Tiers of Service framework and approach

System planning for children's health services is a major area of focus for Child Health BC and its collaborators, (health authorities, ministries, non-profit organizations, school boards, etc).

Children's health services are provided by community based providers including family physicians, pediatricians, nurses, speech language pathologists, therapists and more. Regional health promotion and prevention services as well as clinics may be also be available to children. BC Children's Hospital has a major role to play as BC's only children's hospital. Our relatively small population spread across the vast geography of the province necessitates us working together in a planned manner. 

The Tiers of Service framework provides a tool which can then be used to define and plan this system of service. Tiers of Service provides a common language and methodology for defining and planning child and youth health services in BC.

Tiers of Service introduction video

The Tiers of Service framework

  • Recognizes that health services, while important, are one of several factors that contribute to child and youth well-being overall. 
  • Is informed by a review of frameworks / tools in other jurisdictions around the world.  
  • Facilitates system planning for clinical services, knowledge sharing/training and quality improvement/research. The responsibilities and requirements for each of these three areas are defined within the Tiers framework.

Six Tiers of Service graphic

Six Tiered System of Service

Having learned from other jurisdictions, and based on some historical approaches in BC, we embarked on the Tiers journey starting off with defining four tiers of service. Quickly, once we started to move forward with planning here in our own BC context, we recognized that the system's resources were better delineated with six tiers like the tiered health systems in Australia. Therefore, we now have six tiers to describe our system of service, numbered Tiers 1 to  6 as shown in the above diagram. (The Tiers were formerly numbered Tier 1, 1 a, 2, 2 a, 3 and 4, with details of the re-alignment rationale found here, for those interested.)

Each one of these tiers is important and each tier has unique roles that it plays. The system as a whole functions best when all the Tiers know and accomplish their responsibilities and fulfill their requirements. Each tier of service relies on the next and, together, services for children are strengthened.

Developing and Using the Tiers approach for system planning 

Child Health BC is leading the use of the Tiers of Service approach to system planning for children's health in BC.  How does this happen?

Creation of a series of modules: For each of the major areas of health services such as children's medicine, children's surgery, children's emergency care,  children and critical care services and mental health services for children and youth, a Tiers of Service module has been or is being created. Each module has three parts. Part one is called "Setting the Stage" and this presents data and literature used to create the module. Part two is called "Tiers in Brief for System Planning" and provides a high level overview of key aspects to the module. Part three is called "Tiers in Full for Operational Planning" and provides tremendous detail regarding the (1) clinical service, (2) knowledge sharing/training and (3) quality improvement/research responsibilities and requirements.   

Self-assessment based on the modules: Once a module is finalized and accepted by the key partners in the province, a self-assessment is completed. Child Health BC works with our health authority and other partners as necessary to get this work completed. 

System planning and service planning based on the self-assessment results Using the self-assessment analysis, provincial, regional and local planning is undertaken with significant efforts by our health authorities' collaborators, facilitated by Child Health BC. 


Tiers of Service Self Assessment video


A series of one page Fact Sheets outlining each of steps is found in the Reports and Background Documents  section in the right hand column.


Completed Tiers of Service Modules

The following six modules are complete, have been accepted by the key provincial partners, and can be found at the below links:

Clinical Service Modules:

Clinical Diagnostic & Therapeutic Services Modules:

The Tiers at a Glance section provides an overview of Children's Health Care Services.  It provides the highlights of all of the Tiers of Service modules that have been completed or are under development.