Appendix

Appendix A: Definitions

Children’s Treatment Centres (CTCs) – provide multidisciplinary assessment and rehabilitation services (physiotherapy, occupational therapy, and speech-language therapy) to children and youth with physical disabilities, developmental disabilities or communication disorders ^{footnote 19[19]}. CTCs will be accountable for all SmartStart Hubs functions.

Children with special needs – is a broad term used to refer to children and youth with identified service needs, which includes children with disabilities as well as children who may not identify as disabled.

Solution - focused practice – provides a humanistic approach to service provision by recognizing the child/youth (and their family) as the expert ^{footnote 20[20]}, and by focusing on setting of goals and finding solutions that build upon the client/family’s current capacity ^{footnote 21[21]}.

Strengths - based approach – moves beyond a deficit lens to recognize the resilience, strengths and capabilities of a child/youth and their family. This approach builds upon these attributes to empower the child/youth and their family^{footnote 22[22]}.

Culturally - safe services – service provision that acknowledges the power dynamics that exist between provider and the person receiving the service and works to dismantle this imbalance. Cultural safety recognizes that providers may not know the norms and customs of every culture they may encounter, and instead asks providers to provide an environment that is free of racism, discrimination and oppression. Culturally-safe service provision relies on respectful engagement by the provider, to support all children, youth and families to feel safe receiving services ^{footnote 23[23]}

Anti-racism – requires people to acknowledge the ways in which racist systems show up in thinking, action and practices, and to actively dismantle this racism as it appears.^{footnote 24[24]}.

Anti-oppression – Oppression is the use of power or privilege by a socially, politically, economically, culturally dominant group (or groups) to disempower (take away or reduce power), marginalize, silence or otherwise subordinate one social group or category ^{footnote 25[25]}. Anti-oppression requires people to acknowledge the ways in which oppressive systems show up in thinking, action and practices, and to actively dismantle this oppression as it appears^{footnote 26[26]}

Trauma-informed – trauma-informed care seeks to recognize that children and families are impacted by a variety of experiences and situations – both past and present – which may affect their health or ability to seek care. Trauma informed care acknowledges that trauma is prevalent and seeks to integrate knowledge about trauma into all practices, and to actively avoid re-traumatization.

Ableism - discrimination towards someone based on their abilities, often favouring those who do not have a disability and seeing less value in those that do. Ableism can be reflected in actions, words, behaviours, and access issues. ^{footnote 27[27]}

Equity - deserving or marginalized groups – those groups and communities that experience discrimination and exclusion (social, political and economic) because of unequal power relationships across economic, political, social and cultural dimensions. ^{footnote 28[28]}

Racialized – Recognizing that race is a social construct, we can describe people as “racialized person” or “racialized group” instead of the more outdated and inaccurate terms “racial minority”. “visible minority”, “person of colour” or “non-White”. ^{footnote 29[29]}

Xenophobia – a fear or hatred of strangers or foreigners, including immigrants and migrants, or those who are perceived to have migrated. ^{footnote 30[30]}

Islamophobia – a prejudice towards, and hatred of, Muslim peoples that can lead to hate, threats and abuse of Muslim people, or those assumed to be Muslim. Islamophobia is entrenched in many systems and institutions ^{footnote 31[31]}.

Anti-Semitism – a perception of Jewish people that is often expressed as hatred towards Jews^{footnote 32[32]}.

Anti-Blackness – the unique form of racism that impacts Black people, due to the unique histories of slavery and colonization as well as the current nature of systemic racism ^{footnote 33[33]}.

Appendix B: Mapping Problem Statements to Hubs Functions

The table below intends to map the problem statements identified in Part 2 of these guidelines against the SmartStart Hubs functions, to connect the functions to the issues/problems it is attempting to address.

Appendix C: Example Client Profiles

Kobi

Kobi is 4 years old. He lives in Toronto, Ontario, with his mother, father, and two older siblings. Kobi’s family emigrated from Ghana when Kobi was 2 ½ years old and speak English and Akan at home. His father and mother work full-time shift work. They live in an apartment building in the Jane and Finch neighbourhood, in a threebedroom unit. Kobi loves watching YouTube videos about science experiments and playing basketball.

