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Invitation for Consultation

In light of the growing concern caused by COVID-19, Community Living Toronto has decided to cancel our upcoming April 15th consultation session until further notice. Our top priority is the well-being of our staff, partners and community members and we are taking every precaution with guidance from top health officials. Please know that we will be updating this page with a rescheduled date as soon as we know more. 

For now, if you are interested in attending future sessions and would like to register to receive updates, please click here

You can also email us at digital@cltoronto.ca with any questions or concerns. 

We are grateful for your understanding and invite you to learn more about COVID-19 and how to protect yourself by visiting the Public Health Agency of Canada Website


Our Next Consultation Session:

A New Strategy for Digital Service Delivery

In the coming year, Community Living Toronto is revamping their digital strategy to advance MyDirectPlan, MyCommunityHub.ca, ConnectAbility.ca, and DiscoverMyRoute. We will grow, modernize, and improve all four products in order to better serve families, agencies, and community brokers. 

We will be hosting a monthly consultation session (in-person and online) for those who would like to know more and provide comments. We will also be posting all materials that we develop online, with comments visible to all contributors to encourage a discussion about how to develop and integrate these digital tools. 

Your participation and support are essential to the success of our digital strategy!


If you are interested in attending future sessions and would like to receive updates

Road to Relationship Game

Presenter: Deanna Djos, Sexual Health Promoter for the Relationship Group

A fun and interactive card game that has characteristics/quality of a person which creates friendly and constructive debates that can benefit participants and open their minds to new ideas and feelings.

Download and print your own cards

Road to Relationship card game

Recorded at the Shared Learning Forum January 25, 2019

A few examples of game play

Would this person make a good friend?

Would you have an intimate sexual relationship with this person?

Autism & 90-90-90: Reaching for the Goal

Presenters

Ryan Lisk, Director of Community Health Programs, ACT
Brandon Wulff, ASD & HIV Prevention Coordinator, ACT

Presenting preliminary findings on ACT’s “ASD & HIV Prevention Needs Assessment” survey and explaining the impact the autism spectrum has on negotiating safer sex, accessing services, and community connection.

Recorded at the Shared Learning Forum January 25, 2019

Download a PDF of the presentation

Everybody’s Trauma: Supporting adults with intellectual disabilities who have experienced violence

Presented by Vania Sukola

Colleagues from the Violence Against Women and the Developmental Services sectors discuss the impact of violence on adults who are labeled with intellectual/developmental disabilities. Topics such as: The impact of trauma on the community Various safety planning tools to prevent further victimization The uses of different therapeutic tools Other opportunities include: showcasing services, networking, collaborating, exchanging and consulting. This conference was generously funded by the Ministry of Community & Social Services and coordinated by the Violence Against Women team at Family Service Toronto.

These videos were taken at the one day conference held in Toronto on November 30, 2018

From Trauma to Trust: Healing Trauma Through Multi-Modial Therapy

Presented by: Amanda Gee, Jessica Capra, Virginia Jahyu

From trauma to trust is a clinic, which serves people with intellectual disabilities that have experienced trauma. We take a person-centered approach by attuning and adapting therapeutic methodologies. The therapeutic modalities we offer at trauma to trust clinic were specifically curated to make therapy more accessible to people with intellectual disabilities and dual diagnosis who, for the most part, have never had the opportunity to work towards healing. We will discuss how the clinic runs, the people who come to the clinic, and the trauma they have experienced, explore the individual therapies, the adaptations necessary, and give ideas for how to access services.

Self-Regulation for Practitioner Resilience

Presented by: Jennifer Cordoso

Self-regulation involves taking a pause between a feeling and an action – taking the time to think things through, make a plan, wait patiently. Children often struggle with these behaviours, and most adults do as well. Add in additional toxic stress and trauma and one’s ability to regulate themselves becomes limited. The goal of this workshop is to teach you to draw on your own ability to regulate and to help your clients and patients to do the same.

