New clinic to support mental health in kids.

The numbers aren’t pretty, but the future may be brighter for families with children experiencing learning or mental-health issues, thanks to a new initiative led by Western Education.

According to Children’s Mental Health Ontario, as many as 1-in-5 children and youth in the province will experience some form of mental-health problem, with 5-in-6 of those not receiving the treatment they need.

The Child and Youth Development Clinic hopes to fill that gap by welcoming children who are currently without access to the types of services the clinic offers. This week, Western opened the clinic’s doors in the former Bank of Montreal Building, 1163 Richmond St., just outside the Western Gates.

“Every family has a child who, at one time or another, is at risk of learning or mental-health issues,” said Vicki Schwean, Education Dean and the clinic’s founder. “Ensuring the mental health and wellbeing of our next generation is immensely important and we’re thrilled to open the doors to the community at our new clinic.”

The clinic offers services for kids 3-18 years of age with educational, psychological, behavioural and speech and language difficulties – without a doctor’s referral.

Parents, guardians and service providers, such as school officials, mental-health providers and doctors, may refer children and youths to the clinic.

Families may call 519-661-4257 to make an appointment. They will be emailed a package asking them to fill out the child’s or youth’s developmental, medical, social or academic history. This information, along with any reports from previous evaluations and/or school information, will help the clinic plan the most appropriate assessment(s).

Cost is based on a sliding scale based on a parent’s income. No health card is required.

Western graduate students – under the supervision of experts in their field – will provide assessment and treatment options for children with educational, psychological, behavioural and speech and language difficulties either individually or in groups.

The clinic has eight Psychology graduate students and eight Speech and Language students.

As a school and clinical child psychologist, Education professor Colin King has learned a lot working in a variety of hospital, community and private settings with children having various learning, social-emotional and behavioural challenges.

“An interdisciplinary assessment provides families with the most complete profile for their child,” said King, who serves as the clinic’s director.

“It takes a village to raise a child. Once we fully understand a child’s developmental, medical and academic history, we can provide the most informed evidence-based psychological assessment, intervention and treatment.”

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Drummond Report Chapter 5 Review (Part 2)

The Drummond Report was commissioned for the purpose of addressing the rising costs of health care in the provincial budget and gave a series of recommendations in a variety of areas related to the health care system. One such area under review was hospitals, which the report argued was not being incentivized to increase efficiency due to a funding model based on average costs across the province. The report goes on to state that there is little understanding of the true costs of procedures and that in order to ensure Ontario is getting the best value for its money, the costs incurred by hospital procedures needs to be examined from region to region and hospital to hospital (Ministry of Finance, 2012). The Drummond Report makes six recommendations in this area related to changing how hospitals are funded, operated, and administrated. Almost 3 years after the release of the report it is clear that Ontario has made great strides towards achieving many of the recommendations outlined in the report pertaining to hospitals.

Recommendation 5-50 proposes the use of the Health-Based Allocation Model (HBAM) system to set appropriate compensation for procedures (Ministry of Finance, 2012). This proposed change would represent a shift from the use of the prevailing global funding model, in which every hospital received lump-sum funding, to HBAM which estimates expected health care expenses based on demographics and clinical data on complexity of care and type of care (Ministry of Health and Long-Term Care, 2012). This recommendation has been realized to some extent in Ontario through the introduction of the Health System Funding Reform (HSFR). By 2015/2016 the HSFR will represent 70% of the funding envelope provided to hospitals, while global funding will represent the remaining 30% (Ministry of Health and Long-Term Care, 2015). The organizational-level funding component representing 40% of the HSFR allocation will be determined using the Health Based Allocation Model, while the quality-based procedures component will see specific procedures funded based on a “price x volume approach” meant to incentivize providers for delivering high-quality care.

