Encouraging success in all students

A talk given at the Annual General Meeting for the Learning Disabilities Association of Peel Region, by Dr. Adrienne Eastwood, Psychologist

Good evening everyone, thank you for this opportunity to speak about a topic that I am quite passionate about – the potential for success that lies in each and every student.

As a psychologist, my job involves assessing children, diagnosing learning disabilities, and helping parents to understand what it all means for their child.  Understandably, parents of a child newly diagnosed with a learning disability are often worried and concerned – will my child succeed at school? Go on to post-secondary education? Be successful in life?

It is true that students with a learning disability often have a tough time in school, particularly when teaching approaches and evaluation methods are not adapted in order to meet their needs.  However, parents are often quite surprised when I explain to them that the ultimate barrier to their child’s academic success may not even be their child’s particular learning difficulties.  I let them know that students with all sorts of disabilities are successful when they get the right supports, when they have the motivation to learn, and the persistence to achieve goals that matter to them.  And sometimes, they succeed despite getting less than ideal supports and accommodations.

In my years of practice, I have been impressed by the success achieved by people who some thought did not have the potential to graduate from High School, let alone go on to postsecondary education (which they did!).  Likewise, I have seen how self-defeating attitudes and negative self-perceptions have prevented the most intellectually capable people, without any kind of learning disability at all, from graduating from high school.   Even though research studies confirm that learning disabilities do increase a person’s risk for academic failure, it’s really important to know that it is not the only predictor of important outcomes.

So what is important for parents to know about how to help children succeed?  Tonight I want to share some research results with you that I hope will inspire you to continue your efforts to support the people you know with learning disabilities.   You already know that appropriate accommodations and learning disability-friendly teaching strategies make a big difference in helping children with learning disabilities to achieve academic success.  What I would like to share with you tonight are some research results that are not specific to learning disabilities, but that are relevant for all students.

The research that I am going to tell you about has to do with what people believe about how intelligence works, and how these beliefs impact how they deal with difficult tasks.

Research over the last decade has shown us that a person’s beliefs about how intelligence works actually affect their academic success.  Carol Dweck, a psychology researcher at Stanford University, has published numerous groundbreaking papers about the impact of people’s theories, or beliefs, about intelligence.   She has found that some people believe that intelligence can’t change no matter what – you are just born smart or not-so-smart.  Carol Dweck calls this a fixed mindset.  Other people think that intelligence actually can change, and for the better – she calls this a growth mindset.

People with a fixed mindset behave quite differently than people with a growth mindset.  When someone with a fixed mindset faces a difficult task that they expect they will fail, they are likely to give up.  And when they do fail at tasks, they tend to assume that they were not smart enough to have been successful.  People with fixed mindsets tend to believe that looking smart is more important than how much you learn.

It’s a different story for people with a growth mindset. When someone with a growth mindset is given a task that is too tricky for them, they will increase their effort to conquer the challenge, and they will be pleased when they increase their ability and skills, even if they are still not earning the best marks. When they fail at a task, someone with a growth mindset will assume that the reason is because they did not work hard enough.

These differences in beliefs and behaviour actually translate into different outcomes in academic achievement.  Studies that have followed students over multiple years of schooling have found that when students have a growth mindset, their grades improve over time, while students with a fixed mindset show no improvements in grades.  These patterns hold true whether students are earning high or low marks to begin with.

Now this is a key point… it doesn’t matter whether students were high achieving or low achieving to begin with…. The ones who believe that intelligence can improve tend to perform better over time.

So, why do a person’s beliefs about intelligence impact their achievement? Carol Dweck found out that students who have a growth mindset also hold goals for themselves related to improving their learning, and they are more likely to believe that working hard is both necessary and effective in order to achieve.  With this set of helpful beliefs, students then face setbacks with resilience – they don’t blame their failures on a lack of ability, instead they make plans to invest more time into their work.

Okay, so what the researchers did next was really interesting.  They took a group of kids entering Grade 7, and followed them throughout the year, looking at their beliefs about intelligence, their math marks, and what teachers were saying about them.  This particular group of students was not performing very well; they were overall earning C grades in Math.  What’s more, their grades were dropping as the year progressed.

Then, in the spring term, the researchers had the students participate in an 8-week workshop about the brain and study skills.  Half the students learned that different parts of the brain are responsible for different tasks, and they were taught memory strategies to help them remember new information.

The other half of the students were taught a special growth mindset curriculum, where they also learned about the brain, but instead of learning specific memory strategies, they were taught that their learning can improve through practice.  This was considered the “experimental condition” – the one that the researchers predicted might lead to important outcomes.

I’ll tell you a little more about the growth-mindset curriculum.  The students read and discussed an article called “You Can Grow Your Brain.”  The article teaches them about neurons – those are the cells in the brain that communicate with each other using electrical and chemical signals whenever we think, talk, move or learn.  Students were also taught that the brain is like a muscle that gets stronger with use, and that learning prompts neurons in the brain to grow new connections.  Activities and discussions helped the students to see that they could help their own brains to develop stronger connections, by practicing new skills to mastery.