Making Work Work

Presenter: Michael Mackenzie, Employment/Volunteering Opportunities Developer

Montage offers an innovative approach to employment and volunteering. MakingWorkWork, as an integral component of the person directed planning process, works 1:1 with people to discover, develop and implement an employment plan that meets their own interests, abilities, skills and goals. We use a Customized Employment model that builds on an umbrella of themes that are identified through a discovery process where key information is drawn from the person’s perspective, and then is balanced against the insights of family, friends, circles of support, and other points of connection in the community. Establishing what their ‘role’ is at home and in other environments helps to reveal transferrable attributes.

A primary driving force of Customized Employment is how we connect with Employers first to identify what their needs are and how Montage, and the job seekers we support can address and meet those needs. We offer business solutions that affect the business bottom line.

Download the Making Work Work Manual
MakingWorkWork – Workbook – October 2018

Community Network of Specialized Care – Collaborative Planning for Complex Individuals

Presenters: Marty Lampkin, Complex Support Coordinator and Scott Skinner, Dual Diagnosis and Justice Case Manager

Learning outcomes:

  1. Overview of the Community Network of Specialized Care, Refreshed Mandate
  2. Help you recognize the value of networking and collaboration using a multidisciplinary and multisystem approach.
  3. Plan effectively with an individual using a bio-psycho-social lens at both the individual and system
    level.
  4. Help you learn how to use the Clinical Care Planning Tool as well as other useful tools.

Associated files and templates

Physical Literacy: 
Adaptability and Accommodation

The second of a two-part series developed by the Move and Play partnership.

In the first workshop (Move and Play) we explored a number of ideas to incorporate physical literacy into daily lives, concentrating on strategies to keep children engaged in physical activities starting at a young age and embracing a lifelong physically active lifestyle.

In this workshop we will look at ideas and ways to modify instructions, expectations, equipment and the environment to ensure that all children are included in physical activities and equally inspired to participate regardless of needs. 

How We Learn to Move

It’s important to remember that children do not learn movement skills on their own; they need instruction, encouragement and someone to help show them how. Movement is learned through lots of repetition in a fun, welcoming and supportive environment. Repeat, repeat, repeat in lots of different places: inside and outside, in the rain and in the snow. This will help the child to learn how to move competently through Canada’s seasons and help the child to build self-confidence.

I can, I believe, I want

When children experience healthy active environments they gain physical competence, which builds confidence and the motivation to participate.

And to a child…this means that they have the want, the belief and the ‘I can’ attitude to try new things, make mistakes and take developmentally appropriate risks

Let’s take a closer look at sensory regulation, its link to a child’s learning and to physical literacy.

In this article we are going to highlight the 3 senses that are most impacted during physical movement. These are touch, hearing and vision.

What do we mean when we use the term sensory regulation?

It means how we take in and understand information from the senses.

A person can be sensitive to sensory information or they may be sensory seeking. If a person is sensitive, they may try to block sensory information. For example, if it’s too loud or noisy, they may cover their ears to reduce the sound. If a person is sensory seeking, they may for example, bang toys together to achieve the desired noise level in their environment.

How can you help this child? Be sensitive while calling children’s attention by avoiding whistles, loud music or other sudden loud sounds like popping balloons.

Touch

picture of child playing with slime

So now let’s take a look at the sense of touch. If a child is sensitive to touch, they may strongly dislike light or unexpected touch, or hold objects using finger tips to avoid the palm of the hand.

Some of the strategies you may want to try:

  • Exposing the child to different touches and textures slowly
  • Preparing the child for touch by approaching from the front and saying their name may lead to a less intense reaction
  • Using a variety of balls with different sizes, such as an “O” ball
  • Substituting bean bags, pillows, or scarves for balls
  • Be sure to speak to the child or the child’s caregivers to find out how best to introduce different equipment and play tools.

Alternatively, if a child is sensory seeking, they may purposely bump into objects or walls (as they may have higher pain threshold), enjoy small spaces, or lie on the floor or put their head down.

