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Bloom Blog

Fewer disabled students are getting their needs met at school

By Louise Kinross

Dr. Janice Hansen is a highly skilled psychologist who assesses children with a variety of disabilities to identify the supports they need to thrive in school. She came to Holland Bloorview as a PhD student in 1990. When she graduated in 1994, she joined the hospital and never looked back. She wishes children's rehab and education worked hand-in-hand. Compared to 20 years ago, "More and more of our kids are not getting their needs met at school," she says. "I make recommendations that I know realistically may not happen, and I don't know what to tell our families." We spoke about her role.

BLOOM: How did you get into this field?

Janice Hansen: It was a multi-stage process. I was always interested in kids. I've always been fascinated by kids' development—by how much is going on before a word is spoken. I really love babies and little kids.

When I went to university I took an intro psychology course and became interested in psychology specifically. The special-needs piece came after my master's when I worked at a school for the deaf in Milton. I learned sign language and became focused on kids with special needs.

When I went back to grad school to do my PhD, a fellow student had done a placement at what was then "Hugh MacMillan." It sounded really interesting. I followed and never left. I did my PhD research with clients here—looking at the relationship between self-esteem and friendship in children with cerebral palsy. 

BLOOM: What was your experience at the deaf school like?

Janice Hansen: Learning sign language was fascinating to me. It was a whole field I knew nothing about in terms of how people communicate, as well as the cultural differences and ethical issues. I was a hearing person working in the deaf world and I was very naive initially. Deaf staff used the term deaf versus hearing-impaired because deafness was seen as a cultural difference rather than a disability.

There was also controversy at the time over cochlear implants because of the idea of taking a child who was communicating quite functionally in the signing world, and then giving them a device that made them hear better, but not the same way a hearing person heard. I learned about the history of deaf people's experiences, where some were forced to sit on their hands at school in an effort to make them learn to speak or read.

BLOOM: So abusive. What is a typical day like here?

Janice Hansen: Back in the day when I worked with your son Ben, I did all the hands-on work in psychoeducational assessments. Today we have psychometrists who have their master's and are highly trained to work directly with the kids, under our supervision.

Today some of my work is still spent directly with clients, whether that's interviewing a parent to get a child's history or giving them feedback about their child's assessment. I do all of the autism diagnostic work directly. I also have a solo private practice where I do all the work myself, so it keeps my skills fresh and makes me very familiar with newer versions of the tests. I'd say I have the best of both worlds

BLOOM: What are the greatest challenges of your job?

Janice Hansen: Part of the challenge is you have to really trust the psychometrist. It's a bit of a challenge not having the direct experience with children, but we have good relationships with our psychometrists and I trust them and feel they're my eyes and ears.

When you work in assessment, as opposed to therapy, there's a very high turnover in clients. You're constantly meeting new people and often spend only two to three sessions with them before you're done. You have to develop rapport, and sometimes deliver difficult news, in that very short time span.

You have to quickly assess what stage the parents are at, and what their readiness is to hear news. Many don't speak English, so you're working with interpreters, which can be a barrier in terms of developing rapport. 

Another thing you have to get used to is you rarely know the outcome of the work you do and whether it's been beneficial or not. I provide information and help parents understand their child and link to resources, but I often don't know whether all the work I did made any difference in a child's life. You have to be okay with that.

BLOOM: Is that something that could be changed? Could you follow kids?

Janice Hansen: I've sometimes thought about whether we could offer a follow-up session a year later to see how things are going. But we don't have the resources to meet the needs at the follow-up stage if the school hasn't acted on our recommendations. We are essentially a diagnostic hub, and the work is meant to be done in the schools. 

BLOOM: Having a child tested by a psychologist is nerve-wracking for a parent. What emotions do you experience sharing a diagnosis?

Janice Hansen: That's an area where you only really learn how to do that over time. Grad school doesn't prepare you for the reality of sitting in front of a parent and having to tell them bad news. It's one thing to know how to make a diagnosis on paper. That's the knowledge you have as an expert.

When you're dealing with a person and their child, it can be more challenging. I've evolved in my approach to that situation and come a long way in two ways. First, in terms of my confidence in what I know, and second, in my ability to trust that parents are more resilient than I might give them credit for. 

I became a parent literally at the time I finished my PhD. Early in my career I feel like I had a tendency to identify with the parents, even though the child is my client. In hindsight, I think I became quite protective of the parent and worried about having to deliver potentially bad news. I feel like I might have been subconsciously white-washing or hedging if I thought the diagnosis was probably there, but I wanted time for the parent to adjust. So I would hold back a bit. 

Over time, I've learned it's important to have those hard conversations early. It doesn't mean you don't give hope, and there are ways to be truthful and still gentle and supportive. I know now that it's not doing parents any favours if I know the answer but wait a couple of years. Then they don't access resources and they may have unrealistic expectations of their child and become frustrated. 

