Position Statement on Child Life Practice in Healthcare 2018

Paediatric Psychosocial Care in Hong Kong
Children are our most valuable resource and our hope for the future. It is the universal value to provide the best to our children. Hong Kong is an international city and is also one of the wealthiest cities in the world. We are renowned for our advanced medical technologies andhigh standards of medical practice. However, the psychological and emotional wellbeing of the sick children is not receiving the same level of quality care while we are striking for high quality medical care. In the Article 24 of the United Nations Convention on the Rights of the Child, it states that “State Parties recognize the rights of the child to the enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health”. The Government of the Hong Kong Special Administrative Region committed to concur with the obligation therein for its signatories in 1994.
In public hospitals in Hong Kong, there is no dedicated staff providing and coordinating pediatric psychosocial care to children. Needs of psychological and emotional wellbeing of the sick children are handled in remedial manner. Frontline healthcare staff does not have proper or adequate trainings to this specialised area. Chronic manpower shortage in physicians and nurses do not allow them to respond to the individual needs of child patients when routine care is not enough. Child Life, an allied health profession, is responding to this gap in paediatric psychosocial care.
What is Child Life profession?
Child life is an allied health profession with expertise in helping children and families to cope with stresses and challenges brought by their diseases or the medical experience. Child Life Specialists embrace the philosophy of patient- and family-centered care and provide education and support to parents or other family members to facilitate their active involvement in the curing process of their sick children. Child life is a profession which commonly found in North America. Other titles, such as Child Life Therapist, Hospital/Healthcare Play Specialist are used to describe a similar role in countries like Australia, New Zealand and UK.
Child Life Specialists empower children and families in healthcare through a range of interventions to make pain or distresses or fear more manageable and prevent lasting negative impacts on their wellbeing. Child life specialists work alongside with medical and allied health professionals to provide:
  1. Psychological preparation for medical procedures, examinations and surgeries
  2. Support during medical procedures and identified stress moments
  3. Therapeutic medical and recreational play that promote self-expression, understanding and mastery
  4. Teaching of stress reduction techniques to facilitate adaptive coping for children and families
  5. Activities to promote normalization and a sense of comfort and safety
  6. Care for grief and bereavement in children and families
  7. Support to enhance siblings’ understanding and coping
Child life specialists recognize that clinical care must be grounded in evidence-based practice. An extensive review of the literature along with child life clinical experience have validated that most children prepared for medical procedures experience significantly lower levels of fear and anxiety compared to children who are not prepared. Preparation also promotes long-term coping and adjustment to future medical challenges.
There is rising demand for the specialized care provided by Certified Child Life Specialists 1  internationally. The number of child life programmes outside North America is growing and the number of Certified Child Life Specialists in Asia is also increasing in the past few years.
Child Life (or Hospital Play) personnel were first introduced to Hong Kong in the 90’s by non-profit organizations. The Child Life Specialists in Hong Kong has demonstrated through their clinical practice that positive changes could be achieved if child life interventions were utilized and delivered as an integral part of the total care in pediatrics in the past two decades.
Recommendations
The psychological and emotional wellbeing of the sick children is equally important to their physical wellbeing. Children’s health should be managed in an environment that prevents or reduces emotional and psychological trauma which may have permanent consequence. Healthcare providers should take steps to minimize physical and emotional pain, trauma and distress to children undergoing procedures. Children and parents shall have the right to be informed in a manner appropriate to age and understanding. Children should be able to play and learn while in a healthcare facility.
Child Life is a discipline specializing in this area of work. In the policy statement on Child Life Services issued by the American Academy of Pediatrics in 2014, it has stated that “the provision of child life services is a quality benchmark of an integrated patient- and family-centered health care system, a recommended component of medical education, and an indicator of excellence in pediatric care”. Care provided by Certified Child Life Specialists should be included in paediatric healthcare in Hong Kong. Hospital Authority is managing approximately 90% hospital medical service in Hong Kong, it has a role in formulating the best practice in paediatric service in public hospitals. This year, Hong Kong is looking forward to a new milestone in the development of paediatric healthcare – the opening of Hong Kong Children’s Hospital. The Hong Kong Children’s Hospital states that its mission is “to raise the professional standards and enhance the quality of paediatric services by concentrating expertise, research and training with multi-partite involvement” and “be the key player of the whole paediatric services network, responsible for planning, coordinating and leading the paediatric services in the public healthcare system of Hong Kong”. The opening of Hong Kong Children’s Hospital Child Life practice into the public health system in Hong Kong.
1 Certified Child Life Specialist (CCLS) is the most widely recognized credential managed by the Association of Child Life Professionals in the United States which aims at maintaining and enhancing the professional standard of training, both academically and clinically. HKCLA recommends child life practitioners in Hong Kong follow this professional standard for Child Life practice in Hong Kong.
Endorsed by the Executive Committee of Hong Kong Child Life Association on Oct 22nd 2018
The Hong Kong Child Life Association (HKCLA) was established in April 2018 by a group of Certified Child Life Specialists with the missions to advocate for the field of Child Life (or Hospital/Healthcare Play) and to promote the continued development of Child Life practice in Hong Kong.