Recommendation 5-51 was aimed at creating a blend of activity-based funding and base funding managed through accountability agreements. Ontario has begun the shift towards activity-based funding also known as patient-based funding, by categorizing hip replacement, knee replacement, dialysis and other treatments for chronic kidney disease and cataract surgery as quality-based procedures in which outcome is used to help determine payment (MOHLTC, 2012). The province plans to add to the list of procedures classified as quality-based procedures in the coming years in the hopes that it will maximize efficiency and incentivize providers to increase the quality of care they deliver to patients receiving these procedures.

The introduction of the HSFR in the funding model can also be seen as helping to facilitate recommendation 5-53 of the Drummond Report, which pushed for a new funding model that would incentivize hospitals to specialize so that not all were trying to provide all services regardless of comparative advantage (Ministry of Finance, 2012). By tying the performance outcomes of procedures to payment, it encourages hospitals to specialize in procedures for which they can deliver high-quality outcomes in order to maximize the level of funding they receive. This change to the funding model follows the logic proposed by the Drummond report, which believed that the way to encourage hospitals to cut costs and provide better quality care was to incentivize them to specialize (Ministry of Finance, 2012). Specifically the report stated that if a certain reimbursement rate were set for an activity, hospitals that could not provide the service within that rate would gravitate away from it. The quality-based procedures component of the HSFR model is meant to achieve the goal of better quality and system efficiencies by basing payment on outcome. Ontario has decided to continue down this route with the planned addition of other procedures in coming years (MOHLTC, 2012).  In 2013, six other procedures were added as quality-based procedures which included: chronic obstructive pulmonary disease, congestive heart failure, vascular, stroke, chemotherapy, and endoscopy (South West LHIN, 2014).

Recommendation 5-52 encouraged the creation of policies to move people away from inpatient acute care settings by shifting access from emergency rooms and toward community care, home-care, and long-term care (Ministry of Finance, 2012). Currently in Ontario over 184 family health teams have been operationalized with the purpose of expanding access to comprehensive family health services across Ontario by ensuring teams are set-up based on local health and community needs (MOHLTC, 2014). Family Health Teams in the province are community-centered and have been established in traditionally underserved rural and northern communities with unique populations and specialized health needs. By virtue of the many different types of health care professionals that comprise a Family Health Team including family physicians, nurses, social workers, and dieticians, Family Health Teams are meant to facilitate a more comprehensive and coordinated level of care for patients. The broad range of services they can provide are expected to help decrease reliance on the more costly and overburdened emergency departments in part by helping to prevent and treat chronic disease.

Recommendation 5-55 highlights a huge problem that has plagued the Ontario health care system, which is the lack of coordination between the different health care professionals including hospitals, Family Health Teams, and long-term cares facilities. In order to facilitate the discharge of patients and reduce costs there needs to be coordination with other health care professionals to optimize patient outcomes. Recommendation 5-55 proposed the use of hospitalist physicians to co-ordinate inpatient care from admission to discharge and follow a patient as they move through the health care continuum (Ministry of Finance, 2012). Increasing health care costs and chronic illness have led to a need for better coordination of care and the creation of hospitalists, the fastest growing medical specialty in North America with more than 300 practitioners and 62 programs operating in Ontario hospitals today., who are defined as physicians who spend the majority of their professional time providing general medical care to hospitalized patients (White, 2011). However, there are concerns as to the financial sustainability of hospitalist programs, satisfaction amongst patients and providers and perhaps most importantly, whether patient outcomes are adversely affected by the transfer of responsibility between providers.

The province of Ontario has restructured the funding model for hospitals in recent years from the traditional global health model towards the Health-Based Allocation Model and activity-based funding in the hopes of cutting costs and increasing efficiency and quality of care. This restructuring addressed many of the concerns in the Drummond Report about the way hospitals are funded, in particular the lack of incentives the old model contained for to specialize based on comparative advantages. The province continues to head in the direction proposed by the report by decreasing the portion of the payment that is under the Global Health Model and is expected to continue to do so in the upcoming years. The province also continues to employ hospitalists with the hopes of increasing coordination of care to ensure better health outcomes and cutting costs. The controversy surrounding the profession of hospitalists indicates more research should be done into the cost effectiveness, financial sustainability, and impact on patient outcomes to determine whether the profession is attaining the goals it set out to. This also highlights the importance of remaining critical of the recommendations in the report as they are implemented, and the need to ensure that there are not unintended consequences stemming from these changes to the system.

