas of training and skill. It is also important to recognize that the utilization of a scope of practice designation was as much about professional self-protection as it was about professional identity. The NCSBN (2009) states:

The practice of medicine was defined in broad and undifferentiated terms to include all aspects of individuals’ care. Therefore, when other healthcare professions sought legislative recognition, they were seen as claiming the ability to do tasks which were already included in the universal and implicitly exclusive authority of medicine. (NCSBN, 2009, p. 5)

[This produced debates that were] perceived as turf battles between two or more professions, with the common refrain of “this is part of my practice so it can’t be part of yours.” Often lost among the competing arguments and assertions are the most important issues of whether this proposed change will better protect the public and enhance consumers’ access to competent healthcare services. (NCSBN, 2009, p. 3)

If our scope of practice is eclectic, utilizing facets of many different professions in an applied and preventive manner, then we should embrace that identity. If we try to become more like a problem-based service, we may be more accepted but we will lose the essential core of who we are.

There are certainly gray areas in the services provided by physicians, nurses, and various therapists and technicians, just as there are gray areas in the services provided by child life and other healthcare or mental health/development- based professions. Navigating these gray areas is often a challenge for child life: Do we hand a nurse a piece of medical equipment when she asks us to do so? When a child’s oxygen mask slips off, do we help them replace it, or call a nurse or a respiratory therapist? What words do we use in our chart notes to avoid making a mental health diagnosis such as anxiety? Is it appropriate for child life to establish a behavioral intervention program for a hospitalized child? We know that what we do would often be considered counseling by other professions. But do we call it counseling? These issues are faced by child life professionals in almost every setting, and all reflect the difficulties inherent in understanding scope of practice.

There are two places in our professional documents in which scope of practice is specifically addressed. In the Child Life Competencies, under the area titled Professional Responsibility, the first competency is “The ability to practice within the scope of professional and personal knowledge and skill base” (Child Life Council, 2011). Although there is discussion of the knowledge and skills involved in meeting this competency, there is no attempt here at a specific definition of the scope of practice for child life. This competency does state that the child life professional should have the knowledge to manage overlaps in scope of practice with other professionals.

The second set of statements about scope of practice can be found in the Child Life Code of Professional Practice. Principle 8 states, “Child life professionals have an obligation to engage only in those areas in which they are qualified and not to represent themselves otherwise, but to make appropriate referrals with due regard for the professional competencies of other members of the healthcare team or of the community within which they work” (Child Life Council, 2011). In both of these documents, it would appear that anything listed under the Child Life Standards of Clinical Practice would be within the scope of a child life professional. When looking at the 15 bulleted services under Standard III, Child Life Service, it can be seen that every single one of our standard services could be and often is included in the standard services of other professions. Establishing trusting relationships is not unique to child life. Being knowledgeable about child development is not unique to child life. Even “play” and “therapeutic play,” which we think of as cornerstones of our profession, are often provided by play therapists, recreation therapists, and pediatric occupational therapists, and are included in their scope of practice. According to NCSBN (2009), “Healthcare education and practice have developed in such a way that most professions today share some skills or procedures with other professions. It is no longer reasonable to expect each profession to have a completely unique scope of practice, exclusive of all others” (NCSBN, 2009, p. 3). So is there anything within the scope of child life practice that is unique and identity-defining and establishes a difference between child life and other professions?

Perhaps the things that define our scope of practice are neither specific services nor are they locations or populations or service provision. Rather, what makes child life unique is the philosophical focus within which most of our practice occurs. Child life is primarily preventive, proactive, and health enhancing. On a day-to-day basis, much of what we do is assess possible high-stress or development-threatening situations and provide children and families with tools to manage and cope with the challenges inherent in these difficult experiences. Comparatively, healthcare is almost exclusively reactive and problem-based. Of course, child life professionals have the ability to intervene when problems develop, such as helping a child who will not take his or her medication find an acceptable and non-traumatic method for the required medicine. But most of our work is about psychosocial health and resilience, and the maintenance of normal developmental skills across all categories. Of course, this emphasis on prevention makes it more difficult for us to fit into the healthcare field, and more difficult to develop research that assesses our impact and value. It is always easier to “prove” successful problem solving than it is to illustrate successful prevention.

Just because our scope of practice does not include procedures, actions, and processes that are unique only to child life does not mean we should veer from continuing to embrace our fundamental philosophical foundation. If our scope of practice is eclectic, utilizing facets of many different professions in an applied and preventive manner, then we should embrace that identity. If we try to become more like a problem-based service, we may be more accepted but we will lose the essential core of who we are.


Child Life Council. (2011). Official documents of the Child Life Council. Bethesda, MD: Author.

Federation of State Medical Boards. (2005). Assessing scope of practice in health care delivery: Critical questions in assuring public access and safety.

National Council of State Boards of Nursing. (2009). Changes in healthcare professions’ scope of practice: Legislative considerations.

Scope of practice. (n.d.). In McGraw-Hill concise dictionary of modern medicine.