And what happened to these two groups of students?  Students who received the growth-mindset intervention improved their marks, while students in the control condition continued to have their marks slide.  Kids also began to behave differently after they participated in the growth mindset intervention. Teachers, who had been completely unaware that there were even two different groups, were asked to notice, which students were changing for the better (or worse) with respect to motivation or performance?  When teachers identified a student who had improved, that student was much more likely to have been in a growth mindset workshop than in the control group.

So, what about kids with learning disabilities specifically?  Does this research really apply to them?  Is it really true to say that they can improve their intelligence?  Won’t all this research make kids with learning disabilities feel as though it is their fault they are not getting good marks by trying harder?   Certainly, one can see the possibility for harm when it comes to applying the idea of the growth mindset to students with learning disabilities.  We all know individuals with learning disabilities who try so hard, and yet, still struggle to learn.

In thinking about the answer to these questions, it’s important to consider what a growth mindset is not:

Having a growth mindset is not about becoming skilled at a task simply by believing that one is capable, or believing that one can make a disability go away by just trying harder.  It doesn’t mean that a struggling student will suddenly earn As simply because they understand that the brain can grow new connections.  Having a growth mindset is also not about believing that everyone has the exact same potential.  The truth is that we don’t all have the same potential to learn, and we don’t all improve our skills at the same rate.  But, it is true that anyone can improve skills with practice.  And it is true that all skills must be practiced in order to achieve competence.  Even child prodigies like Mozart, reportedly born with innate talent, spent their whole lives practicing and perfecting their skills.

When it’s used in a helpful way, a growth mindset means telling the truth about a student’s current achievement and then, together, doing something about it, helping them to learn to do something that previously they did not know how to do.  Using a growth mindset also means helping the student to identify what is the next skill they need to learn, in order to achieve their goals.  And when students find themselves stuck on a task, using a growth mindset means encouraging them to sort out what else they can do to find a solution.

So, people with learning disabilities don’t need to hear that they should try harder.  The majority of them are already working so much harder than students without learning disabilities.  What they need to hear is that progress is possible, and that their efforts can pay off.  Students with learning disabilities need to be validated for the progress that they do make as a result of their efforts.  They need to know that you care more about their progress than their grades.

We also need to teach students with learning disabilities that their brains are learning machines, and that they are in charge of those machines.  They need to hear that their brains are constantly developing and improving whenever they practice a skill.

When students with learning disabilities encounter failure, as we all do, we can help them to see it as an opportunity for learning and growth.  When we make mistakes ourselves, we can show our kids that we are interested in figuring out how to do things differently next time.  We can show them that we don’t feel anxious, upset or angry when failures occur – either about our own mistakes, or theirs.

When we give students positive feedback, we need to do so deliberately and specifically.  We can praise them for their persistence or strategies, rather than making general praise statements like “you’re so smart”.  Even when kids are smart, telling them that they are smart may suggest a fixed mindset instead of a growth mindset – that you care more about how smart they are than how much progress they make in their learning.   Kids, and many adults, assume that if they are smart, then things should be easy.  So when things do not come easily, they may feel as though they are not smart.  You can’t go wrong when you let kids know how proud you are of their efforts, their perseverance, and their progress relative to where they were before.  When students learn to care more about their progress than their performance, then they will achieve so much more.

Thank you for your attention, and for all that you do to support students with learning disabilities.

References:

Putting a Canadian Face on Learning Disabilities Study (PACFOLD) http://pacfold.ca/download/WhatIs/en/executiveSummary.pdf

Lisa S. Blackwell Kali H. Trzesniewski and Carol Dweck (2007) Child Development, Volume 78, Number 1, Pages 246 – 263.  Implicit Theories of Intelligence Predict Achievement Across an Adolescent Transition: A Longitudinal Study and an Intervention. https://psychology.stanford.edu/sites/all/files/Implicit%20Theories%20of%20Intelligence%20Predict%20Achievement%20Across%20an%20Adolescent%20Transition_0.pdf

The Secret to Raising Smart Kids by Carol Dweck, January 1, 2015, Scientific American https://www.scientificamerican.com/article/the-secret-to-raising-smart-kids1/

Online growth mindset training based on Carol Dweck’s research: www.mindsetworks.com

Article similar to the one used in Carol Dweck’s 2007 study: https://www.mindsetworks.com/websitemedia/youcangrowyourintelligence.pdf

September 22, 2015.  Commentary in Education Week by Carol Dweck http://www.edweek.org/ew/articles/2015/09/23/carol-dweck-revisits-the-growth-mindset.html

Kyla Haimovitz and Carol S. Dweck (2016) Psychological Science, Vol. 27(6) pages 859–869.   What Predicts Children’s Fixed and Growth Intelligence Mind-Sets? Not Their Parents’ Views of Intelligence but Their Parents’ Views of Failure.

Boredom in the classroom

A talk given at the Annual General Meeting for the Learning Disabilities Association of Peel Region, by Dr. Adrienne Eastwood, Psychologist

Good evening, and thank you for inviting me to speak at your AGM.

Tonight I would like to talk to you about some interesting research about the feeling of boredom, and how it impacts learning in the classroom. I hope my talk won’t bore you!

We have all experienced boredom at one point or another, and no one likes the feeling. Boredom is an unpleasant feeling that happens when we want something interesting to do, but for whatever reason, we can’t find it. When do you feel bored?

When we are bored, we are disengaged with whatever is happening around us, and we wish that we had something to do that would capture our interest.

