Case Study #1:
Name: Alex
Age: 12 years old

Alex is 12-year-old boy who was assigned female at birth but now identifies as male. Alex was diagnosed with Type 1 diabetes and requires frequent hospital visits to see his endocrinologist to assess his insulin administration to manage his diabetes. While Alex is generally coping well with his diabetes care, he has encountered instances where health care team members misgender him by not using his preferred name and pronouns. This has caused him to feel frustrated, isolated, and misunderstood. This has affected not only his emotional wellbeing, but also his level of comfort and trust in the health care team and the hospital.

While Alex’s parents are supportive and have been proactive in seeking care, they have also found it challenging in ensuring that Alex’s gender identity is respected and understood by the healthcare team. They are also worried about the privacy of Alex’s gender identity and how it is communicated within the healthcare facility.

Questions for reflection:

• Which actions could health care team members take to foster more inclusive practices in the healthcare setting?

• How might it feel for Alex when healthcare professionals misgender him?

• What entrenched personal biases or assumptions might be contributing to the misgendering of Alex, and how can individuals challenge these biases?

• -Which actions could the healthcare institution take to ensure that all patients feel respected and supported  (e.g., comprehensive training and redevelopment/revisiting of protocols)?

Case Study #2:
Name: Elizabeth
Age: 8 years old

Elizabeth is an 8-year-old black girl who has epilepsy and a sensory processing disorder (SPD). SPD affects her ability to respond to and cope with sensory stimuli such as noise, light, and touch. Elizabeth requires regular visits to the hospital for various treatments and assessments related to her epilepsy, as well as her SPD. However, the sensory environment of the hospital has posed significant challenges for her.

The hospital environment is often noisy, busy, and has a constant hum of machinery, frequent announcements, and other noises such as call bells and alarms. The lighting is harsh and there are many bright and flashing lights with little to no options to control the lighting.

When Elizabeth has to undergo procedures such as bloodwork, she becomes especially overwhelmed by the busy hospital decor (e.g., paintings and colors on the walls). Receiving physical contact from healthcare providers who are unfamiliar to her and being exposed to unfamiliar textures is also overwhelming for Elizabeth. These sensory inputs can cause her significant stress, leading to heightened anxiety and difficulty coping with necessary medical procedures.

Elizabeth’s parents have tried to prepare her for these visits and manage her sensory sensitivities as best as they can, but they find it challenging to address the sensory overload that comes with the hospital environment because they feel like they cannot change it. They are concerned about how these sensory challenges affect Elizabeth’s comfort and cooperation during medical visits and are seeking ways to make her experience more manageable and supportive.

Questions for reflection:

• What specific strategies can healthcare team members implement to create a more sensory-friendly environment for patients with sensory processing challenges?

• How can you, as a healthcare provider, empathize with Elizabeth’s experience to better support her during hospital visits?

• Which entrenched attitudes, biases or assumptions may be at play in shaping Elizabeth’s experience?

• What steps can the healthcare institution take to modify the environment and practices to be more accommodating for patients with sensory processing disorders (e.g., noise reduction, softer lighting, sensory-friendly spaces)?

Case Study #1:
Name: Liam
Age:3.5 years

Liam is a 3.5 year-old boy who enjoys spending time in the dramatic play centre in his preschool classroom. He can be frequently found during free play time in the dramatic centre, engaging in various pretend play scenarios. Lately, Liam has been choosing to wear the pink dress and heeled shoes while pushing the baby stroller with his baby inside. Liam has been observed caring for the baby, feeding it and offering it a bottle and changing its diaper. One evening during pick-up time, Liam was wearing the dress and pushing the stroller when his father arrived. His father smiled at Liam, said a hearty hello to his son, and approached one of the educators and asked, “Why is Liam pushing the stroller? Boys should not be wearing dresses and pushing strollers. Does he do this often?”

Questions for reflection:

• How can we acknowledge Liam’s father’s feelings and concerns while reinforcing a positive and inclusive approach to gender expression for all children?

• How can we engage Liam’s father in a conversation about Liam’s play to understand his perspective better and provide reassurance and support for Liam’s explorations?

• How can we ensure that Liam (and all children) feels validated and supported in his interests while navigating potential external pressures or misunderstandings?

Case Study #2:
Name: Emma
Age: 4 years

Emma is a 4-year-old girl at a childcare centre who often plays alone. She frequently wanders around the room, observing other children engaged in various activities but seldom initiates or joins their play. She tends to stay close to the children playing. Educators have noticed that while Emma appears interested in the group activities, she does not take steps to engage with the other children. This pattern of behavior raises concerns about Emma’s social development and inclusion.

Questions for reflection:

• What might be the underlying reasons for Emma’s reluctance to join group play? Could there be social, emotional, or developmental factors at play?

• How can we assess whether Emma’s behaviour is a sign of shyness, social anxiety, or a preference for solitary play?

• Are there aspects of our current practices or environment that may inadvertently discourage Emma from participating in group play?

• How can we review and adjust our approach to ensure we are supporting all children in developing their social skills effectively?

• What role should staff play in facilitating or modeling social interactions for Emma? How can we support her in finding her own way to engage?

• How can we involve Emma’s family in understanding and supporting her social development? What insights might they provide about her behaviour at home or in other settings?