The Landscape of Child Life in Canada: 

Big Country - Diverse Programs

ACLP Bulletin | Summer 2020 | VOL. 38 NO. 3

Joan Turner, PhD., CCLS
Mount Saint Vincent University, Halifax, Nova Scotia

Chantal LeBlanc, MHS, CCLS
IWK Health, Halifax, Nova Scotia

Lois Wolgemuth, BA, CCLS
Stollery Children's Hospital, Edmonton, Alberta

Cathy Humphreys, MSc, CCLS
MSC Child Life & Pediatric Psychosocial Care, Hamilton, ON

Allison Sohanlal, MSc, CCLS
McMaster University, Hamilton, ON

Canada has had a unique and foundational role in the establishment of the profession of child life, seeing growth and evolution of programs over the past 35 years and providing services to a widely dispersed population across the provinces and territories. Early child life programs were established in tertiary care hospitals located in large urban centres, each serving a large catchment area that encompassed rural and remote northern communities. Today, child life programs also thrive in suburban and rural areas, serving a diverse population that reflects the multicultural fabric of our society. Hospital play programs in Canada and the United States were developed through close collaborations among early pioneers from various child development and education backgrounds, which later led to the establishment of the Child Life Council (Turner & Brown, 2014). Remarkable characteristics of Canada, including the vast geography, diverse population, and unique commitment to multiculturalism and universal health care have had a significant impact on the delivery of child life services across the country.

What Is the Population of Canada?

Population growth was high during the later half of the 20th century due to the baby boom (1946-1965) and strong migration into Canada. By 1959, the population of Canada reached 17.5 million. According to Canadian Demographics at a Glance, Canada experienced a larger baby boom than other G8 countries, resulting in a younger population (Statistics Canada Demography Division, 2016). Further comparison to G8 countries shows that between 2005 and 2010, Canada showed the strongest annual average population growth rate, about 1.1%, due to greater rates of immigration. The Canadian population of 37.5 million (World Population Review, 2019) is close to that of the state of California and includes eight million children and youth (UNICEF Canada, 2019). Presently, immigration contributes significantly to the population growth and is attributed, in part, to inclusive Canadian perspectives such as multiculturalism, immigration, and refugee resettlement policies. 

Where Do People Live In Canada?

Canada extends over 9.9 million square kilometers and is geographically the second-largest country in the world. Canada extends from the Arctic Ocean in the north to its border with the United States in the south, and from the Pacific Ocean in the west to the Atlantic Ocean in the east. Canada is made up of ten provinces and three territories; however, most Canadians live in a narrow belt near the southern border, leaving large sparsely inhabited regions in the north. According to World Population Review (2019), the overall population density of four people per square kilometer is contrasted with much higher density in urban centres. The city of Toronto, for example, has 2,930 people per square kilometer. In fact, more than half the population live in the multiple urban centres located in the provinces of Ontario and Quebec.

What Does Multiculturalism Mean In Canada?

Multiculturalism is an important component of Canada’s landscape. In 1982, the Canadian Constitution adopted a “Charter of Rights and Freedoms” to protect multiculturalism (Canadian Immigrant, 2013). Diversity is part of our country’s identity. While English and French are the official languages in Canada (Office of the Commissioner of Official Languages, 2019), there is significant diversity in cultures, ethnic groups, and languages among its residents. This is not just a result of refugee resettlement or immigration, but due to Canadians’ belief in “the importance of preserving and enhancing the multicultural heritage of Canadians” (Government of Canada, 2014).

Canada is known for its refugee and humanitarian resettlement programs, particularly for Syrian refugees over the last few years. In addition, refugees from Nigeria, Haiti, India, and Mexico rank highest for their resettlement in Canada (Immigration and Refugee Board of Canada, 2019). Additionally, there are more than 1.4 million people in Canada who identify as indigenous persons and more than 600 First Nations communities that are represented by more than 60 indigenous languages (Government of Canada, 2018). Therefore, providing respectful services and supports tailored to the cultural needs of children, youth, and families is an important element of child life services.

How Is Health Care Delivered Within Canada?