Kobi’s parents have noticed him stuttering when speaking English but he does not have a problem understanding his family in English or Akan and is sociable with his siblings and cousins. Kobi attends kindergarten during the day. His teacher has expressed to Kobi’s parents that Kobi does not tend to engage with the other children and gets very frustrated when trying to communicate.

Kobi’s parents are concerned that his frustration and difficulty interacting with kids at school are related to his stutter. Kobi’s parents brought their concerns up to their family doctor who suggested that Kobi’s challenges might be due to a ‘lack of a parental presence at home’. Kobi’s parents left the appointment feeling confused and worried that they might be flagged to the Children’s Aid Society, like what happened to one of their neighbours.

Kobi’s parents are afraid to seek help from a professional but want to ensure that their son is provided with the proper care.

Mohammad

Mohammad is a 13-month old infant who immigrated to Canada from Jordan with his 19-year old mother and 23-year old father from Jordan, approximately 6 months ago. MA has a 1-month old sister. Parents speak Arabic and all appointments require Interpreters. Paternal extended family members also live in Canada. Mother is the primary caregiver and relies on her for all aspects of his care. Father is currently enrolled in English as a Second Language class and looking for work. Referring Physician describes the family as highly stressed.

Mohammad was referred to CTC for a Developmental Paediatric consultation, he was born with microcephaly at 36 weeks gestation by emergency C- section. Parents report that he suffered from seizures in his first few days of life. Notes indicate he was given phenobarbital for 4 days. Since his discharge from the NICU his parents indicate he has been quite healthy. They have not seen any other seizures.

Parent’s main concern is that Mohammad can’t stand/walk or sit up on his own yet.

Mohammad’s parent’s report he sleeps through the night and still has 2 naps per day, he does not follow or focus on objects held directly in front of him. He does respond to his parents voices by smiling. He makes sounds such as “ah” or “ag” and his parents feel he makes these noises to draw their attention. He likes to be held and when not sleeping he will cry if he is put down. His parents note that he responds differently to them than strangers – he seems calmer around them. He also likes the bath and music and will turn towards parents when they call his name. They report he also likes the car but will cry when mother says bye.

Parents indicate he is able to lift his head in a little bit, but does not like being on his stomach. When held in a seated position he does not have good head control. He is not reaching for items and will only hold items for a few seconds when items are placed in his hands. He does not feed himself and likes mixture of fruits and thick creamy textures and drinks only from a bottle. He occasionally will cough or choke when being fed and sometimes food falls out of his mouth.

Sorin

Sorin is a 5-year-old Indigenous child who lives in Timmins Ontario. Sorin currently lives with his grandparents who offer ample knowledge and support in form of connection to culture, traditions and ceremonies. Sorin’s parents are unable to care for him at this time and, prior to living with his grandparents, was placed in care of the children’s aid society at the age of 4. There are currently supervised access visits between Sorin and his parents for 3 hours, twice a week at the local children’s aid society.

As an infant, caregivers found it difficult to soothe Sorin when he was upset. His behavioural needs continued to progress and become more apparent as he got older. During school he would become aggressive with teachers and students. Sorin has kicked, punched, and slapped teachers when he gets upset. Sorin often becomes overstimulated and acts impulsively to get what he needs, e.g. a child was turning the lights on and off and Sorin pushed the child to the ground and yelled at them to stop. Due to his aggressive behaviour, Sorin has been removed from the school multiple times. Sorin is currently only attending school 2 half-days a week because of his behaviours.

Sorin has difficulty regulating his emotions when he reaches a heightened state. He often responds with fighting or shutting completely down and disengaging. In the home, his grandparents struggle to make it a few days without a major outburst. When he is angry in the home, he has broken items in the home and become physical. When Soring is calm, he is able to express his emotions verbally and explain what made him upset. The structure and routine in the home is helpful for Sorin, as he knows what to expect during his day. If something changes quickly it can trigger an outburst. When Sorin has positive days, he enjoys riding his bike, scootering, listening to music and playing video games. Sorin is apprehensive when he is trying a new task and often needs someone to encourage and show him how to do it before trying it himself.