Works Cited

Ministry of Finance. (2012). The commission on ontario’s public services. Retrieved from  

Ministry of Health and Long-Term Care (2015). Health system funding reform (HSFR). Retrieved from

Ministry of Health and Long-Term Care (2014). Family health teams. Retrieved from

Ministry of Health and Long-Term Care (2012). Patient-based funding overview. Retrieved from

South West LHIN (2014). Health system funding reform update. Retrieved from

White, Heather L. (2011). Assessing the prevalence, penetration and performance of hospitalist physicians in Ontario: implications for the quality and efficiency of inpatient care. Retrieved from


Why Cannabis Should Not be Legal in Canada

Cannabis sativa, a species of Cannabis, is a flowering plant that is used in the creation of marijuana (United States Department of Agriculture, 2011). Although its use has been illegal in Canada since 1923, cannabis is the most widely used illicit drug in Canada, and the country has the third highest prevalence rate of marijuana usage in the world (Haines-Saah et al., 2014). Cannabis is often referred to as pot, dope, marijuana, ganja, and hemp and has been classified as a pychotropic drug which acts as a modulator of the central nervous system (Nolin & Kenny, 2002). In Canada, it has been labelled a Schedule II controlled substance, a drug that has a higher than average potential for addiction and abuse (The Canadian Consortium for the Investigation of Cannabinoids, 2014).  The illegality of cannabis is a highly debated and controversial subject with many calling for its decriminalization and others suggesting a public health approach to minimize the consequences that follow its use (Haines-Saah et al., 2014).  Decriminalization would involve the removal of a behaviour or activity, in this case cannabis, from the scope of the criminal justice system in which an administrative decision is made to not prosecute acts that nonetheless remain against the law. On the other hand, legalization would involve legislating under a regulatory system the culture, production, marketing, sale and use of a substance (Nolin & Kenny, 2002). The use of cannabis-containing products has been linked to increased respiratory and reproductive health concerns, increased likelihood of psychosis including schizophrenia when used in adolescence. A lack of scientific consensus and knowledge on the long-term health impacts of cannabis would make it difficult to predict what outcomes the legalization of marijuana would have. The decision on whether or not to legalize cannabis should be made solely on the basis of scientific knowledge and not based on public desire, and current research is insufficient to support legalization. The arguments for legalization including lessening the burden on the criminal justice system and lessening exposure to other illegal substances if marijuana was regulated in a similar way to alcohol, are not sufficient to override the health concerns that have been raised. At this time, the benefits shown for patients with chronic conditions including reduced pain and symptoms are enough to support the continued legality of medicinal marijuana if prescribed by a physician and stringent regulations are in place to prevent misuse or abuse. I contend that current scientific evidence supports the continued illegality of cannabis in Canada, but medical marijuana should continue to be available for individuals when prescribed by a health care professional.

Tetrahydrocannabinol, also known as THC is the active ingredient in marijuana and is thought to produce feelings of relaxation, enhanced sociability, a diminished ability to focus, distorted time and depth perception, and physiological side effects including an increased heart rate, increased appetite, and reddened eyes (Canadian Public Health Association, 2003). While intoxicated It may also result in impairment to short-term memory and attention span, motor skills, skilled activity and reaction time, and anxiety and panic reactions (Hall & Solowij, 1998). Heavy marijuana usage is associated with chronic bronchitis symptoms, development of chronic obstructive pulmonary disease, and is a possible risk factor for the development of lung cancer (Joshi, M., Joshi, A., & Bartter, T 2014).  The dosage of marijuana needed to produce these lung diseases is not yet known and must be further studied. The research on the reproductive effects of cannabis smoking is inconsistent, however, low birth weight babies, impaired sperm production and viability, and behavioural and developmental effects on infants exposed in utero have been suggested as potential consequences of cannabis use (Hall & Solowij, 1998). Long-term use of cannabis can also lead to psychological or physical dependence and withdrawal symptoms when the user is unable to use cannabis (Centre for Addiction and Mental Health, 2010).