People who are bored may be kind of agitated or frustrated, or they may appear more sloth-like. Either way, people who are bored have trouble concentrating, and they feel like time is moving slowly.

In contrast, when a person is interested in something, they enjoy that activity, they are focused on it, and it is very likely that they will try to do that activity again.

So, does boredom happen in the classroom? Of course it does.

Boredom can be a big problem in the classroom. Research on boredom in the classroom has shown that kids who report more boredom are less motivated, have poorer study strategies, and lower academic achievement.

And if you are a parent of a child with ADHD or LDs, then perhaps you have heard your child complain about being bored at school.

There actually isn’t much research yet about boredom in people with ADHD/LD, but there is good reason to believe that there is an important relationship there that needs to be investigated. For example, some of the same brain regions are implicated in both boredom and ADHD. One important network of brain structures is called the Default Mode Network or (DMN) . The DMN is active when people’s minds are wandering or when they are “off task”. The DMN is quiet when people are concentrating. Not surprisingly, the DMN is generally more active in people with ADHD than in those who do not have ADHD. And the DMN is also more active when all people are bored compared to when they are not.

So, there is a connection between academic problems and boredom. But what comes first? Are students performing poorly because they are bored? If so, maybe teachers need to jazz it up. Or, are students bored because they are performing poorly? If so, then students may need support for learning so that they can more easily engage with the material. Researchers are only just beginning to untangle this chicken-egg problem.

So far, it looks like the causal direction goes both ways. In other words, students who are initially bored experience a subsequent drop in academic achievement, which then results in their feeling even more bored.

One interesting study cleverly distracted people on purpose, to see whether they would feel bored. How did they distract them? The researchers asked participants to listen to an educational audio recording and rate how bored they felt under three different conditions. In the first condition, there was a loud, clearly noticeable noise in the adjacent room – this was called the conscious distraction condition because the participants knew that they were being distracted. In the second condition, there was a just noticeable noise in the adjacent room – this was called the unconscious distraction condition. The last condition involved no distraction at all. Who felt the most bored? It was actually the people in the unconscious distraction condition. Their distraction resulted in lowered attention, and they reported more boredom because they didn’t realize they were being distracted by the noise. Instead, they figured they were distracted because the recording must have been boring. People in the conscious distraction condition realized they were being distracted, but didn’t report more boredom, because they blamed the loud noise for getting them off track.

A leading boredom researcher, John Eastwood, along with his colleagues, have developed a model of boredom. In a nutshell, they propose that when we fail to become mentally engaged in the world around us, we will feel bored. And when we are bored, we are not learning well.

Psychological research supports the idea that paying attention to things increases our interest and engagement. Consider the following research findings:

• If you ask people to pay attention to objects, then later on they will rate them more positively than objects they have not paid attention to. This is called the “exposure effect”.
• In general, the more often we encounter a particular object, the more we like it.
• Even just gazing or looking at an object will result in our preferring that object over another one.
• When it comes to information and learning, researchers have shown that people prefer information that is processed deeply as opposed to shallowly.
• On the other hand, objects that we actively ignore are subsequently judged more negatively. This is called the ‘distractor devaluation,’ effect.
• stimuli that we struggle to focus our attention on becomes less interesting, and this difficulty in processing appears to give rise to more feelings of boredom.

In summary, research suggests that we: like things we deliberately pay attention to; dislike things we deliberately avoid paying attention to; and find boring things that are difficult for us to pay attention to.

John thinks that teachers and students need to notice when students feel even a little bored, because that likely means that students are disengaged from the learning process, and a change is needed to facilitate learning. If we learn to notice that we are bored, then we can be ready to make a change that will hopefully promote interest and engagement. In this way, boredom can be a helpful feeling, just like anxiety or even pain. Boredom tells us that something is wrong and we need to fix it.

As educators, we need to tackle the problem of boredom head on; otherwise our students will find maladaptive ways of coping with boredom. Because boredom is such a yucky feeling, students tend to look for quickest and easiest way to feel better. Unfortunately, this often results in focusing attention on something other than the task at hand (e.g., acting out in class).

It’s important to remember that the person who is bored is actually highly motivated to be engaged in something, they are just struggling to engage with whatever they are being asked to learn in that moment. It’s not that the bored student doesn’t care, or doesn’t want to learn; in fact it can be quite the opposite.

So what can we do to help students?

If we know that distraction and difficulty engaging with material is the main cause of boredom, then we must ask ourselves what are the possible causes of a student’s distraction, and address those.

There are surely many reasons why students are distracted in the classroom. Today I would just like to touch on one particular issue that is important to me as a psychologist, and that I know will be important to all of you as well.

There are many students out there with undiagnosed learning disabilities and ADHD. As you know, Learning disabilities and ADHD are neurodevelopmental disorders that start in childhood and that are lifelong. They interfere with learning in a variety of ways – these are students who are of average intelligence but they process information differently, and, as a result, end up falling behind academically. Students with both learning disabilities and ADHD have trouble engaging with learning at school, particularly when the approach to teaching or classroom management does not meet their particular needs. For example, kids with ADHD need to move in order to learn. If the classroom teacher does not allow for movement, then a student with ADHD will be more distracted and less engaged. I would predict those students would complain of being bored. Likewise, students with writing disabilities generally find most paper and pencil tasks difficult to complete. Because their learning disability prevents them from engaging with writing tasks, they’re likely to complain of boredom. But what if that same student is given the opportunity to dictate, talk or role-play? Then you’d see that student would be engaged, and would not likely complain of boredom.

