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The Extensive Needs Service (ENS) is a program that provides vital wrap-around services for children and youth with urgent and extensive needs in Ontario who have co-occurring urgent medical, physical and developmental complexities and/or social vulnerabilities.

This integrated pathway helps streamline the process for children and families to access help in support of optimal health outcomes. The service is designed to reduce barriers to accessing timely, evidence-based, and trauma-informed treatment for some of the most vulnerable children in Ontario. See the program criteria below to see if your child is eligible.

Holland Bloorview, the Children’s Hospital of Eastern Ontario and McMaster Children’s Hospital are the three sites in Ontario leading this program funded by Ontario’s Ministry of Health and the Ministry of Children, Community and Social Services. 

Expanding ENS to more families in the GTA

In an effort to provide ENS to more families closer to where they live, Holland Bloorview has partnered with three organizations across the Greater Toronto Area: Michael Garron Hospital, Grandview Kids and the Children’s Treatment Network. These three organizations deliver the ENS program in their local communities. Additionally, Surrey Place provides dedicated service coordinators who work closely with families to access ENS at Holland Bloorview. They also provide expert support with navigating the health and social service sector for families with complex and urgent needs.

We are continuing to actively work to expand this service so that we can reach out to more eligible families to provide the necessary support and assistance.

Please check back regularly for updates and additional information on how to access our program.

Referrals to Holland Bloorview

Toronto families interested in the Extensive Needs Service program and who are not currently receiving care at Holland Bloorview can:

  • Receive a referral from their community physician/health professional (referral forms below for health-care providers)
  • Refer themselves by connecting with Surrey Place, Toronto’s designated SmartStart Hub, online or by calling 1-833-575-KIDS (5437) to inquire about their eligibility to access these supports. The SmartStart Hub acts as a clear point of entry to children’s developmental services for families and caregivers.

 

For families living in East Toronto or outside of Toronto, please see below for information to refer to ENS partner organizations.

