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