These few examples illustrate the importance of understanding every child’s learning profile when trying to find ways to engage them. Psychological assessments are one important way to get a better understanding of child’s learning needs, and to make sure that neurodevelopmental disorders do not go undiagnosed.

As you may know, our healthcare system, as wonderful as it is, lacks equity when it comes to mental health. Not everyone who needs to see a psychologist gets to see one. That is why I’m so excited to partner with your organization to provide psychological assessments to students who need them, but who have not been able to access them. Thanks to your dedicated advocacy efforts on behalf of families, more children will be able to get the help they need to engage in learning. Together, we will help more kids spark an interest in learning that will put boredom in its place!

Enhancing Outcomes with Progress Monitoring

The Globe & Mail published an article highlighting the use of routine progress monitoring to improve the effectiveness of psychotherapy. Given the time and money clients invest in psychotherapy, it is important that clients receive feedback-informed psychotherapy to enhance the effectiveness of treatment. Routine progress monitoring is a practice that clinicians implement at Eastwood Psychologists.  I will be sharing my experience with progress monitoring as a Psychologist (Supervised Practice) at Eastwood Psychologists and how it has benefited my work with clients.

What is Progress Monitoring?

Progress monitoring is a self-report survey completed routinely by a client to assess his or her functioning each week on various areas of concern (e.g. mood and anxiety symptoms). The questionnaire can be completed as a hard copy or electronically prior to each session. This survey is scored immediately and reviewed by the treating psychotherapist at the beginning of each session.

The Globe and Mail published an article on April 7, 2018, titled: “Rethinking therapy: How 45 questions can revolutionize mental health care in Canada.” The benefits and drawbacks of regular progress monitoring were discussed.

Some of the downsides of progress monitoring noted in the article are that the surveys can be lengthy and may distract from the focus of therapy by asking irrelevant questions. Therefore, some clinicians would prefer to rely on a client’s words and presentation, than rely on a self-report measure.  Despite these opinions, the article goes on to identify many benefits of progress monitoring.

The article suggests that routine progress monitoring can enhance the effectiveness of psychotherapy and may transform the healthcare system. Progress monitoring is useful in identifying when a client is improving over the course of therapy, but it can also identify when a client is not progressing in treatment. This information can be used to improve therapy effectiveness and perhaps reduce the risk of early dropout. Other areas of medicine use clinical tests, such as blood tests, to inform and enhance treatment. Similarly, the use of progress monitoring could serve the same purpose in psychotherapy.

Progress Monitoring at Eastwood Psychologists

Eastwood Psychologists have regularly used progress monitoring with their clients since 2011. The tool used at Eastwood Psychologists is a measure called the Outcome Questionnaire-45 (OQ-45). The OQ-45, developed by Psychologist Dr. Michael Lambert, is a 45-item measure that produces an overall distress score and a distress score in three categories:

  1. Symptom Distress – examines mood and anxiety symptoms
  2. Interpersonal Relationships – examines relationship satisfaction
  3. Social Role – assesses difficulties in the workplace, school or at home

The OQ-45 also highlights Critical Items that capture a client’s risk in potentially high-risk areas, including suicide potential, substance abuse, and workplace violence potential. The questionnaire is completed online, takes approximately five minutes to complete, and is automatically scored and reviewed by the clinician prior to session.

My Experience with the OQ-45

 As expressed by many clinicians in the article, I also find that the use of routine progress monitoring augments and enhances the psychotherapy process.  Specifically, the OQ-45 presents a weekly snapshot of a client’s distress, can be a collaborative tool, and can be rewarding to reflect on.

The OQ-45 provides me with a window into a client’s functioning in the past week, even before he or she enters the office. The client’s OQ-45 overall and subcategory scores are compared to a growing database of other groups, such as the general population or an outpatient mental health center. This gives me a context for the severity of a client’s distress.  Moreover, I use this data in conjunction with client presentation, verbal reports, and my clinical judgment. Together, this informs my understanding of a client as whole, allows me to monitor client safety, and helps determine the best use of our time in session.

The OQ-45 is also useful as a collaborative tool with my clients. The completion of the OQ-45 offers another means by which clients can communicate their concerns to me weekly. A discussion of a clients’ OQ-45 score can help them feel heard and understood. I also point out when there is a discrepancy between a clients’ OQ-45 score and what they express in session in body language and their words. These discrepancies helps me and my clients further understand how they cope with their distress, and help us target underlying concerns that may have remained concealed, if not captured by the OQ-45. In addition, tracking OQ-45 scores provides an opportunity to reflect on and revise the treatment plan in consultation with my supervisor, colleagues, and/or my clients.

Reflecting on change over time on the OQ-45 with my client is also a rewarding experience. The OQ-45 plots clients’ weekly data on a graph over the course of psychotherapy. I share progress graphs with my clients at various points over the course of treatment, providing them with evidence of the change they have described. Clients often express surprise, pride and contentment at how much they have changed over the course of treatment. Impressed with their progress, many clients request to take the graph home.

