A trauma-assumed approach to Applied Behaviour Analysis, Practical Functional Assessment and Skill Based Treatment enables the behaviour therapy team to work with clients and their families while centering on three priorities; safety, dignity, and rapport.
Trust is built between the client and behaviour analysts/technicians by ensuring the client consents/ascents to treatment throughout sessions, explaining what the goal of each session is and clearly signaling when a demand is about to be placed, and responding to the needs of the client within sessions.
All interfering behaviour is met with empathetic statements/gestures and individualized support to meet the client’s needs, and never ignored. Foundational goals of Skill Based Treatment focus on teaching clients functional communication to get their needs met, tolerance of everyday frustrations and disappointments, and contextually appropriate behaviours.
Contextually appropriate behaviours are individualized goals made in collaboration with clients and their caregivers that are meaningful for their everyday life (e.g., leisure, self-care, communication, etc.) and are responsive to change when needed.
Treatment allows a behaviour analyst/technician to work directly with a client to systematically build skills and reduce the need to engage in interfering behaviour within manageable steps.
Caregivers are involved in each step of treatment and become active members of treatment once the client consistently demonstrates the skills with the clinician. As a final step, the skills learned and practiced within the clinic setting are generalized to the environments a client lives, learns, and engages in leisure.
Child and adolescent psychiatrists specialize in the diagnosis and the treatment of disorders of thinking, feeling and/or behavior affecting children, adolescents, and their families. Depending on the client’s needs, they may provide a one-time consultation or they may provide a number of follow-up visits with both the client and their family members.
The child and adolescent psychiatrist may prescribe medications or recommend changes to current medications. They work closely with the rest of the team to ensure that they have a full understanding of the client and family’s needs.
Child Life Specialists are clinically trained and specialize in helping children and families navigate the impacts of illness, hospitalization, trauma and disability. They provide evidence-based interventions such as therapeutic play, outlets for expressing emotions, preparation for procedures and work with children to reduce fear, anxiety and pain.
Within Extensive Needs, the work of a Child Life Specialist starts with a trauma-assumed approach and is built on trust with the child and family over time. Child Life Specialists work with the families to meet each child’s individualized goals within the program and support transitions between teams and programs. Additionally, Child Life Specialists offer valuable sibling supports to ensure family coping, health and well-being.
The ENS Psychologist provides psychodiagnostic assessments to inform interventions for clients. They collaborate with an interdisciplinary team to tailor individualized psychotherapy intervention to address the unique mental-health, emotional, and behavioural needs clients and families experience. They also provide consultation to schools, agencies, and other professionals to support clients' transitions to community services.
Clinical pharmacists ensures that medications are used in a safe, effective and evidence-based manner. Clinical pharmacists within Extensive Needs are highly trained and specialized in pediatric pharmacotherapy.
The clinical pharmacists works with the clinical team and family to assess the impact and benefit of medications for each child. They will work with community team members to support ongoing monitoring for medication side effects.
Additionally, the clinical pharmacists can provide detailed education on medications and suggestions to help with medication administration. Ultimately, the goal is to use medications in a way to support each child’s individualized needs and ongoing learning and development.
Through a unique partnership with Surrey Place, clients in the Extensive Needs Service at Holland Bloorview have dedicated access to this important service.
Some of the supports that Service Coordinators can provide include:
- Making referrals to other community agencies and services as required.
- Providing information to clients, caregivers, service providers and staff on the availability and appropriateness of community services and funding support.
- Participate in service coordination group meetings, chairing case conferences, and community tables and meetings as required, as well as engage in community outreach to develop a collaborative approach to service delivery.
Developmental paediatricians provide specialized assessment and care for children and youth accessing the Extensive Needs Service. Depending on the client’s needs, they may provide a one-time consultation or they may provide a number of follow-up visits.
Developmental Pediatricians will review and prescribe medications when necessary. They work closely with other members of the team to provide care that focuses on physical, mental and behavioural health.
The occupational therapy team provides a trauma-informed and evidence-based approach to client-centered care. The goal of occupational therapy is to enable participation and engagement in activities that are meaningful in the individual’s everyday life.
Occupational therapists on the Extensive Needs Service can work with children and youth with a variety of conditions to achieve their goals. Our clients have experienced barriers to accessing care within their community due to interfering behaviours and mental health challenges.
The occupational therapist will collaborate with the client and their families to determine the most meaningful goals, establish an individualized treatment plan and/or identify the need for supports within the community.
