How Child Life Specialists Play a Role in Delivering Culturally Competent Healthcare
Child life specialist reflects on the importance of cultural competence for both the child and their family.
Child life specialist Karlie Bittrich with patient

Certified child life specialists (CCLSs) provide children with emotional safety, therapeutic play, education, and preparation for procedures. The support of a child life specialist can make all the difference to a child or adolescent feeling anxiety, fear, or pain in the hospital or clinic. They optimize pediatric patient and family outcomes while supporting the clinical team by providing the child with comfort and distraction, offering diagnosis education, and assistance in overcoming barriers to treatment adherence. In essence, they play an important role at Boston Medical Center (BMC) and other hospitals around the country.

As an integral part of the healthcare team, child life specialists help empower families to become more engaged, active and informed about their child’s health. It is crucial that CLSs be aware of the broader issue of cultural competence, which is defined as the ability to engage knowledgably with people across cultures, and must also include respect and empathy for the patient that embraces their gender identity, sexual orientation, age, language, values, and economic and housing status.

HealthCity spoke with child life specialist Karlie Bittrich about how she and fellow child life specialists at BMC integrate cultural competence into their daily work. Bittrich has worked in Ambulatory Pediatrics at BMC for four years.

HealthCity: What does cultural competence mean to you as it relates to the field of child life?

Karlie Bittrich: To me, cultural competence is not just the awareness of cultural differences, but it is using that awareness to effectively interact with, understand, and communicate with people from backgrounds different from your own. It also involves understanding the potential impact that cultural differences can have on healthcare delivery.  

Within my work in child life, I focus on understanding common coping themes in various cultures and examining how culture and parenting work together to influence a child’s healthcare experience. This helps inform my assessment of psychosocial needs so I can individualize my interventions to meet each child and family where they are.

HC: Why is it important to deliver culturally competent care? 

KB: Recognizing and addressing the disparities people from diverse racial, cultural, and socioeconomic backgrounds often encounter helps us ensure that our patients get the care they need to live healthier lives. Being knowledgeable of and appropriately addressing any language barriers or health literacy limitations the patient or family has, as well as understanding differences in communication styles, all work together to drive culturally competent care. This is important because it encourages active dialogues in which patients and providers can ask questions, correct misunderstandings, and build trust. 

HC: Do child life specialists receive any formal cultural competence training?

KB: Child life specialists must complete and show competency in a series of clinical domains as part of our certification process. Cultural competency falls under our “Ethics” domain and has been a big topic of discussion at conferences, webinars, and research papers in the field over the last few years. We pursue a variety of professional development opportunities throughout our career that help us maintain our certifications.

HC: How do you juggle your relationship with the child or their parent if their primary language or culture is different? 

KB: Play is the universal language of children and their natural mode of self-expression. If I encounter a pediatric patient whose primary language is different from my own, I can still build rapport with them and start creating a therapeutic relationship via play while we await interpreter services, if needed. 

When playing with a child who speaks another language, I look for other cues such as smiles, laughs, and their level of engagement in what we are doing. If I enter a room and sit on the floor and begin to color, does the child show interest and actively come sit beside me and join in? If I blow bubbles, do they pop them or do the universal motion to indicate it is their turn?

Once a basic level of trust and comfortability is formed, I pivot to play that is more focused on a medical theme for preparation. For example, I bring out a medical play set and let them explore the stethoscope and blood pressure cuffs.

Cultural competence is not just the awareness of cultural differences, but it is using that awareness to effectively interact with, understand, and communicate with people from backgrounds different from your own.Click To Tweet

HC: Can you share any examples of how a family's culture and parenting might influence how you approach their care? 

KB: Families from different parts of the world often have different perspectives and societal norms regarding how they approach healthcare. For example, staff may perceive a caregiver as being indifferent or uninvolved during a visit, when in actuality, they are unaccustomed to being an active participant in their child’s care. It’s possible they do not want to express disrespect to the provider by questioning their methods.   

Conversely, some patients or families may be resistant to some diagnoses or treatments due to misunderstandings or cultural stigmas. In those situations, communicating with the family in a respectful way, such as by validating and addressing their concerns while highlighting the importance of proper care, is key.

HC: What advice about cultural competency would you give to new child life specialists?

KB: For newly practicing child life specialists, I recommend taking the time to get to know the population that your hospital serves in your community. It is also beneficial to take classes on cultural competency to continue learning and growing in this skill set. Lastly, I think it is important for new child life specialists to challenge themselves in their thinking by examining their internal biases, which will improve how they support families from all different backgrounds during their hospital visit or stay.

To learn more about Karlie Bittrich's impact as a Child Life Specialist, read a patient's story about how she has helped him throughout his time at BMC.