In summary, routine progress monitoring is a valuable addition to psychotherapy. This feedback informed approach not only informs the clinician session-by-session but also informs the treatment plan as a whole for increased therapy effectiveness. As stated in the Globe & Mail article, a brief 5-minute survey can contribute to enhanced treatment outcomes and improve the quality of mental health care.

Working to close the “practice-research gap” in psychotherapy and clinical psychology

The Canadian Psychological Association (CPA) recently published a report prepared by the Task Force on Outcomes and Progress Monitoring in Psychotherapy.  You can find and read the report, entitled Outcomes and Progress Monitoring in Psychotherapy” on the CPA website at the following link:

https://cpa.ca/docs/File/Task_Forces/Treatment%20Progress%20and%20Outcome%20Monitoring%20Task%20Force%20Report_Final.pdf

This important report discusses:

  • The importance of monitoring both client progress and outcomes in psychotherapy, and,
  • The barriers to using progress and outcome measures by Canadian psychologists and psychotherapists.

The report defines outcome and progress monitoring as follows:

Outcome monitoring should involve the assessment, at both intake and at the cessation of treatment, of patient functioning by the therapist, patient, and/or a third party in areas deemed important by the patient and therapist.

Progress monitoring involves repeated assessment of patient progress during therapy, typically conducted from the patient’s perspective at every session or every other session. A key aspect of progress monitoring involves continuous feedback to the therapist on the patient’s status, which facilitates the assessment of treatment progress and may suggest changes to the course of treatment, if necessary.“ (Page 4)

Although considerable research demonstrates that psychotherapy is more effective when clinicians systematically monitor client progress and outcomes, a recent survey found that only 12% of Canadian psychologists routinely track client progress in their clinical practices (Ionita & Fitzpatrick, 2014).  When clinical practice is not well informed by research, we refer to the situation as a “practice-research gap”.  Practice-research gaps are common in all health care fields; it is challenging for busy clinicians to keep up with research findings, and to sort through sometimes conflicting results.  So, it is helpful when professional organizations such as CPA put together reports that help translate key research findings into actionable steps that clinicians can use to improve their practice.

The Outcomes and Progress Monitoring in Psychotherapy” report makes recommendations in the following areas:

  • Implementing outcome and progress monitoring in clinical contexts
  • Ensuring uptake and maintenance of outcome and progress monitoring
  • Training (of psychotherapists and psychologists)
  • Ethics

At Eastwood Psychologists, we are pleased to report that progress and outcome monitoring has been a routine part of our practice since 2011, and that we are already implementing the recommendations put out by the CPA task force.

At Eastwood Psychologists, we also strive to close the “practice-research gap”, by working hard to stay on top of current research in our areas of practice.  We benefit from Dr. John Eastwood’s role as an Associate Professor of clinical psychology at York University, where he participates in research in several areas pertinent to our practice.  Training the next generation of clinical psychologists, Dr. John is well apprised of current psychological science, and he regularly shares his knowledge with the whole team.

All our doctoral-level psychologists come from a strong science-based background and have conducted original research in a variety of domains including:

  • The predictors of early reading skills.
  • Neuropsychological deficits in children with Learning Disabilities and ADHD.
  • Moment-to-moment interactions between clients and therapists in psychotherapy that result in good outcome.
  • Understanding how to help psychotherapy clients tell their stories in new, healthy ways.
  • Development of community-based programs to support immigrant families.
  • Experiences of South-Asian mothers who parent children with Autism.

Some of our clinicians are also actively involved in clinical science – getting involved in relevant clinical trials such as the “Better Days Better Nights” program out of Dalhousie U (see http://ndd.betternightsbetterdays.ca for more information).

Our clinicians also support knowledge translation efforts including http://www.teachadhd.ca/Pages/default.aspx and https://depression.informedchoices.ca, thereby working hard to decrease that “practice-research gap”.

All clinicians at Eastwood Psychologists also participate regularly in professional development, including workshops and professional training programs, and discussion of research articles during our regular group meetings.  We take pride in being “scientist-practitioners” – relying on the research literature to inform what we do.

References:

Ionita, G., & Fitzpatrick, M. (2014). Bringing science to clinical practice: A Canadian survey of psychological practice and usage of progress monitoring measures. Canadian Psychology/Psychologie canadienne, 55(3), 187-196. https://doi.org/10.1037/a0037355

Letter to MPP about the Provincial Advocate for Children and Youth

Dear Prabmeet Singh Sarkaria,

My name is Adrienne Eastwood; I am a psychologist in Brampton, and a resident of your riding. I am writing to express my disbelief and discontent with the Progressive Conservative’s decision to repeal the Provincial Advocate for Children and Youth Act, 2007 and close the Office of Child Advocate (“Advocate’s Office”). As you know, the Advocate’s Office ensures that young people in the care of the government are aware of their rights, and that their voices are heard and considered when decisions are made about their lives. The Advocate’s Office serves the children in child welfare services, youth in the justice system, Indigenous youth, as well as youth with disabilities and mental illness. In the 2016-2017 fiscal year, there were 12 794 children and youth in the care of children aid societies across the province, which reflects only a fraction of the people served by the Advocate’s Office. The closing of the Advocate’s Office leaves these children and youth without an independent body to protect them. It also means that Ontario becomes the only Canadian province without an independent child advocate.