Troy

Troy is 4.7 years old lives with his mother, Sara and 3-year old sister, Lily. The family is in the process of moving from Hamilton back to Toronto. Sara is a single parent and though she is in contact with Troy’s father, they disagree about the developmental concerns Troy is presenting. Sara is 22-years old and receives support from her mother and her mother’s partner who both work full time. Sara and her two children have been spending most of their time at Sara’s mother’s home during the moving process. This has been a big help for Sara, as her mother has a great relationship with both Troy and Lily.

Troy has never attended a child care or school setting. Sara is in the process of finding a residence in Toronto and has not yet registered the children for school. Sara and Troy participated in Early Abilities (Toronto Speech and Language Program) when Troy was 2-years old; however, the service discontinued when the family moved to Hamilton. Currently, Sara and Troy engage in social opportunities by attending an Early ON program in her Scarborough community.

Troy was born full-term at 40 weeks, there were no complications during labor or post birth. Troy has an allergy to peanuts and carries an epi-pen. Presently there are no know medical conditions. His last hearing test was at birth, which he passed. Troy has never been seen by a dentist, nor had a vision assessment. Sara has eliminated dairy from Troy’s diet as it seems that it causes stomach issues such as gas and diarrhea. Mom has been unable to follow up with the family doctor to further investigate this issue.

Sara’s current concerns for Troy focus around his communication skills, behaviour at home and in the community, and his independence with toileting skills. Troy currently will communicate using a combination or single words, scripted phrases, hand guiding and gestures. It can be difficult to understand his articulation at times when he attempts 3- or 4-word scripted phrases.

At home, Sara is continuously managing conflicts between Troy and his sister. Sara believes it is mostly centred around getting her attention. Typically, Troy will attempt to disrupt his sister’s play, usually by removing her toys while she is playing. This will generally get Sara’s attention and she will attempt to resolve the issue and/or separate the children. Sara’s attempt to resolve the conflicts have ended up with Troy having a “tantrum” that can last anywhere from 5 minutes to 1 hour. The tantrum can involve screaming and crying, hitting Sara, or attempting to hit his sister. These challenges happen at home, mostly, but can also happen in the community. Sara also has difficulty transitioning Troy when he is together with his sister; however, when it is just mom and Troy, he seems to follow her direction better. When these challenging transitions occur, Sara is unable to give verbal instructions alone. Troy requires more direct support such as physical help dressing to leave the home.

Sara is also concerned with Troy’s independence with toileting routines. Troy can void in the toilet during the daytime; however, he does have a few accidents throughout the week. It has been difficult for Sara to teach toileting routines, as Troy’s focus when in the washroom is typically around playing with the toilet paper, water, or removing the back of the toilet.

Sara is concerned about the supports Troy may need and is unsure of where to start or who to connect with. She wants to schedule an appointment with her family doctor to further explore her concerns. However, as a single mother she has found it difficult to navigate the system and make appointments with both children in her care during the day.

Appendix D: Background on the Ontario Indigenous Child and Youth Strategy

The Ontario Indigenous Children and Youth Strategy (OICYS) was fully codeveloped with First Nations, Inuit, Métis and urban Indigenous partners across Ontario.

Between 2013 and early 2015, MCYS engaged extensively with partners through:

• Leadership roundtables (LRTs) (First Nations LRT; Inuit LRT; Métis and urban Indigenous LRT)
• Bilateral meeting processes
• Technical tables (First Nations technical table; Métis, Inuit, and urban Indigenous technical table)
• Agency and association engagements (25 sessions, including representatives from over 150 agencies)
• Youth engagements (engagements led by MCYS and partners with 500+ total youth)

In winter 2015, the resulting policy framework was endorsed by First Nations, Inuit, Métis, and urban Indigenous leaders across the province.

The OICYS is the long-term strategic framework for fundamentally transforming the system of services for Indigenous children and youth.

The Ontario Indigenous Children and Youth Strategy