Skip to Main Content Go to Sitemap

Paediatric Advanced Care Team

555 University Avenue, Room 5401

When a child or adolescent has a potentially life-limiting condition families want to know that they are receiving the best care possible. The Paediatric Advanced Care Team (PACT) works with your existing health-care providers to enhance the care your child is already receiving to make sure it reflects the values and preferences of your child and your family, and to maximize quality of life and comfort for your child.   

Our team consists of health care professionals including physicians, nurses, grief support coordinators, community liaisons and administrative assistants. PACT works with a population of children who have serious or potentially life threatening illnesses. 

PACT partners with other professionals like music therapists, massage therapists, art therapists, child life therapists, psychiatrists, chaplains, bioethicists, researchers, volunteers and parents to ensure each child and family is receiving optimal support.  

PACT works with your usual hospital teams as well as a variety of community partners to facilitate comprehensive care planning and delivery across the continuum of a child and family’s illness experience, and in a variety of settings, including within the home or community. 

Some of the ways in which PACT can help include: 

  • Focus on Quality of Life  
  • Identify and Implement Goals of Care  
  • Difficult Discussions  
  • Management of Pain and Other Symptoms  
  • Pre-natal Consultation  
  • End-of-life care  
  • Grief Support 

The Paediatric Advanced Care Team is also dedicated to the professional development of health care providers and volunteers who care for dying children and their families, high quality research and evidence based practice and advocacy on behalf of children and families who face pediatric life limiting illness and conditions.

If you're looking to learn more about available education and fellowship opportunities, please click here. 

If you are a healthcare provider that is interested in referring to our service, please click here to find the referral form. 

How we support families

Expand the sections below to learn about our services and programs.

  • PACT wants to help make every day as good as it can be for your child and family. By getting to know more about your child, your family and what is important to you, we can often find ways to positively impact your child’s quality of life. 
  • We work with a team of professionals who can be involved with your child at the hospital or at home, to improve quality of life. This team includes music therapists, a massage therapist, an art therapist, spiritual care providers, child psychosocial support providers and other community resources.  

  • PACT can help your family establish goals of care by identifying what is most important to you and your child, and how your child’s care can reflect this given the circumstances they are facing. Over time, your child’s condition might change. PACT can help support you with decision making and planning for the future.  
  • Families may be faced with difficult decisions, including ones about the possible use of medical technology (For example, devices to help with feeding or breathing) or organ transplantation. PACT will work with you and your child to help you make the best possible decisions that are in line with your specific goals of care.  

  • Children with serious medical conditions and their family members often have fears and concerns about what will happen over time. PACT can help facilitate these hard, but important, conversations with your child by preparing you for them, being present when they occur, or occasionally leading these conversations. These conversations help decrease fears by clarifying misconceptions or creating a plan to address specific concerns.  
  • PACT is also available to help support siblings and address their own unique worries.  

Serious medical conditions may be accompanied by distressing symptoms, such as breathing difficulties, pain, nausea and vomiting and other sources of discomfort. PACT works with other teams that are part of a child’s care to reduce these symptoms as much as possible.  

  • PACT meets with women and their partners/support people prenatally when they are pregnant with a fetus with a life-threatening diagnosis. 
  • We can help support families with decision making around the pregnancy and preparing siblings. We also provide ongoing support to families after the birth of a baby, whether they are living with or dying from their underlying condition.  

Should end-of-life care be needed, PACT will be there to provide your family with support in your preferred setting –home, hospice, or hospital– to ensure your child’s comfort, help create meaningful legacies and memories, and to support you during your grieving.  

Your relationship with SickKids does not end once your child has died. Our team is here to support you.

Pathways Grief Support Program is housed within PACT at SickKids. All families who have experienced the death of a child who was cared for at SickKids are offered the opportunity to receive services and support from Pathways. Together, in collaboration with PACT, they can help you access the resources and support that your family requires, both within the hospital and in the community. 

Two Grief Support Coordinators are available to help you Monday-Friday, 8:00-4:30. To reach the program please email:

Prenatal Diagnosis (i.e. before the Baby’s Birth) 

When an unborn baby is found to have a life-limiting condition, that baby’s parents start on a journey filled with overwhelming emotions and difficult decisions. PACT clinicians (along with our colleagues at Mt. Sinai Hospital and Emily's House have experience helping parents develop birthing plans based on the goals of care they have agreed on for their baby. Such plans would cover the labour and delivery period as well as the care that will be provided to the baby after birth. 