It is appalling that this decision comes less than two months after an investigation by the Ontario Office of the Chief Coroner regarding the suicides of 12 youth in the care of child protective services. This investigation, and countless other examples, confirm the importance of an independent body that oversees and investigates the treatment of children in the child welfare system, and that reviews government policies and practices that impact society’s most vulnerable children and youth. Simply rolling the program into the Ombudsman’s office is not sufficient to ensure that some of the most vulnerable individuals in our society have a voice. The government cannot and should not monitor itself.

Given that the PC government claims to be “working for the people”, I would like to urge you and your fellow MPPs to consult and reconsider this short-sighted and faulty plan. I believe strongly that the provincial government needs to take a lead in putting forth policy initiatives that support children and youth’s rights to individual rights advocacy, systemic advocacy, and independent investigations. In doing this, the government is strongly encouraged to follow principles of the United Nations Convention on the Rights of the Child.

Sincerely,

Adrienne Eastwood, Ph.D., C. Psych., BCBA

COVID-19: For Parents

The post below was written by Michele Palk.

The Eastwood Psychologists team remain committed to supporting the mental health and wellbeing of our clients and community as we face COVID-19.  Now more than ever, parents may wonder how best to support their children and youth deal with uncertainty, strong emotions like anxiety and sadness, and isolation from regular supports and social opportunities like school, recreation, respite, spiritual, community and other gatherings.

Given the next while will be a period of transition for us all, we want to provide some suggestions that may be helpful for your children and family:

1)   Help children learn how to accept uncertainty: At times it is difficult for all of us to accept that many things are actually outside of our control.  Now is an excellent time to teach children the difference between what they can, and is within, their control (i.e. choices, behaviour, attitude), and what is beyond their control (i.e. how long social distancing will be needed, how long schools will be closed).

2)    Be available to listen: Although parents often want to help by fixing whatever is going wrong for their children, it is often more helpful to sit back, listen closely, and tell your children you love them.  Helping your children by giving them the language to talk about, and name, challenging and intense feelings will also be helpful.  Instead of waiting for your children to come to you, consider regularly checking in with them, and asking directly about how they are feeling at that particular moment.

3)   See social media as social support and connection: The majority of children and youth are already connected to one another via various social media and gaming platforms; now is the time to let your children show you all they know, become involved in their online worlds, and encourage ongoing connection with friends and loved ones.  This is also a natural way to monitor your children’s television and gaming routines.  Consider things like scheduling times to be online with other families for gaming competitions, watching movies and television shows “together” at the same time, learning how to cook and bake that vegetarian lasagne your child’s friend always brings to potlucks by watching their uncle make it “live,” learning how to make kinetic sand from scratch, amongst others. These are just some of the many things your children, family and social connections can do “together” during the next while using available technology.

4)    Promote a healthy, consistent routine with healthy options: During times of stress, often the first things we sacrifice are the very things that are most helpful: sleep, exercise, nutritious foods, hydration, meditation, mindfulness, laughter, amongst others.  Help your children by modelling, scheduling, and encouraging healthy choices each day.  Keep a regular bedtime routine, schedule in daily exercise/movement, tell jokes, remember funny stories, and eat your fruit and vegetables.  Reminders and modelling about hand hygiene, greetings using elbow pumps, coughing and sneezing with a tissue or using the crooks of their elbows, social distancing, and letting you know as soon as they begin experiencing any symptoms of fever, cough, and cold will go a long way to supporting both your family and our larger community.

5)    Help our community: When children and adults alike experience stress, anxiety, depression and other strong emotions, the desire to withdraw into, and focus on ourselves becomes very enticing.  While on the one hand that focus is important to (re)establish and practice healthy routines like those mentioned above (regular sleep, exercise, health eating), helping others is another important way children and adults alike can support their mental health.  During this time, connecting with you and your child’s friends, parents/caregivers, neighbours, and extended families and determining what kinds of support are needed, and who can provide them, will show your children they can help others even when they are experiencing stress and other challenging feelings.

Our world is currently going through rapid changes, so it makes sense to feel confused about the best ways to support our children and families.  Being honest, available and open, creating healthy routines and choices, maintaining social connections and offering social support are important ways to help foster the skills our children, families, and communities need to help manage the current, as well as future trying times, and prosper thereafter.

Telehealth & Telepsychology: Efficacy, Benefits and Patient Satisfaction

The health care field is rapidly adopting the use of technology, and this is especially true in the midst of the Covid-19 pandemic. Due to physical distancing guidelines, an increasing number of health care professionals are using technology to provide services remotely.

The use of technology for health care is unfamiliar to many people.  Exploring and embracing technology, however, will help individuals stay connected with health care providers and continue to receive services.

What is Telehealth & Telepsychology?

The World Health Organization describes telehealth as the delivery of health care services via telecommunications and virtual technology. Telehealth relies on technology to allow a patient to communicate and share information from their home with a health care professional. The delivery of mental health treatment via technology is known as telepsychology.

Telepsychology can be delivered in a variety of forms, including telephone, videoconferencing, web chats (i.e. internet text-based therapy), and apps. The common factor among all these modalities is the need for an Internet connection and an electronic device, such as a laptop or cell phone. These formats differ on whether the service is received in “real-time” or not.

