Inside the evolution of SickKids’ Child Life Specialist team — and their next era

“I’m with Child Life, and we try to make it easier to be in the hospital.” 

This is how Erin Boyle begins to introduce herself to patients and families on the neurosciences and trauma unit at the Hospital for Sick Children (SickKids). She explains that Child Life Specialists can help a patient in a myriad of ways, including developing coping strategies together to lessen their pain or fear, helping patients to learn more about their hospitalization to increase elements of control and supporting them during procedures to ease the experience. Often, families feel overwhelmed and they’re very appreciative to meet someone whose role is to be their advocate and be a companion. 

“It’s a truly impactful role — and it draws on a wealth of scientific knowledge,” Boyle says. 

You can’t go far in the hospital without running into one of Boyle’s Child Life colleagues. With recent changes to the team, SickKids' Child Life department is one of the largest in North America. Child Life Specialist support covers inpatient units across the hospital and clinics by referral, and the team runs several dedicated programs and spaces for patients and families. While their work may look like fun play — and that is part of it — there has always been a lot more happening under the surface. 

Child Life Specialists make sure patients across the hospital — and even outside of it — receive great emotional care. They are essential members of the clinical teams at SickKids and they have shaped some of the hospital's most public and enduring programs and initiatives. As SickKids reflects on its 150th birthday current and former Child Life Specialists say the team has come a long way over the years — and they have big plans for what’s coming next. 

Becoming Child Life

Prior to Child Life, people in a variety of roles — doctors’ wives, nurses, volunteers, teachers and others — played with patients because of limited visiting hours for families. The role eventually became more formal: in 1962, “Department of Volunteers and Recreation” was created, and five years later, it employed eight Recreation Therapists, also called Recreationists. 

In their early days, Recreation Therapists helped to create SickKids-wide initiatives and programs that are ubiquitous today. For instance, in 1981, Rita Kuiper, a Recreation Therapist who joined SickKids in 1973, helped to create a program where volunteers with certified dogs come to visit patients and staff and helped to start the hospital’s therapeutic clown program. 

While Recreation Therapists were doing a lot of good within the hospital, many were looking for more clarity on the role, says Kim O’Leary, a former leader of the Child Life team. 

In 1988, SickKids followed the lead of the U.S. based, international organization Child Life Council (now called the Association of Child Life Professionals) in adopting a new name for the specialized hospital role: Child Life Specialists.

Today, all Child Life Specialists are certified or on the path to certification and many have Master’s degrees in Child Life. 

The name change also reflected a shift in the role itself. 

Leanne Brister joined SickKids in 1988, just as the role’s name changed, and saw Child Life grow: “It moved from play-based fun, playroom-focused programming, over the years, more toward therapeutic interventions.” 

Child Life’s research-backed expertise started to become embedded in hospital processes and decision-making — this was the beginning of a journey to move toward infusing patients’ voice and needs into their hospital journey.  

Child Life today 

There was a time when Child Life Specialists would hand out a card to colleagues in the hospital outlining the top 10 reasons to call them. This was one way the team was able to advocate for their involvement in patient care. 

As the team expanded into more areas of the hospital, people saw the impact they had on patient care. Electronic charting also helped Child Life Specialists share patients’ coping plans, including their voices in their care and highlighting the impact of the Child Life team’s involvement to other clinical staff. 

“We’re more integrated into health-care teams now — we are members of the health-care team, versus an add-on,” says Shaindy Alexander, the team’s clinical manager. “More and more, we’re part of discussions, planning committees, project work and research.” 

“We’re getting better and better at knowing our worth, and having theories and data to back it up. And it shows when we are in a room.” 

In the late ‘80s, when the role’s name changed, there were 18 people on the team. Today, as its own department, there are 46 Child Life Specialists and 10 Child Life Assistants offering support in inpatient units, outpatient clinics and within the Family Spaces. The team also has a studio producer and studio assistant working on broadcast content and other programming in Marnie’s Studio. Child Life Specialists can also be found in other impactful roles throughout the hospital. No matter the part of the hospital, the Child Life team is instrumental in supporting patients’ emotional safety and coping at SickKids.  

Inpatient and outpatient support 

Child Life Specialists practice differently, depending on their patient population, Akila Dada, the Child Life Specialist on the inpatient cardiology unit, says. “The commonalities are the fact that we meet kids where they are, and that we know how to provide developmentally appropriate information. Everything else sometimes looks really different.”

An important piece of the role, Dada notes, is explaining diagnoses to patients and their siblings. She reminds parents that it’s likely a patient in cardiology may need to come back to the hospital, and it builds trust to tell children and youth the truth — and to validate their feelings. 

In the span of a day, Dada may help a patient prepare for cardiac surgery, provide education and prepare a patient who is receiving a heart transplant, provide end-of-life support to a family, or plan another patient’s birthday party.

“That’s the thing that sets our profession apart from other people, and I’m not sure if people fully grasp sometimes how many different things we do.” Child Life Specialists support patients of all ages, from infants to teenagers. No matter the circumstances, they use developmentally thoughtful language and approach. 