Strategies to try:

  • Crawling under a structure (such as a table, tree trunk) or through a tunnel (solid or cloth)
  • Navigating an obstacle course
  • Jumping, animal walks
  • Using heavier equipment such as pushing a weighted wagon

Hearing

picture of child covering ears

If a child is sensitive to loud noises or a particular tone they may cover their ears from certain noise or loud sounds, hum or sing to block unwanted sounds, or get easily distracted by noises

Strategies to Try:

  • children can wear headbands, headphones or earplugs
  • turn off fluorescent lights to reduce the buzzing sound produced
  • incorporate quiet versions of games, yoga or isometric activities
  • use smaller group sizes

If a child is seeking additional auditory input they may purposely drop or bang items to hear the thud, place their ears close to noisy items such as musical instruments or sound-producing toys.

Strategies to Try:

  • signal transitions through the use of low-tones such as hitting a drum
  • use different tempos to cue for different activities, such as fast clapping for running, slow drumming for hopping, ring a bell for hands on top of head to signal tidying up.

Vision

picture of child wearing sunglasses

If a child is sensitive to visual stimulation they may prefer dim lights or dull patterns, avoid eye contact, cover or close eyes, appear fearful of bright lights, or have difficulty scanning the environment for a desired object.

Strategies to try:

  • when possible, limit additional visual input such as dimming lights
  • engage in rhythmical, predictable activities such as freeze dance
  • use a smaller area for activity so the object is easier to find

Outdoor strategies can include wearing hats or sunglasses

If a child is seeking extra visual input they may miss objects when trying to grab, they might stare or become excited when they see bright flashing lights or bright colours, they might also hesitate or fear using stairs or steps.

Strategies to try:

  • incorporate bubbles, flashlights or flashing balls into the activities
  • Be mindful when setting up program areas to provide physical cues. For example use outlined or otherwise marked areas for activities. This can be as simple as the pattern on the gym floor

Heavy work

What we’ve learned in terms of techniques and strategies to address sensory regulation, is that one of the most effective methods is using what is called “heavy work.” This describes engaging in activities that provide input into the muscles and joints which results in the ability to focus and learn. All children benefit from heavy work. For children who are constantly on the move or appear fidgety, have difficulty focusing on tasks in an appropriate manner, or appear hyperactive or out of control, you can try these strategies to help them regulate:

  • pushing or pulling a weighted item, such as a wagon, backpack, bin of toys
  • animal walks – bear walks, crab walks, frog jumps, snake crawls on belly
  • yoga
  • isometric exercises
  • movement breaks throughout the activity if waiting time is too long
  • relay course
  • carrying weighted objects such as a bin of balls
  • fidget items
  • music and dancing
  • tug-o-war in a variety of positions such as kneeling or laying on their tummy
  • The more children move, the less likely you are to have issues with behaviour and the more likely the child will be willing to learn when the time comes.

Tips for Successful Inclusion

Remember to always actively include all children in the program and encourage friendships and connections between them. This benefits everyone and helps to build trust and comfort as children learn to move in their environment.

The teacher should lead by example and engage actively with the children. Children want nothing more than you to play with them at times. Show them that you can have fun and move in different ways as you move around the activity. Let’s not forget that children need to be prompted to move. Asking questions like, can you move backwards, sideways, or what about upside down, encourages children to be creative and move in different ways. Don’t forget to role model this throughout your day.

How you provide instruction is key for successful inclusion:

Remember:

  • keep instructions clear and simple, and close to 30 seconds or less
  • use cooperative games and activities,
  • use prompts (physical, visual, verbal),
  • keep your group together,
  • pair children who have extra support needs with children who have more confidence,
  • Praise the children for participation,
  • extend the child’s existing skills by challenging them to carry the next step of the game, or movement.
  • Minimize lineups and waiting
  • Keep it fun and child focused.

Equipment

Equipment plays a huge role in getting children engaged. – Use your imagination to inspire children to move differently and promote exploratory play. If you don’t have enough equipment, then try to think of another activity that can happen at the same time without equipment. This will minimize wait times and maximize engagement. Rotate your props and equipment and modify existing equipment to match the needs of all the children in your program. For example, use a Batting “T” when playing baseball and a pool noodle as a cricket bat.

Environment

The environment is everything to a child.