Research and Evaluation
  • Baysarowich, R., Remedios, J., Johansen, T., Decker, K., & Margallo, K. (2024, May 15-18). Extensive Needs Service: The development of a new wrap-around care model to support children and youth with high support needs [Poster presentation]. International Society for Autism Research 2024 Annual Meeting, Melbourne, Australia.
  • Edwards, J., Drmic, I., Jeyabalan, T., Ferguson, G., Baysarowich, R., Denomey, N., Hayawi, L., Mitsakakis, N., Rombos, V., Salami, Z., Webster, R., D’Angiulli, A., & Penner, M. (2025, April 17). Pathway to change: Preliminary results from a comprehensive evaluation of the Extensive Needs Service program in Ontario [Poster abstract]. Offord Centre Research Day, Hamilton, Ontario, Canada.
  • Edwards, J., Ferguson, G., Drmic, I., Baysarowich, R., Denomey, N., Hayawi, L., Jeyabalan, T., Mitsakakis, N., Rombos, V., Salami, Z., Webster, R., D’Angiulli, A., & Penner, M. (2025, March 26). Pathway to change: Preliminary results from a comprehensive evaluation of the Extensive Needs Service program in Ontario, Canada [Poster abstract]. McMaster Child Health Research Day, Hamilton, Ontario, Canada.
  • Ferguson, G., Baysarowich, R., D’Angiulli, A., Decker, K., Denomey, N., Drmic, I., Edwards, J., Hayawi, L., Jeyabalan, T., Johansen, T., Margallo, K., Mitsakakis, N., Rombos, V., Salami, Z., Webster, R., & Penner, M. (2024, October 14-19). Implementation of measurement-based care in a clinical program for children with mental health concerns and co-occurring extensive needs [Poster accepted]. American Academy of Child and Adolescent Psychiatry, Seattle, Washington, United States of America.
  • Ferguson, G., Baysarowich, R., D’Anguilli, A., Decker, K., Denomey, N., Drmic, I., Edwards, J., Hayawi, L., Jeyabalan, T., Johansen, T., Margallo, K., Mitsakakis, N., Rombos, V., Salami, Z., Webster, R., Penner, M. (2025, April 14-15). Pathway to change: Preliminary results from a comprehensive evaluation of the Extensive Needs Service program in Ontario [Poster presentation]. Children’s Healthcare Canada, Ottawa, Ontario, Canada.
  • Ferguson, G., Baysarowich, R., D’Anguilli, A., Decker, K., Denomey, N., Drmic, I., Jeyabalan, T., Lui, T., Milicevic, T., Rombos, V., Salami, Z., & Penner, M. (2024, October 20-22). Pathway to change: A comprehensive evaluation of the Extensive Needs Service pilot program in Ontario [Poster abstract]. Children’s Healthcare Canada, St. Johns, Newfoundland and Labrador, Canada.
  • Johansen, T., Drmic, I., Decker, K., McKenna, S., & Margallo, K. (2025, April 14-15). Ontario’s Extensive Needs Service: Lesson learned about right-sizing care for Ontario’s highest need neurodiverse children [Poster presentation]. Children’s Healthcare Canada, Ottawa, Ontario, Canada.
  • Lepinskie, K., Ravary, J., Nagle, I., Hinton, C., & Jarock, V. (2024, October 20-22). Right sizing healthcare for children with complex neurodevelopmental health needs: Examining the supportive visits stream of Ontario’s new Extensive Needs Service [Poster presentation]. Children’s Healthcare Canada, St. Johns, Newfoundland and Labrador, Canada.
  • Lepinskie, K., Stinson, J., Burns, C. (2024, October 20-22). Right sizing the family journey: Showcasing quality improvement initiatives in interdisciplinary delivery of Ontario’s new Extensive Needs Service [Poster presentation]. Children’s Healthcare Canada, St. Johns, Newfoundland and Labrador, Canada.
  • Lui, T., Decker, K., Milicevic, T., Kennedy, J., Dillon, K., Truong, N., & Slaunwhite, T.  (2024, October 20-22). Development of a Greater Toronto Area network of Extensive Needs Service providers to increase equitable access to care [Poster abstract]. Children’s Healthcare Canada, St. Johns, Newfoundland and Labrador, Canada.
  • Olaseni, B., Chan, T., Decker, K., Ferguson, G., Hatrick, R., Jani, S., Rombos, V., & Penner, M. (2025, April 16 - 17). Barriers and facilitators to providing successful respite care for children with complex behavioural needs: Insights from respite care providers in the ENS program [Poster abstract]. Empowered Kids Ontario, Toronto, Ontario, Canada.
  • Olaseni, B., Rombos V., Salami Z., Ferguson G., & Penner, M. (2024, November 7-8). A comprehensive characterization of Holland Bloorview's Extensive Needs Service research participants [Poster presentation]. Holland Bloorview BRI Symposium. Toronto, Ontario, Canada.
  • Remedios, J., Decker, K., & Drmic, I. (2023, October 21-24). Building the Extensive Needs Service - bridging the gaps for children and youth in Ontario, Canada [Poster presentation]. Kids Brain Health Network Annual Conference 2023, Ottawa, Ontario, Canada.
  • Remedios, J., Johansen, T, & Baysarowich, R. (2024, October 20-22). Fostering interprofessional collaboration and clinical skills through the use of visual thinking strategies: A preliminary study in pediatric healthcare [Poster presentation]. Children’s Healthcare Canada, St. Johns, Newfoundland and Labrador, Canada.
  • Remedios, J., Johansen, T, & Baysarowich, R. (2024, October 20-22). Unveiling team synergy: Understanding the impact of creating interdisciplinary teams in pediatric neurodevelopmental health care [Poster presentation]. Children’s Healthcare Canada, St. Johns, Newfoundland and Labrador, Canada.
  • Salami, Z., Olaseni, B., Ferguson, G., Rombos, V., Baysarowich, R., D’Anguilli, A., Decker, K., Denomey, N., Drmic, I., Jeyabalan, T., Lui, T., Milicevic, T., & Penner, M. (2024, October 30 – November 1). Establishing a rapid learning health system to enhance care and outcomes for populations of children and youth with extensive needs [Poster presentation]. Geneva Centre for Autism Symposium, Toronto, Ontario, Canada.
  • Salami, Z., Rombos, V., Ferguson, G., & Penner, M. (2024, September 21-24). Implementation of measurement-based care for children with mental health concerns [Poster presentation]. Canadian Academy of Child and Adolescent Psychiatry Conference 2024, Winnipeg, Manitoba, Canada.
  • Salami, Z.O., D'Angiulli, A., Drmic, I., Edwards, J., Ferguson, G., Rombos, V., Baysarowich, R., Decker, K., Denomey, N., Hayawi, L., Jeyabalan, T., Johansen, T., Margallo, K., Mitsakakis, N., Webster, R., and Penner, M. (2025, April 30 - May 3). Pathway to change: A comprehensive evaluation of the Extensive Needs Service pilot program in Ontario [Poster presentation]. International Society for Autism Research, Seattle, Washington, United States of America.
  • Siddiqui, H., Henderson, A., Lewis, I., & Penner. M. (2025, April 14-15). Utilization of emergency department services among children with neurodevelopmental diagnoses: a scoping review [Poster abstract]. Children’s Healthcare Canada, Ottawa, Ontario, Canada.
  • Siddiqui, H., Henderson, A., Lewis, I., & Penner. M. (2025, May 25 - 28). Utilization of emergency department services among children with neurodevelopmental diagnoses: a scoping review [Poster presentation]. International Conference on Emergency Medicine, Montreal, Quebec, Canada.
  • Siddiqui, H., Henderson, A., Lewis, I., & Penner. M. (2025, May 29 - 31). Utilization of emergency department services among children with neurodevelopmental diagnoses: a scoping review [Poster abstract]. Canadian Paediatric Society, Quebec City, Quebec, Canada.

Holland Bloorview Inaugural Extensive Needs Partners

 

Holland Bloorview logoGrandview Kids logoMichael Garron Hospital logo
Surrey Place logoSurrey Place logo
 

Extensive Needs Service Tri-Agency Lead Partners

 

CHEO logoHolland Bloorview logoMcMaster Children's Hospital logo
 

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Serves children and youth up to 18 years with extensive needs.

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Specialized and individualized services and supports to clients and their families.

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A trauma informed and evidence based approach to care.
Contact us
Kezia Romany
416-425-6220
Ext.
6390