Given the distribution of the population, it comes as no surprise that tertiary health care centres are primarily located in areas with the highest concentration of people. Thirteen large urban centres are home to children’s hospitals. Access to health care is publicly funded, universal to all Canadian residents, and portable when travelling within Canada for medically necessary hospital and physician services (Government of Canada, 2016). Canadians receive medical care without paying out of pocket; however, the vast size of our country can lead to times when travel is needed in order to obtain specialized health care services. Acknowledgement of the additional stress on those children, youth, and families traveling or relocating to large urban centres for health care is reflected in the services provided by child life programs across the country.

"Pioneers in the Canadian Child Life field have been involved since the beginning... Canadians made up 50% of the first Child Life Council Board of Directors and were integral in the development of academic and clinical training standards."

- LeBlanc, 2018, para. 2

What Does Child Life Look Like Across Canada?

The Association of Child Life Professionals’ Archives in Utica, NY, documents the early play and education programs in North America and notes the establishment of Montreal Children’s Hospital in Quebec in 1936. More than 40 years later, the Canadian Pediatric Society “Child in Hospital” resolution advocated for organized play facilities, child life professionals to meet the psychosocial needs of hospitalized children, and open visiting policies and rooming-in facilities in pediatric units for Canadians (C. Humphreys, personal communication, January 14, 2020). Confirmation of this early commitment can be found in Larsen (1978): the Canadian Institute of Child Health reported that of the 180 general hospitals caring for pediatric patients in 10 provinces, 93% had play spaces and 37% of the play spaces had salaried staff (1977, cited in Larsen, 1978); and Post reported there were nine Canadian pediatric hospitals in 1978, all with dedicated play spaces and salaried staff (1978, cited in Larsen, 1978). Subsequently, child life programs at children’s hospitals across Canada have been established to provide
services to vast catchment areas including northern communities. Today, Certified Child Life Specialists, non-certified child life specialists, and child life assistants can be found across the country.

Children’s hospitals which are also teaching hospitals have the largest child life programs in Canada compared to the programs located in regional or general hospitals across the country. Currently, there are 13 dedicated children’s hospitals in Canada providing specialized tertiary care for the pediatric population. Several provinces have one children’s hospital serving the entire province and beyond (e.g., British Columbia, Saskatchewan, Manitoba, each with additional catchment areas that include service to northern communities such as the Yukon Territories, Northwest Territories, and Nunavut). 

Figure 1
Number of Certified Child Life Specialists by Province/Territory
However, the greatest growth in hospital-based child life programs is in smaller-community regional and general hospitals where children and youth receive primary and/or acute care closer to their homes. Approximately 77% of known Canadian hospital-based child life programs have one to three child life specialists on staff, with an average of 10 to 15 Certified Child Life Specialists in the larger programs, with some supported by child life assistants. The largest program is located at McMaster Children’s Hospital, with a complement of 30 plus Certified Child Life Specialists. 

Figure 1 presents the number of Certified Child Life Specialists across Canada (Association of Child Life Professionals, personal communication, September 16, 2019).

Education and training opportunities for child life specialists in Canada have adapted to the changing scope of practice and the increasing opportunities outside of tertiary health centres. Originally offering a post- accalaureate child life diploma starting in 1989, McMaster University now prepares graduates with a Master of Science in Child Life and Pediatric Psychosocial Care. Two streams of study are offered: preparation for child life certification and advanced practice in psychosocial care for Certified Child Life Specialists, nurses, physicians, psychotherapists, and others. Recently, the University of the Fraser Valley in British Columbia established a Child Life and Community Health graduate certificate program.

Canadian child life specialists provide child life services in a range of program settings beyond the hospital. For example, community organizations with specific child life programming include Ronald McDonald Houses, Gilda’s Club, Kids’ Cancer Care, Calgary & Area Child Advocacy Centre, Nanny Angel Network, Rotary Flames House, St. Joseph’s Hospices, Kids Health Links Foundation’s Upopolis Program, and Camp Brigadoon. Several Certified Child Life Specialists work in private practice. Many others work in the community or academia, applying their child life skills though they may not hold the job title of a child life specialist (e.g., behaviour specialists, grief and palliative care counsellors, infant mental health specialists). 

"There is really great work happening in community hospitals. We have to share our best practices with others."