Effective strategies when adapting your environment include:

  • having smaller group sizes which also supports no line ups or shorter wait times,
  • Have enough props,
  • Set Up the program area prior to the children’s arrival to motivate for physical literacy,
  • reduce auditory and visual distractions

All children deserve the right to play, to be engaged and to learn. Always be mindful and open to drawing from your toolbox as the needs of children change over time and are different on different days-Be creative. Include children in your planning. What would you like to do during activity time is always a good question to ask.

As the children master the beginner levels, remember to increase the difficulty of the task to keep them challenged and engaged…laughing and smiling. But don’t be afraid to keep them challenged.

Expect that all children can participate and will be included.

What is the adult’s role in all of this? That you will join in on the fun, be an active participant and make sure that no one is left out, everyone in!


In this video we suggest ideas and ways to modify instructions, expectations, equipment and the environment so that all children can be included in activities and equally inspired to participate regardless of needs. These suggestions should in no way be a substitute for training or for your own judgement as a professional regarding appropriateness and safety.

MAP videos are intended solely for general information purposes and to supplement, not replace, proper training and supervision by qualified professionals. Content does not constitute the provision of professional advice or substitute for professional advice, diagnosis or treatment plan for any child.

York Region: Why Wait Demonstration Project

York Region Lifetime Independent Facilitation

The York Region “Why Wait” Collaborative Demonstration Project provided four innovative housing models to eight individuals identified on the DSO eligibility list. The models are individualized to suit each person’s needs and desires, yet share several components in support of long-term sustainability: Independent Facilitation, incorporated microboards, coordinated agency-based staffing supports, and shared administrative costs including for fund administration, brokerage, and QAM oversight.

Live-in Caregiver Model (Housing Model 1)

Jonathon

Jonathon has his own separate apartment in the family home basement with a separate entrance and with 24 hour live in support.

Amanda

Amanda lives in her own self-contained apartment in the family home basement and is supported by staff.


Technology Model with the right support at the right time (Housing model 2)

This model relies on technology to support the overnights, rather than a in-house staff. These three housemates share a rental accommodation and staff support during “common” times (evening meal times) and utilize PSW support for the morning care routines (Ministry of Health funded support through the LHIN). All other staff is individualized, allowing them to have ongoing access to activities of choice.

Stephanie

Julian


Right support at the right time with technology (Housing Model 3)

This individual has a very active social life and many interests in his community. He has individualized staffing for various portions of the day/evening to support his access to these activities. When in the home, the use of technology and sharing of staff support for meals has greatly reduced the cost of staff support.

Derek


Turner Syndrome

Fact Sheet

What is Turner Syndrome?

Turner Syndrome is a rare chromosomal disorder that affects females. The disorder is characterized by partial or complete loss (monosomy) of one of the X chromosomes. Turner Syndrome is highly variable and can differ dramatically from one person to another. Affected females can potentially develop a wide variety of symptoms, affecting many different organ systems. Common symptoms include short stature and premature ovarian failure, which can result in the failure to attain puberty. Most women with Turner Syndrome are infertile. A variety of additional symptoms can occur including abnormalities of the eyes and ears, skeletal malformations, heart anomalies, and kidney abnormalities. Intelligence is usually normal, but affected individuals may experience certain learning disabilities. Turner Syndrome may be diagnosed before birth or shortly after birth or during early childhood. However, in some cases, the disorder may not be diagnosed until well into adulthood, often as an incidental finding. The exact, underlying cause of Turner Syndrome is not known. Furthermore, most cases do not run in families and appear to occur randomly for no apparent reason (sporadically).

There are different types of Turner Syndrome. Classic Turner Syndrome, also known as “XO” or 45, X karyotype, occurs when the female is missing one complete X. A mosaic karyotype refers to a missing or rearranged X chromosome in some but not all cells in the body chromosome or missing only part of the second chromosome. There are different potential health issues associated with the different types of Turner Syndrome.

How is it manifested?

Appearance: Features of Turner Syndrome may include a short neck with a webbed appearance, low hairline at the back of the neck, low-set ears, hands, and feet that are swollen or puffy at birth, and soft nails that turn upward.

Stature: Girls with Turner Syndrome grow more slowly than other children. Without treatment, they tend to have short stature (around 4 feet, 8 inches) as adults.

Puberty: Most girls with Turner Syndrome do not start puberty naturally.

