Blog

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

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