As births do not occur at SickKids, PACT will work with the team providing care to the mother and baby and work towards those goals along with our community partners.   We will continue to be involved and provide support for whatever time the baby continues to live and will support the family in the aftermath of the baby's death.

Postnatal Diagnosis (i.e. After the Baby’s Birth) 

Not all serious medical conditions can be or are diagnosed before birth. PACT also provides help to families in situations where a newborn baby is found to have a serious medical condition in the first days or weeks of life. These families also receive grief support in the aftermath of death. 

Who we are

At SickKids

PACT is a consult service, working in partnership with all of the inpatient and outpatient teams at SickKids. We are asked to meet children and their families for many reasons. Many families find our team helpful in providing a ‘sounding board’ for medical decision making,  We use the experience of other families to outline what each particular option might look like and reflect on how your goals and values as a family may help you to know which option is right. We can provide guidance around pain and symptom management to your primary team, and should you choose to have your child die at SickKids, we can provide support around end of life care. We are more than happy to attend family meetings and be present at every step of your journey.

In the community

PACT has strong relationships with many community resources, such as your local Health and Community Care in your LHIN. Your local LHIN can provide you and your family with the necessary supports to care for your child at home, such as nursing care, hospital beds, commodes etc. Our medical team works in conjunction with community physicians to ensure the best quality of care is in place for your child. We can arrange for a community palliative care physician to care for your child at home, and will be in constant contact with available around to them around the clock to provide guidance and support. 

Hospice support 

Emily’s House Children’s Hospice in Toronto provides residential end of life care for children and their families in a home like environment. Emily’s House is staffed by registered nurses, registered practical nurses and personal support workers, all of whom have experience in and passion for providing care to patients at the end of their lives. PACT provides physicians coverage for end of life patients at Emily’s House.  We work in conjunction with their staff nurses to ensure that your child has and family receive the best care possible in a hospice setting. 

See more nursing, respite and hospice resources here.

Key staff

Below you'll find lists of our key staff in the SickKids PACT.

Nadeera Carranza - Administrative Assistant & Patient Information Coordinator Phone (416) 813-6905 



Jenny Loor, Administrative Coordinator 

Phone: (416) 813-7654 ext. 202698 



Kira Goodman, Project Manager 

Phone: (416) 813-7654  


Shaindy Alexander - Grief Support Coordinator (covering LOA until fall 2019) 

Shaindy Alexander has been at SickKids for 16 years, having completed her Bachelor of Arts in psychology and post graduate degree in Child Life at McMaster University in Hamilton. Clinically, prior to this role, Shaindy worked as a Certified Child Life Specialist in various areas across SickKids.  In 2018, she joined PACT as one of the Grief Support Coordinators.  Shaindy’s clinical areas include: Emergency, PICU, Surgery (5th and 6th floors) and the Haematology/Oncology program. Shaindy can be reached at: (416) 813-7654 ext. 201775 


Lori Ives-Baine, RN, BscN, MN (CPB, CWT) - Grief Support Coordinator 

Lori Ives-Baine has been a nurse at SickKids for almost 30 years, having completed her undergraduate degree in nursing at McMaster University and her master's in nursing and bioethics at the University of Toronto. Clinically, Lori worked in the NICU for 23 years, as a staff nurse and then as the program's bereavement coordinator (19 years). In 2013, Lori has joined PACT as one of the Grief Support Coordinators. Lori is also a teacher (George Brown, U of T and UOIT) and researcher (UOIT and York University) and is passionate about ensuring best practices in end-of-life care and bereavement. Lori values the support that can be provided to families and staff and looks for creative ways to continue that support. Lori's clinical areas to support include: Cardiac Critical Care, NICU, 4D and the 7th floor. Lori can be reached at (416) 813-6782. 


Sarah Lord, MD, MHSc., BSc. - PACT Physician 

Sarah is a staff physician on the Paediatric Advanced Care Team (PACT). She completed her undergraduate studies in life sciences at Queen's University and medical school at the University of Toronto. Following her general paediatrics residency training (University of Toronto), she stayed on to do fellowship training in paediatric palliative care at SickKids and to pursue an MHSc in bioethics at the University of Toronto. She works with PACT as well as the Paediatric Medicine and Complex Care programs at SickKids. Sarah can be reached at or 416-813-7654 ext. 201820 