“I often say play is the language that I speak,” says Katie Brazel, the team’s interim professional practice lead. “It’s one of the tools I use to help patients understand and cope with what they’re experiencing.” 

Child Life has also grown its outpatient presence, meaning offering support to patients coming in for procedures or surgeries. 

“Some of the evolution of Child Life is becoming more and more involved in the medical treatment side,” says Caleb Tait, a Child Life Specialist who works in perioperative services and phlebotomy. 

In this way, he notes, Child Life is helping patients prepare before a procedure — in some cases, even helping a scared patient get out of the car — and distracting or helping to process after it. They’re also providing compassion in helping patients through the hard thing itself, whether it’s an invasive or uncomfortable procedure like bloodwork or a sedation. He uses the metaphor of a diving board to represent his role in a difficult procedure: “We don’t want to push the patient, but rather hold their hand and jump with them,” he says. 

Another clinical space where Child Life has made a big difference is Diagnostic and Interventional Radiology (DIR). Child Life Specialists help some patients who need an MRI get one without needing sedation by developing a plan, ensuring they’re prepared and supporting them during the procedure.  

This has meant more patients can receive an MRI without sedation, which has had a measurable impact on the MRI waitlist in addition to giving patients control and support. Helping to tailor patients’ experiences based on the choices they make is one way the Child Life team exemplifies the Precision Child Health movement. 

Family Spaces 

Family Spaces are several spaces in the hospital where Child Life support and programming is offered. 

That includes Marnie’s Studio, where closed-circuit TV station The SKOOP supports daily live broadcasts to every patient room, in collaboration with Child life, Creative Arts Therapy and the Family Centre. Shows include story time, games, arts and crafts, video games and trivia. The broadcasts help patients in isolation participate from their room while connecting with others around the hospital. Child Life also helps to develop programming that offers educational information about SickKids and tips on coping with hospitalization, such as content about learning about feelings or procedures like MRIs or blood work.  

Other Family Spaces are Marnie’s Lounge, a space for patients to play games and connect with their family, friends and others going through similar experiences, the Multisensory Room and the Samsung Space, a drop-in area with outdoor space. 

“They are great spaces for families to come and just debrief with us or have a bit of respite and connect with other families,” says Brianna Sugrue, a Child Life Specialist who works in the Family Spaces.  

As part of the one-on-one programming offered in the Family Spaces, Sugrue recently started a coping clinic for patients with needle fears. She and other Child Life Specialists meet with patients to learn about their experience with “pokes” and to discuss coping strategies. She may also use medical play, demonstrating the procedure with a doll. 

“There’s all these different choices that we can provide in the care, so that even when it doesn’t seem like kids have a lot of choice in getting a poke there is still some choice they can have within it,” she says. 

Helping a paediatric patient with a needle fear can have life-changing impacts — it's an example of atraumatic care, or an intervention to help prevent trauma from happening. Child Life is helping to provide proactive support for better future coping. It’s another way the team embodies SickKids’ Precision Child Health movement. 

Child Life’s impact across the hospital 

As the team has grown, “Not only do we have more people, we have people where there didn’t used to be any Child Life at all. So it’s that opportunity to be involved more — not only in the patients we see directly, but also indirectly to work on institutional aspects,” Tait, who works in perioperative services and phlebotomy, says. He helped create a video and workbook for patients coming in for surgery, so they can know what to expect. “It’s not just who I see in front of me, but as a department we’re able to support people that we may not even meet.”

Alexander echos this: “The fact that Child Life has spanned across inpatient, outpatient, community and Family Spaces, even if you don’t meet a Child Life Specialist, when you come to SickKids, you’re being impacted by Child Life.” 

Patients and families feel those positive impacts deeply.  

“Because we are showing up for the patient and family and offering them support, they learn to trust themselves, they learn to trust the hospital, they learn how to advocate, and then they build coping mechanisms that they’ll bring forward into the next and the next and the next visit,” Alexander says. 

Hospital-wide events, like the annual Prom for patients who may have missed their own, and widespread programs are other ways Child Life Specialists and Assistants have a broad impact across the hospital.  

Child Life initiatives, too, have had a big impact on the hospital. Bravery Beads  is one well-known program that Child Life Specialists worked with colleagues in the Women’s Auxiliary Volunteers (WAV) to bring to SickKids. Through the program patients receive beads that acknowledge experiences or milestones in their SickKids journey. Among many hospital initiatives, Child Life also implemented “What Matters to Me” cards for room doors, so patients can share what they want staff to know about them to enhance emotional safety.  

A Child Life Specialist facilitates the SickKids’ Patient Advisory Council, formerly the Children’s Council. There are also Child Life Specialists working with the Paediatric Advanced Care Team (PACT) to provide community psychosocial support, the Patient & Family Experience team and as Donation and Events Specialists. 

Tait emphasizes that although Child Life has evolved, its foundational reasons and principles have remained constant. “Our role is becoming varied, and it will continue to evolve and grow and look different, but retain the same heart at its core.”