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We are proud to introduce our integrated pathway for Children and Youth with Extensive Needs. The new pathway will streamline services for families by providing multidisciplinary assessment and specialized intensive clinical treatment to children with multiple neurodevelopmental, behavioural, medical and physical needs, and social vulnerabilities. The Extensive Needs Service provides individualized support that emphasizes collaboration with families and care teams, reducing challenging behaviors, and addressing underlying health concerns. . The service is designed to reduce barriers to accessing timely, evidence-based, and trauma-informed treatment for some of the most vulnerable children in Ontario.

Holland Bloorview is one of three sites in Ontario leading this new prototype program funded by Ontario’s Ministry of Health and the Ministry of Children, Community and Social Services. Please refer to the announcement made on March 9. We are working with our partner sites - Children’s Hospital of Eastern Ontario and McMaster Children’s Hospital to ramp-up services and build a proof of concept program.

We are actively working to open this service to community referrals and we will reach out to eligible clients and families directly to provide the necessary support and assistance.

Please check back regularly for updates and additional information on how to access our program.

A Trauma Informed and Evidence Based Approach To Behaviour Therapy

A trauma-assumed approach to Applied Behaviour Analysis, Practical Functional Assessment and Skill Based Treatment enables the behaviour therapy team to work with clients and their families while centering on three priorities; safety, dignity, and rapport.

Trust is built between the client and behaviour analysts/technicians by ensuring the client consents/ascents to treatment throughout sessions, explaining what the goal of each session is and clearly signalling when a demand is about to be placed, and responding to the needs of the client within sessions.

All interfering behaviour is met with empathetic statements/gestures and individualized support to meet the client’s needs, and never ignored. Foundational goals of Skill Based Treatment focus on teaching clients functional communication to get their needs met, tolerance of everyday frustrations and disappointments, and contextually appropriate behaviours.

Contextually appropriate behaviours are individualized goals made in collaboration with clients and their caregivers that are meaningful for their everyday life (e.g., leisure, self-care, communication, etc.) and are responsive to change when needed. 

Treatment allows a behaviour analyst/technician to work directly with a client to systematically build skills and reduce the need to engage in interfering behaviour within manageable steps.

Caregivers are involved in each step of treatment and become active members of treatment once the client consistently demonstrates the skills with the clinician. As a final step, the skills learned and practiced within the clinic setting are generalized to the environments a client lives, learns, and engages in leisure.

Occupational Therapy

The occupational therapy team provides a trauma-informed and evidence-based approach to client-centered care. The goal of occupational therapy is to enable participation and engagement in activities that are meaningful in the individual’s everyday life.

Occupational therapists on the Extensive Needs Service can work with children and youth with a variety of conditions to achieve their goals. Our clients have experienced barriers to accessing care within their community due to interfering behaviours and mental health challenges.

The occupational therapist will collaborate with the client and their families to determine the most meaningful goals, establish an individualized treatment plan and/or identify the need for supports within the community.

Occupational therapists on our team assist in reducing barriers in the environment to ensure equitable access to meaningful activities in the community. The occupational therapist will work with each client to facilitate improved performance and satisfaction with their life by addressing the client’s sensory processing, emotional regulation, sleep hygiene and social skills.

Our occupational therapists will highlight each clients’ strengths to optimize their success in their everyday life. Working with the occupational therapist, our clients will be able to maximize their independence and quality of life.

Registered Dietitian Services

Registered Dietitians (RDs) in Ontario are regulated health professionals that assess and provide care for nutritional and dietary related problems. Dietitians translate medical and scientific nutrition evidence into practical information to help families and individuals based on their nutritional needs. Nutrition Care for feeding challenges is provided by a Registered Dietitian as part of Extensive Needs Services. A trauma Informed, weight-inclusive and client centered approach is emphasized and prioritized in the care of each client.

Our dietitian primarily provides treatment for children with feeding challenges (with or without an ARFID diagnosis) who present with a variety of conditions using a Responsive Feeding Therapy approach (RFT). RFT is a multi-step trauma-informed approach to treating feeding challenges that emphasizes the child’s agency (upholding their right to say no to interventions). It focuses on motivating children to eat based on their own interests and internal cues rather than using intensive or forceful methods. Responsive Feeding Therapy (RFT) values individualized care, autonomy, relationship and internal motivation.

Along with treating ARFID our dietitian also provides treatment for the following common challenges amongst our population: 

  • Poor Appetite Related to Medications
  • Increased Appetite Related to Medications
  • Binge Eating Disorder
  • Restricted Eating related to body image concerns and associated trauma


Nutrition care would involve the dietitian conducting an in-depth nutritional assessment with the family followed by collaborative formulation of a comprehensive nutrition care-plan. Care plans will include nutrition education and SMART (Specific, Measurable, Achievable, Relevant, and Time-Bound) goal setting as well as scheduled follow-ups to monitor progress. 

Working with a dietitian will allow clients and their families to feel supported knowing that they will be receiving the most up-to-date, evidenced-based nutrition information and individualized treatment.

Contact us
Kathryn Decker, Director, Extensive Needs Service