Francis Macapagal, RN, BScN, MN - Clinical Nurse Specialist 

Francis Macapagal has been a nurse at SickKids for 13 years and is currently a Clinical Nurse Specialist on the Paediatric Advanced Care Team (PACT). Francis completed his Bachelor of Science in Nursing and Masters of Nursing at Ryerson University. In his current role he provides education, support and comprehensive coordination of care to children with potentially life-limiting illnesses and their families. Francis also supports the interprofessional healthcare team in providing care to these patients and families through staff mentorship and education. In his spare time Francis enjoys rock climbing and cycling.  (416) 813-8332 


Kate Nelson, MD - PACT Physician  

Kate Nelson is a staff paediatrician on the Paediatric Advanced Care Team (PACT). Kate completed undergraduate degrees in English and chemistry at the University of Missouri-Columbia and received her medical degree from Harvard. Following a general pediatrics residency at the Children's Hospital of Philadelphia, she completed a fellowship in pediatric palliative care at Children's Hospital Boston. At SickKids, she is also a Janice Rotman Fellow in homecare innovation and an academic general paediatrics fellow, pursuing a PhD in clinical epidemiology at the University of Toronto looking at patient-centred outcomes for children with severe neurologic impairment. Kate can be reached at (416) 813-6905. 


Adam Rapoport, MD - PACT Physician and Medical Director 

Adam Rapoport is a general paediatrician with a Masters in Bioethics. His palliative care career began in 2009 when he joined the Temmy Latner Centre for Palliative Care at Mount Sinai Hospital, as their pediatric consultant. In July 2011 Adam became the first medical director of the Paediatric Advanced Care Team (PACT) at SickKids. This service provides both inpatient and outpatient care to children with life-threatening illnesses, and their families. In 2013 Adam became Medical Director at Toronto’s first pediatric residential hospice – Emily’s House. Adam’s academic work focuses on the intersection of his three primary interests: Paediatrics, Palliative Care and Ethics. Adam can be reached at (416) 813 6905 ext. 206905. 


Kevin Weingarten, MD - PACT Physician 

Kevin Weingarten is a physician on the Paediatric Advanced Care Team (PACT) at The Hospital for Sick Children, in Toronto. After completing his residency in paediatrics, he went on to do fellowships in paediatric haematology/oncology (at SickKids) and pediatric palliative care (at Boston Children’s Hospital) Kevin is currently completing his Masters in Bioethics at the Joint Centre for Bioethics at the University of Toronto. Kevin can be reached at (416) 813-7500. 


Kim Widger - PACT Nursing Research Associate 

Kimberley Widger is a nursing research associate at The Hospital for Sick Children and an associate professor at the the Lawrence S. Bloomberg Faculty of Nursing, University of Toronto. Kim worked with Dr. Bonnie Stevens for her post-doctoral fellowship, which was focused on knowledge translation and end-of-life pain management for children. Kim’s doctoral research was a multi-centre study to develop and test an instrument to measure the quality of care provided to dying children and their families from the perspective of bereaved parents. Kim was previously a clinical nurse specialist with the Pediatric Palliative Care Service at the IWK Health Centre. Kim can be reached at (416) 978-7925. 


Rebecca Williams, NP, RN - Nurse Practitioner 

Rebecca Williams has been a nurse practitioner on the Paediatric Advanced Care Team (PACT) since 2012 after completing her combined Master's in Nursing and Paediatric Acute Care Nurse Practitioner at the University of Toronto. Prior to that she worked as a registered nurse on the Haematology/Oncology in-patient unit at The Hospital for Sick Children on the Haematology/Oncology in-patient unit for six years.  Rebecca can be reached at (416)-813-2268. 

Empty lecture hall of 15 rows and a speaking podium

Education and training opportunities

PACT is excited about having trainees join our team. 

Fellowship training 

We offer a one-year paediatric palliative care clinical training program for those who have completed, or are in the fourth year of a general paediatrics residency. The fellowship is focused on advancing the trainee's knowledge of pediatric pain and symptom management, end of life care, and quality of life concerns. 


  • Board-eligible or board certified in paediatrics or one of its sub-specialties. 
  • Commitment to incorporating palliative care into practice. 

**An elective experience with the Paediatric Advanced Care Team (PACT) is strongly recommended prior to applying (see below). 


The trainee will become familiar with comprehensive, interdisciplinary care, evaluation, and management of children with diverse advanced illnesses and their families, and will be responsible for the care of inpatients and outpatients in varied settings, including an academic teaching hospital, hospice, and home. 

