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In-person services at Eastwood Psychologists during the coronavirus pandemic

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On May 26, 2020, the Ministry of Health amended Directive #2 to support the gradual restart of all deferred and non-essential and elective services carried out by Health Care Providers.  This includes the work of psychologists, who are regulated health professionals. For Directive # 2 http://www.health.gov.on.ca/en/pro/programs/publichealth/coronavirus/docs/directives/RHPA_professionals.pdf

At Eastwood Psychologists, we are gradually resuming in-person services where indicated .  We are following the Ministry of Health’s Covid-19 Operational Requirements: Health Sector Restart document, also published on May 26, 2020. For COVID-19 Operational Requirements: Health Sector Restart: http://www.health.gov.on.ca/en/pro/programs/publichealth/coronavirus/docs/operational_requirements_health_sector.pdf

Specifically, we are applying a hierarchy of hazard control methods, as recommended by the government.

1.         Elimination and Substitution

The most effective way to contain health hazards is to eliminate in-person health care visits, and substitute them with telehealth.  By offering services virtually, we are able to prevent possible exposure to the coronavirus.   We continue to recommend that clients see their psychologist virtually wherever possible, to ensure everyone’s safety.  Research to date (with adolescents and adults) suggests that virtual therapy is just as effective as in-person therapy.  Thus we expect that it will make sense to continue to offer telehealth services to most of our clients.  For more information about virtual therapy, please see Dr. Naomi Carpenter’s blog post. At Eastwood Psychologists we have two general options for clients to participate in telehealth.

From your home:    This option works well when you have a private space in your home where you can go to meet with your psychologist.  This option also works best when you have a strong Internet connection, particularly when you want to meet with your psychologist using videoconferencing.  Meeting with your psychologist from your home is often more convenient, because it eliminates the need to travel to our office.

From our office:      Now that we have begun to re-open our physical office, you have the option to use one of our offices in order to meet with your psychologist virtually.  Your psychologist will join you virtually from their remote office.  This option works well when you have few options for a private meeting space in your home.

Although we continue to recommend virtual therapy wherever possible, there are some circumstances where virtual therapy is not advisable, possible, practical, or effective.  Before deciding to see a client in-person, we will discuss the need for in-person services and whether it makes sense to proceed.  For clients who will be attending sessions in-person, the following health hazard control measures will apply.

2.         Engineering and Systems Control Measures

These include the use of equipment/barriers to keep people apart and to increase ventilation, in order to reduce opportunities for transmission.  At Eastwood Psychologists, we have installed plexiglass screens that physically separate clinicians and staff from clients.  When the weather allows, windows will be opened to increase ventilation.  When the windows are closed, we will run HEPA filters to assist in removing potential pathogens from the air.

3.         Administrative Control Measures

These measures include the implementation of policies, procedures, training and education with respect to infection prevention and control.    Our policies include the following (subject to regular review and revision as needed):

Education and training:

  • Informed consent process for clients.
  • Passive screening (i.e. signs posted) reminding everyone of symptoms to watch out for and where to get help.

Screening:

  • Active screening when appointments are booked and the day before the appointment.
  • Clients and clinicians must be symptom free in order to proceed with in-person sessions.

Physical Distancing:

  • All staff, clinicians and clients will wear masks at all times while at the office.
  • The waiting room will not be used.
  • Clients will wait outside (on the porch or in their vehicle) until they are cued to come in for their appointment (via text message).
  • Client appointments will be scheduled such there will be at least 15 minutes between sessions to minimize the overlap of clients coming to the office. 
  • When appropriate, individuals accompanying clients but not participating in the session, such as those providing transportation, will be asked to wait elsewhere and return to meet the client after the appointment.
  • Office rooms are furnished to allow physical distancing between clinicians and clients.
  • Our office manager will continue to work from home most of the time, but she is able to assist as needed via phone.

Sanitation:

  • All staff/clinicians and clients will wash hands upon arrival at the office.
  • Staff/clinicians wash hands after every client interaction.
  • Signage throughout the office will direct clients regarding where to go and how/when to sanitize their hands.
  • Common areas and other high-touch surfaces and objects handled by clients/patients (e.g., reception counters, chairs and seating areas, door handles, handrails, credit card machines, washroom fixtures, etc.) will be cleaned and disinfected after each use with a hard surface area cleaner approved by Health Canada.
  • Assessment materials or other equipment or items handled by multiple clients/patients will be cleaned and disinfected after each use as above.
  • Sufficient supplies will be available for proper hand hygiene, including hand sanitizer, soap, warm running water and paper towels. Non-touch, lined waste disposal receptacles for use by both staff and clients are provided throughout the office.

An important note about your privacy:

Your privacy is important to us.  It is important for you to be informed that we may be required to share some information about you with public health.  We will be keeping a daily log of everyone coming to the office, staff and visitors alike, in order to provide contact tracing should a case of COVID-19 be associated with our office.   The log will include arrival and departure times of each individual.  The log will be shared with public health if needed/requested.

Telehealth & Telepsychology: Efficacy, Benefits and Patient Satisfaction

By   Psychotherapy, Telehealth & Telepsychology   1 Comment

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.

COVID-19: For Parents

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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.

Letter to MPP about the Provincial Advocate for Children and Youth

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November 16, 2018

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

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

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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

Enhancing Outcomes with Progress Monitoring

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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. Continue reading…

Boredom in the classroom

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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? Continue reading…

Encouraging success in all students

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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? Continue reading…

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