- Peggy Wheaton

Access to Child Life Services for Smaller Communities

Three child life leaders across Canada, working in different health care settings, were interviewed to discuss the current focus of child life work in their communities. Each spoke to the provision of appropriate services and supports tailored for children, youth, and families, and acknowledged their needs in accessing health care in their communities.

Working in one of the most culturally diverse communities in Canada, Alex Christofides, MSc, CCLS, spoke to the need to adapt to population changes, given the increasing number of newcomers to Canada and refugees settling in the Toronto area (A. Christofides, personal communication, September 6, 2019). As a result of this influx, the hospital requires yearly staff training related to cultural diversity and inclusion. The introduction of technology at Humber Regional Centre in Toronto, Ontario offers opportunities to accommodate diversity in innovative ways. The “interpreter on wheels” provides the flexibility of bringing a tablet attached to a rolling pole to the patient/family and utilizing a live interpreter via an online interpretive service. Similarly, Pepper, the hospital’s humanoid robot, has a tablet that a child life specialist can use for preparation and teaching; Pepper has also been found to be effective in supporting patients with autism spectrum disorder during procedures and as they go into the operating room. According to Alex, the outcome of integrating technology into practice “is spectacular.” The child life specialists at Humber Regional Centre use Pepper to facilitate modelling what the child needs to do, and children want to copy what the robot does. 

Pepper, a humanoid robot used for preparation and support.

Child life was integral in the development of the Pediatric Observation and Assessment Unit program in Moncton, New Brunswick, a unique intitiative designed to improve the care provided to patients with behavioural and mental health challenges. Peggy Wheaton, BCS, B.Ed, CCLS, spoke of bringing the perspective of typical child development, the importance of play, and the need for expressive outlets, as well as individualized patient-and family-centred plans of care, to the pediatric and psychosocial team at Moncton Hospital Regional Centre (P. Wheaton, personal communication, September 9, 2019). Peggy emphasized, “Our voice and tenacity can affect change over time… [and] it is our professional responsibility to advocate and inform at a higher level [to executive leaders and administrators]. This type of advocacy is as critical as providing direct psychosocial care.” Child life expertise was acknowledged as an integral part in helping the team to appreciate the developmental and psychosocial aspects in addition to the behavioural and/or mental health challenges for patients and families. Child life had an important part to play in the successful development and implementation of this unit by engaging across disciplines, programs, and services. The unit allows children, youth, and families with complex behavioural, psychosocial, and/or mental health concerns that did not meet the threshold for a mental health admission to be assessed and supported through direct psychosocial care in their community.

Winter Ghostkeeper, BA, CCLS, was surprised at how easy it was to collaborate with colleagues at Alberta Children’s Hospital to build programs for families focused on bridging the gaps in psychosocial support in the community (W. Ghostkeeper, personal communication, September 10, 2019). Kid’s Cancer Care in Calgary provides unique programming to meet the psychosocial needs of pediatric cancer patients and their families. Child Life at Home allows a child or youth to be referred for coping support and receive up to six one-on-one sessions in their preferred location (in their home or at the Kids’ Cancer Care office). Cancer in the Classroom provides support for the transition back to the classroom by meeting with teachers and/or sharing information with classmates in a developmentally appropriate manner. The Kid’s Cancer Care child life specialist also helps families whose child is immunosuppressed connect with and utilize community-based services. This community child life program has identified gaps that families experience when they are primarily receiving services in clinics, in their own home, or when separated from community school due to immunosuppression. More importantly, child life provides respectful services and supports tailored to address the unique needs of children, youth, and families in smaller communities to enhance the child life services they receive when at their larger children’s health centre for tertiary care.

Big Country - Diverse Programs

Child life in Canada reflects the Canadian landscape. The small yet diverse population across the country requires child life leaders to identify ways to support children, youth, and families who are newcomers to Canada and those who may be receiving specialized care a great distance from their home communities. Smaller-sized Canadian child life programs, as the interviewees suggest, are equally as innovative, passionate, and involved in shaping the psychosocial care services as their larger counterparts. The child life profession strives to mirror the diversity of its population in order to meet the psychosocial needs of all the children, youth, and families in their communities. As the Canadian child life professional community continues to expand, the commitment to the delivery of pediatric psychosocial care is represented by more and more voices speaking from all corners of the country.


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