BLOOM: What are the greatest joys?

Janice Hansen: Working with kids, obviously. Helping parents understand their child better. Sometimes parents are relieved to have a reason and understanding for why a child hasn't been able to do something, or has been struggling. I can give them permission to say this isn't a reasonable goal for your child right now, so don't beat yourself up about it. Let it go and you can work on these other things. I know some parents find that liberating, which I rewarding. 

BLOOM: How do you cope with stress?

Janice Hansen: First of all I have a sense of humour. I try really hard to look on the bright side and find the humour in things. I laugh at myself a lot. Humour is a quality that's important. I've also been a runner, for decades and decades, and I have other hobbies. I'm very involved in acting and theatre, outside of my day job. I feel I have a good balance in my life. My career is a part of who I am, but my other activities help me manage it and keep it in its place.

BLOOM: You have experience testing children who don't speak, but many psychologists don't. How do you adapt your testing?

Janice Hansen: There are non-verbal tests available to any psychologists. They can be used with children who don't speak or who are newcomers to Canada, or who are deaf. They are visually based and require some multiple choice answers. If a child can point or indicate their choice in some way, you can do a lot.

What takes some skill and experience is working with a child who has unconventional methods of communicating. If they use eye gaze, it can be difficult for an inexperienced clinician to interpret a client's responses reliably. If a child has motor impairment like poor trunk control, a psychologist may not realize the fatigue that happens when they struggle to move their hand. The brain works on moving the hand and has little left to figure out the answers that are being asked.

BLOOM: What qualities do you need to be good at your job?

Janice Hansen: You need a lot of energy, especially with young kids. You need to keep up with them and handle their physical energy. You also need a lot of mental energy when you're doing assessments. You may be shifting between clients in one given day, doing an assessment with one child and then giving feedback about another child back-to-back. 

You have to have really good time-management skills and a sense of humour because the job is stressful. You have to find the joy. People sometimes ask me 'Isn't your job depressing?' There may be something wrong with me, but I have never found it depressing.

These kids and families have joy. I see the love between parent and child. I see the creativity with being able to problem-solve around things. I see them as families first. I never dismiss the disability, but I don't see it as the whole. 

BLOOM: Have your thoughts about intelligence changed in any way over the years?

Janice Hansen: I assess children's intelligence. It may not be popular to say that. It's for the purpose of school planning and goal-setting. I believe there's a lot of value to standardized testing. But I would say that I now have a better appreciation for how intelligence can manifest itself in kids who have no traditional ways of communicating.

I also see the ways that motivation plays out in how we assess intelligence. That's particularly true for kids with autism, who may do very poorly because they're not engaged and they're on their own agenda.

There are also many other kinds of intelligence we don't measure. There's emotional intelligence and mechanical intelligence. There are different ways kids can thrive that won't show up on a formal IQ test.

I help some parents understand that university may seem like the be-all or end-all, but for some kids that's not the path, and that's totally okay. There are other ways to be meaningful members of society. They may volunteer. Over the years I've seen some clients who didn't go to university who are now staff here, and they're accepted and valued members of our team. And they're giving back. That's a lesson I've learned.

BLOOM: If you could change one thing about the system we work in, what would it be?

Janice Hansen: Only one thing Louise?

Because my work is so closely aligned with the school boards, I wish there was more integration between health care and school, because those are the two worlds our kids live in.

There's such a disconnect between the work we do in health care and how that translates into what happens, or doesn't happen, in the school system. More and more of our kids are not getting their needs met at school. 

I know there's a resource issue, and sometimes we speak different languages, and use different terminology. But the pressures the schools are under have also increased dramatically. They're working with newcomers. Many kids in school don't speak English and come from a trauma background and don't have food in their stomach. These are issues that have nothing to do with education. 

I make recommendations that I know realistically may not happen, and I don't know what to tell our families. Some of our families can afford private education. I just had one parent who said she was thinking of moving to the states. 

BLOOM: If you could give yourself advice on your first day here, with what you know now, what would you say?

Janice Hansen: We have a really good training program here for psychology and I'm very involved in working with interns at the tail end of their PhDs, as well as with psychologists who are early in their career, so I do have the opportunity to mentor them. I'd go back to what we talked about before.

I like to remind my interns and new graduates that they know more than they think they know. We're so carefully trained in graduate school to be aware of our limits of competence, and to not practice outside of the scope of what we're licensed to do. It can create the imposter syndrome. You can feel like 'I know nothing. I can't say anything.' So if I could go back, I would tell myself to trust my knowledge and believe in my competence. I spent many years studying this field, and I have something to contribute.

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