Real-time telepsychology is most similar to traditional in-person treatment due to the live interaction between a health care provider and a patient. Asynchronous telepsychology refers to treatment delivery that does not provide real-time interaction between a provider and a patient. Examples of this include email and automated responses through an app. This article will focus on real-time telepsychology services, as this is the primary approach health care professionals have been using as an alternative to in-person services during the Covid-19 pandemic.

This blog post draws from recent research studies to identify the benefits of telehealth, as well as address concerns regarding its use, with a particular focus on psychotherapy. In turn, this may help promote the use of telehealth to access health care.

What are the Benefits of Telehealth?

Telehealth is a promising health care delivery method that increases access to services, including health care specialists. In addition, it overcomes several barriers to treatment including geographical distance and isolation (e.g. underserved areas), difficulty accessing transportation, travel costs, and time commitments due to travel and wait times to see a health care provider.

Patients can receive care without the need for in-person appointments. Telehealth also allows patients and health care providers to store and forward patient health information for rapid communication with patients or between health care providers.  Telepsychology is a convenient alternative that allows for access to treatment from the privacy of one’s home, while allowing optimal use of a patient’s time.

Is Telehealth Effective?

Despite the benefits, individuals may be reluctant to try telepsychology for a variety of reasons. One reason is the belief that the physical presence of a health care professional would be more effective than services received via technology. With the increasing use of, and reliance on, technology for health care delivery, research studies have taken a closer look at whether telehealth is as effective as in-person appointments.

Almathami and colleagues published a study in 2020 in which they investigated the efficacy of telehealth for the treatment of different health conditions and diseases. The authors conducted a qualitative analysis of 45 published research studies that examined treatment delivery via videoconferencing between a patient and a doctor. The patients in these studies ranged from 1 to 80 years of age, and received treatment within their home for either mental health (e.g. psychotherapy) or physical health conditions (e.g. cardiovascular disease). Treatment ranged in duration from 2 weeks to 12 months. Almathami and colleagues found that 98% of the articles reported that videoconferencing treatment delivery achieved the desired health outcomes. Specifically, videoconference was an effective method in assessing patients’ health conditions and improving patients’ overall health conditions.

What about telepsychology specifically? A study by Varker and colleagues published in 2019 investigated the efficacy of real-time telepsychology treatment of adults with mental health disorders. The authors critically evaluated 25 published studies that examined the efficacy of telephone, videoconferencing, or web chat based treatment for four mental health disorders: major depression, anxiety disorders, post traumatic stress disorder and adjustment disorder. This study found that there is strong and high-quality research examining the efficacy of telephone and videoconference treatment approaches, as opposed to studies examining the efficacy of web chat (i.e. internet text-based live chat). Furthermore, telephone and videoconferencing treatment were found to be as effective as standard in-person treatment on a range of outcomes (e.g. severity of symptoms). There was insufficient evidence to determine the benefits of web chat. The authors concluded that there is clear, consistent evidence of the benefits of telephone and video conferencing treatment delivery methods for psychotherapy, with no evidence suggesting negative effects of these methods.

Limitations of Telehealth

Though these studies highlighted the efficacy of telehealth and telepsychology, it is important to note that telehealth may be challenging with certain treatment populations. For example, young children or a geriatric population with hearing or vision loss and/or a cognitive impairment may have difficulty engaging in online treatment. Almathani and colleagues found mixed results for these populations, as some studies reported challenges, while others reported success and no additional difficulties. The authors concluded that further investigation is required to explore the use of telehealth with these populations.

Overall, research has found that telepsychology is an effective alternative to traditional in-person treatment.  In addition to examining the effectiveness of telehealth, researchers have also examined factors that can positively and negatively influence the use of telehealth.

Influencers and Barriers to Telehealth

Almathami and colleagues identified several factors that can either facilitate or serve as barriers to telehealth. These factors can be categorized as situational (e.g. access to technology) or personal factors (e.g. technology knowledge and skill). Together these factors can influence a patient’s satisfaction and convenient use of telehealth. These factors are summarized below along with suggestions to address barriers and enhance telehealth services.

Internet

Telepsychology services (particularly videoconferencing) require access to the Internet. Internet speed and quality can interfere with the ability to clearly see and hear the health care provider. Internet quality can be influenced by the network and wireless signal coverage in the area, as well as obstructions within or outside the home. Sitting close to the Internet source or connecting to the Internet directly using a cable may improve the Internet connection and speed.

Available Device

In addition to Internet access, telepsychology services require an electronic device that is equipped with video and/or microphone. This can be a desktop computer, laptop, cell phone or tablet. Some devices may allow for easier access to a comfortable and private location for a psychotherapy appointment. For example, using a cell phone or laptop may provide more privacy than the desktop computer in a common area of the home.

Security and Privacy

The storage, transfer and communication of personal health information are important to consider, as not all technology platforms provide the necessary security measures to protect patient privacy. There are telehealth video platforms available that comply with legislation for the use of, management and storage of health information and records for enhanced security.  Eastwood Psychologists uses a video platform called Virtualcare (https://www.thinkresearch.com/ca/products/virtualcare/) that has end-to-end encryption to protect the privacy of personal health information and communication.  Virtualcare also allows documents to be shared securely over the platform.