Occupational therapists on our team assist in reducing barriers in the environment to ensure equitable access to meaningful activities in the community. The occupational therapist will work with each client to facilitate improved performance and satisfaction with their life by addressing the client’s sensory processing, emotional regulation, sleep hygiene and social skills.
Our occupational therapists will highlight each clients’ strengths to optimize their success in their everyday life. Working with the occupational therapist, our clients will be able to maximize their independence and quality of life.
Registered Dietitians (RDs) in Ontario are regulated health professionals that assess and provide care for nutritional and dietary related problems. Dietitians translate medical and scientific nutrition evidence into practical information to help families and individuals based on their nutritional needs. Nutrition Care for feeding challenges is provided by a Registered Dietitian as part of Extensive Needs Services. A trauma Informed, weight-inclusive and client centered approach is emphasized and prioritized in the care of each client.
Our dietitian primarily provides treatment for children with feeding challenges (with or without an ARFID diagnosis) who present with a variety of conditions using a Responsive Feeding Therapy approach (RFT). RFT is a multi-step trauma-informed approach to treating feeding challenges that emphasizes the child’s agency (upholding their right to say no to interventions). It focuses on motivating children to eat based on their own interests and internal cues rather than using intensive or forceful methods. Responsive Feeding Therapy (RFT) values individualized care, autonomy, relationship and internal motivation.
Along with treating ARFID our dietitian also provides treatment for the following common challenges amongst our population:
- Poor Appetite Related to Medications
- Increased Appetite Related to Medications
- Binge Eating Disorder
- Restricted Eating related to body image concerns and associated trauma
Nutrition care would involve the dietitian conducting an in-depth nutritional assessment with the family followed by collaborative formulation of a comprehensive nutrition care-plan. Care plans will include nutrition education and SMART (Specific, Measurable, Achievable, Relevant, and Time-Bound) goal setting as well as scheduled follow-ups to monitor progress.
Working with a dietitian will allow clients and their families to feel supported knowing that they will be receiving the most up-to-date, evidenced-based nutrition information and individualized treatment.
The nursing team in the Extensive Needs Service assesses the needs of each individual client and family that is referred to the program and identifies areas of systemic barriers that prevent equitable access to care to ensure that all clients and families are getting the care they need.
The nursing team will support the client and family’s journey. We use a trauma-informed and family-centered care approach. The ENS nursing team collaborates with families to discuss their goals and priorities they have and conducts a thorough assessment, triaging, and information sharing with the interdisciplinary team. The nursing team has partnered with the research team to ensure the care that we are providing is making an impact for the child and their families.
The nursing team supports the Psychiatrists, Developmental Pediatricians and Nurse Practitioners in applying strength based approach to the protection, promotion and optimization of health and abilities for children with extensive clinical and developmental needs and social vulnerabilities. The nursing team partners with the families to ensure that there in ongoing support throughout this journey in the program.
Registered Social Workers are regulated health professionals that provides a wide range of services to individuals and families in order to improve their quality of life, while valuing their strength and uniqueness. They are regulated by The Ontario College of Social Workers and Social Service Workers.
Social workers are professionally trained to support families to cope with the impact of disability, complex health needs and trauma. They care for the social, emotional and service needs of children, and their families, while respecting the need for client and family confidentiality. Social Workers in Extensive needs services can help with in a variety of ways such as by providing service navigation, advocacy, and crisis management.
A social worker can offer supportive counselling to help manage emotions while proving encouragement and validation during a difficult time. Some of the other ways that a Social Worker may help you are by enhancing coping abilities and advocacy skills, coordinating respite options, educating and assisting with the application to eligible resources and funding options, writing support letters, supporting transitions, assessing and managing social needs and more.
Our speech-language pathologists are deeply committed to delivering trauma-sensitive care through a neurodiversity-affirming framework. We aim to create strong partnerships with our clients and their families, using their lived experience in conjunction with our professional knowledge in order to help them meet their goals.
Through this collaborative approach, we set functional and meaningful goals in consultation with families. These goals are targeted using engaging, evidence-informed techniques that take into account the unique strengths, interests and learning styles of our clients. Our speech-language pathology team draws on years of experience providing caregiver education, diagnostic assessment, and individualized intervention, and is skilled at teaching new skills in fun and engaging ways.
We support the development of a variety of skills related to:
- Language acquisition
- Social communication
- Cognitive communication
- Speech and articulation
- Feeding and swallowing
- Aural rehabilitation
- Augmentative and alternative communication (AAC) systems
Parents and caregivers play an integral role in treatment. We engage key adults in the lives of our clients in order to empower all family members to support the maintenance and generalization of newly acquired skills across multiple environments.