For more information or to submit an application please contact:  

Kevin Weingarten
Program Director, Palliative Care Fellowship, Sickkids 

Jenny Loor 
Administrative Coordinator  
Paediatric Advanced Care Team (PACT) 
Phone: 416.813.6905 | Fax: 416.813.7999 

PACT Elective

PACT is excited to offer elective experiences with our team. These electives are a minimum of 2 weeks and maximum of 4 weeks and are aimed at those interested in incorporating palliative care skills into their practice.  Unfortunately, at this time, we do not accept medical students.  Please note that our electives fill up very quickly, and they are distributed on a first come first serve basis. 

Click PACT Elective Expectations (Word document) for more detailed information about our elective experience.

For more information or to arrange an elective please contact: 

Jenny Loor - Administrative Coordinator 
Paediatric Advanced Care Team (PACT) 
Phone: 416.813.6905 | Fax: 416.813.7999

We have also had nursing students in the past, as well as students interested in grief and bereavement care. Please note that at this time, we cannot accommodate medical students. 

Events and symposiums

Biennial SickKids Paediatric Palliative Care Symposium

Lots of individuals at SickKids, and indeed across Ontario, are interested in clinical or research aspects of pediatric palliative care. Unfortunately, we rarely have a chance to interact, learn from each other and network. In 2009, the Team for Research with Adolescents and Children in Palliation and Grief (TRAC-PG), a network of paediatric palliative care researchers, organized a symposium to rectify this. Although the formal TRAC-PG network is no more, we continue to come together as a paediatric palliative care community once every two years at our Paediatric Palliative Care Symposium. 

Each symposium attracts more than 100 clinicians, researchers, family members and volunteers interested in palliative care for children. The day starts with a key note address at our hospital wide grand rounds given by an invited distinguished guest from the field. The remainder of the day is filled with learning opportunities, presentations of new research findings, expert panel discussions, and more. The food is always great and there is ample time to connect with others who share similar interests. 

Contact PACT

Phone: 416-813-6905 


Fax: 416-813-7999


555 University Avenue 

Room 5401 

Toronto ON, M5G 1X8 

Staff contacts

Adam Rapoport, MD - PACT Physician and Medical Director (416) 813 6905  

Kevin Weingarten, MD - PACT Physician (416) 813-7500. 

Kate Nelson, MD,  - PACT Physician (416) 813-6905. 

Sarah Lord, MD, MHSc., BSc. - PACT Physician or 416-813-7654 ext. 201820 

Shaindy Alexander – Community Support (416) 813-7654 ext. 201775 

Francis Macapagal, RN, BScN, MN - Clinical Nurse Specialist  (416) 813-8332 

Rebecca Williams, NP, RN - Nurse Practitioner (416)-813-2268. 

Sarah Meadows, RN  - Clinical Nurse Specialist (416) 813-7654, ext. 202288. 

Lori Ives-Baine, RN, BscN, MN (CPB, CWT) - Grief Support Coordinator (416) 813-6782 

Andrea Steadman - Grief Support Coordinator (416) 813-7654 ext. 201775 

Kim Widger - PACT Nursing Research Associate (416) 978-7925. 

Our history 

It's a little known fact that SickKids was one of the very first paediatric institutions worldwide to offer palliative care for children and their families. In 1986, a service was created by a small group dedicated nurses on the neurosurgical unit, with physician support provided by the Clinical Pharmacology team. In 1989, a feasibility study was presented to the hospital board, who gave their support to the initiation of a hospital-wide palliative care service. Over the years, palliative care at SickKids has gone through various phases, but a number of dedicated staff have maintained an ongoing service until the present day. In 2003, the first dedicated physician was hired at SickKids to staff what was then called the Palliative and Bereavement Care Service 

In the 2010's, major shifts were underway that ultimately resulted in a considerable expansion of the palliative care service at SickKids. The hospital was increasingly caring for children with chronic complex conditions, many of whom were technology-dependent and some of whom would still have a shortened life. At the same time, more and more people were recognizing that the goals of palliative care - maximizing quality of life and minimizing suffering - were beneficial to those living with serious illnesses, not just those dying from them. In 2011, the first Medical Director was appointed to the team and by 2012, the Paediatric Advanced Care Team (PACT) was officially born. 

Today, PACT consists of a multi-disciplinary group of clinicians who provide a full range of palliative and bereavement care services hospital-wide and throughout the community.

Exterior of SickKids


Learn about hospice supports, financial resources, government options, nursing services, educational opportunities and more.

Exterior of SickKids


Support resources for your family after the loss of a child.

Back to Top