Reproduction: In most girls with Turner Syndrome, the ovaries are missing or do not function properly. Without the estrogen made by their ovaries, girls with Turner Syndrome will not develop breasts. More than 95% of women with Turner Syndrome cannot become pregnant without assistive technology.

Cardiovascular: Turner Syndrome can cause problems with the heart or major blood vessels. In addition, about 20% of girls and 40% of women with Turner Syndrome have high blood pressure.

Kidney: Kidney function is usually normal in Turner Syndrome, but some people with this condition have kidneys that look abnormal.

Osteoporosis: Women with Turner Syndrome often have low levels of the hormone estrogen, which can put them at risk for osteoporosis. Osteoporosis can cause height loss and bone fractures.

Diabetes: People with Turner Syndrome are at higher risk for Type 2 Diabetes.

Thyroid: Many people with Turner Syndrome have thyroid problems. The most common one is hypothyroidism, or an under-active thyroid gland.

Cognitive: People with Turner Syndrome have normal intelligence. Some, however, have problems learning mathematics and can have trouble with visual-spatial coordination (such as determining the relative positions of objects in space).

Who is affected?

Turner Syndrome affects approximately 1 female in 2,000-2,500 live births.

How is it diagnosed or detected?

The diagnosis is made by a blood test which looks at the complete set of chromosomes of the individual. This is called a karyotype. Karyotype analysis shows if one of the X chromosome pair is missing from the full chromosome set, or if there are any structural differences in the X chromosomes.

Before birth, a diagnosis of Turner Syndrome can be made by taking a sample of amniotic fluid or other fetal tissue to look at the fetal karyotype. Ultrasound is also used to screen for patterns often seen in Turner Syndrome, such as fluid buildup around the neck, and kidney or heart abnormalities.

After birth, a diagnosis of Turner Syndrome is confirmed by taking a sample of blood or other tissue to obtain a karyotype. Because there is a range of health, developmental, social, and learning challenges which might affect girls and women with Turner Syndrome to different degrees, it is important to diagnose Turner Syndrome as early as possible.

Additional Resources:

Turner Syndrome Society of Canada www.turnersyndrome.ca
The Turner Syndrome Society of Canada, a non-profit charitable organization, was founded in 1981 by an individual with Turner Syndrome who wanted to share experiences and information. Our organization shares up-to-date medical information on Turner Syndrome to families, physicians and the public.
Telephone: (613) 321-2267
Toll-free: 1-800-465-6744

Turner Syndrome Foundation www.turnersyndromefoundation.org
The Foundation’s advocacy efforts identify these gaps and give voice to leaders who can make a difference. The vision to improve the understanding of Turner Syndrome and to render support for women and children living with Turner Syndrome is made possible by advancing communications and inspiring relevant interest in this women’s health issue.
Toll free: 1-800-594-4585

Books and Literature:

Turner Syndrome across the Lifespan
This book is written for girls and women with Turner Syndrome and their families and it covers issues related to medical and psychosocial health.

Topics discussed include genetics, growth, puberty, infertility and advanced reproductive technology, bone health, diabetes, hearing, school and learning issues, among others. Updated health surveillance issues are outlined. The chapters are interspersed with comments and stories written by girls and women with Turner Syndrome. This book serves as a comprehensive guide for those wanting to learn more about Turner Syndrome.

A Canadian publication, this 240-page book, edited by Jill Hamilton (MD, FRCPC), and Irena Hozjan (RN, BScN, MN), is a comprehensive and up to date overview of Turner Syndrome.

This book can be ordered directly through the Turner Syndrome Society of Canada – www.turnersyndrome.ca

Standing Tall with Turner Syndrome Paperback
This compilation of 18 essays – edited by Claudette Beit Aharon is written by women of various ages who have Turner Syndrome, and share their life experiences living with this condition. There is a foreword by Lynne Levitsky MD, chief of pediatric endocrinology, Massachusetts General Hospital and an introduction by the editor. In addition there is medical information on diagnostic tools and treatments, a FAQ about the syndrome and its ramifications, and a glossary.

The content contained in this document is for general information purposes. It is not the intention to diagnose or treat a child.