Patients can also take steps to protect their privacy within their own home.  It is important to hold appointments in a quiet, private space where personal information can be discussed openly. It may be helpful for patients to schedule appointments when other family members will be busy or out of the home. Patients can also ask their health care providers questions about privacy and security.  Health care providers can help clarify any security concerns about the systems used, and help address concerns about privacy within the home.

Scheduling

Telehealth can allow for flexibility in scheduling. Patients may be able to schedule an appointment time that is suitable and convenient. This convenience may help patients be more willing to engage in, and comply with treatment, which in turn may help improve effectiveness. Health care providers may have availability that is suitable to patients’ schedules and at a time for increased privacy and reduced distraction during appointments.

Familiarity

Familiarity with technology and the online system can ease a patient’s transition to telehealth and promote openness to this approach.   Health care providers or their office staff may be able to provide a test call or tutorial to help patients become more acquainted with the system.  The use of technology for health care can be frustrating and anxiety provoking at first, but with repeated use, it can hopefully become a familiar and comfortable tool.

Telephone or Video Conferencing?

Patients may be offered a choice of videoconferencing or telephone sessions for health care appointments. As mentioned above, both approaches have been found to be effective.  The choice of video or phone may be made based on patient preference, quality of the available Internet connection, and ease of use.  Video conferencing may allow for more nonverbal communication (i.e. gestures, eye contact and body language) between patient and psychotherapist.  On the other hand, telephone sessions may be more familiar and comfortable for some people.

Conclusion

Based on these studies, telepsychology is a promising treatment delivery method due to its benefits, efficacy and similarity to standard in-person treatment. Telepsychology can overcome barriers to treatment, including recommended physical distancing due to Covid-19. Considering factors that can improve the quality of the telehealth experience may improve patient satisfaction with the experience. The adoption of telepsychology will allow patients to benefit from continued psychological services for effective and remote treatment from the comfort of one’s home.

References
http://www.who.int/goe/publications/goe_telemedicine_2010.pdf

References

Varker, T., Brand, R. M., Ward, J., Terhaag, S., & Phelps, A. (2019). Efficacy of synchronous telepsychology interventions for people with anxiety, depression, posttraumatic stress disorder, and adjustment disorder: A rapid evidence assessment. Psychological Services, 16(4), 621-635.

Almathami HKY, Win KT, Vlahu-Gjorgievska E (2020). Barriers and Facilitators That Influence Telemedicine-Based, Real-Time, Online Consultation at Patients’ Homes: Systematic Literature Review. J Med Internet Res 2020;22(2):e16407.

Addressing Privacy When You Do Therapy From Home

Taking care of your mental health is paramount during these times of social isolation, but can be difficult when you are stuck at home with your partner, siblings, parents, children or roommates. Telepsychology can be a great way to help you handle the unpredictability and uncertainty that so many of us are currently struggling with. However, it brings the added burden of seeking privacy while accessing the care you need. This blog post will address how you can obtain the privacy you need to be truly vulnerable when you are at home with others.
Asking family member(s) or other member(s) of your household to leave the home
If your family member(s) are aware that you are seeking psychological care and are supportive of your therapy, you can ask them to leave the home for the duration of your session. If you are not comfortable letting a member of your household know you are in therapy, you can let them know in advance that you would need privacy for an hour at the specific day and time. This will allow you to have privacy without divulging too much information.
You may ask your family member(s) or member(s) of your household to do the following while you have your therapy session:

  • Go for a walk
  • Go for a drive
  • Do groceries
  • Run an important errand

If family member(s) or member(s) of your household cannot leave the home
If the people you are living with are unable to leave the home, you can request them to:

  • Watch a movie or a TV show with headphones on in another room
  • Listen to music with headphones on while doing household chores
  • Take an extended bath or shower

In this option, make sure you inform them when your session is over or when you no longer require that level of privacy!
Therapy outside the home
Alternatively, if  the first two options are not suggestions that can work for your situation, you can choose to leave the home to have your therapy session. The virtual platforms used at Eastwood Psychologists allow clients to have video sessions on their phones, tablets and laptops. Some possible places outside the home where you can have your session include:
 Have the session in your parked car
Prior to the start of your session, drive your car in an isolated parking lot where you can use your device to connect with your therapist for the duration of the session. You can leave the windows down for some air!
 Have the session at a nearby park
You can walk to a nearby park and find a corner that is isolated where you can speak to your therapist through the video platform.
 Have the session in your backyard
If you feel comfortable and have access to privacy in your backyard, you can find a shaded area to have your therapy session.
Have the session in your garage
If you feel comfortable and have access to privacy, you can grab a comfortable chair and have your therapy session in your garage.
Have the session at the Eastwood Psychologists’ Office
You can let our office manager know that you are unable to do any of the listed suggestions and require privacy for your therapy sessions. Our office manager can arrange for you to come to the office and have your video session in a private space while your therapist connects with you from their remote office.
If any of the above do not work for you, you can request the therapist that your session be at a time when your children are sleeping or when your parents are at work. Your therapist will try to do their best to accommodate you as much as possible, but we cannot guarantee that they will be working very early or very late during the day.
Lack of privacy does not need to be a barrier to receiving psychological care. In this blog post, we have listed just some ways you can address privacy issues while starting or continuing therapy. If you would like to discuss this further, please contact our office or your therapist to brainstorm other ideas that can work for your unique situation.