The long-term effects of cannabis on the health of the user are not well understood and are widely debated due to the lack of epidemiological evidence and different interpretations of existing studies (Hall & Solowij, 1998). It is for this reason in particular, that I do not believe that cannabis should be made legal in Canada. The National Institute on Drug Abuse has determined based on the limited evidence available, that marijuana is harmful to the developing brain and has suggested that more research must be conducted in this area (Alcoholism & Drug Abuse Weekly, 2014). However, research on the effects of cannabis on the health of individuals is difficult to conduct because it is hard to collect data from individuals who regularly consume cannabis while controlling for other factors due to ethical implications. The existing gaps in research would make the legalization of cannabis dangerous because of the unforeseen impacts on health that could potentially occur should drugs containing cannabis be made more widely available.

Much of the emerging research on the effects of acute and chronic cannabis use is focused on adolescents and the connection between marijuana usage and psychosis suffered in adulthood. A revolutionary study conducted in Sweden was one of the first to show a six-fold increase in the occurrence of schizophrenia in individuals who used cannabis heavily at age 18 (Andréasson, Allebeck, Engström & Rydberg, 1987). However, it must be said that the study is limited in the sense that its findings are only correlational and cannot be used to determine causality. The study was unable to draw a conclusion as to whether schizophrenia was caused by the use of cannabis, or whether pre-existing symptoms of schizophrenia led to the use of marijuana (Arseneault, Cannon, Poulton, Murray, Caspi & Moffitt, 2002). Further studies have been conducted examining this relationship. The exact neurobiological process that leads to potential psychosis is unknown because a cause-effect relationship has not yet been established, but current research is focusing on the identifying the factors that contribute to the developmental pathway of psychosis (Shrivastava, Johnston, Terpstra, Bureau, 2014).  A study conducted on college students found that heavy marijuana usage, defined as smoking marijuana 29 out of 30 of the previous days, resulted in impaired executive functioning even after controlling for confounding factors (Pope Jr & Yurgelun-Todd, 1996). This study was unable to determine whether impairment is due to a residue of drug in the brain, a withdrawal effect from the drug, or a neurotoxic effect of the drug. Another study reached the same conclusion as the Swedish study, adding that rates of schizophrenia increased after cannabis use even after controlling for psychotic symptoms preceding cannabis use, early use (by age 15) conferred greater risk than later use (by age 18), and risk was specific to cannabis use as opposed to other drugs (Arseneault, et al., 2002). A tenth of the individuals in this study who used cannabis before age 15 developed schizophrenia by the age of 26. The effects of cannabis on the developing brain are not fully known yet but current research suggests that some adolescents may be psychologically vulnerable and thus legalizing marijuana, thereby making it more widely available, could potentially have long-term detrimental effects on the mental health of these individuals.

Many proponents for the legalization of the drug have argued that the illegality of the substance has not prevented it from becoming one of the most widely used drugs in the developed world, and that the government should regulate the substance much in the same way it regulates alcohol or other medications. This claim is made with the belief that the regulation of cannabis would reduce the number of adolescents selling marijuana and their access to other illegal drugs, and would reduce the cost of prosecuting offences related to the use of cannabis. In response to suggestions that the legalization of cannabis would reduce costs to the judicial system, opponents of legalization have proposed decriminalizing marijuana and instead imposing civil penalties for possession including small fines (Alcoholism & Drug Abuse Weekly, 2014). The health of individuals should be the first and foremost priority of health and government officials and the substance should not be made legal simply to reduce the strain on the judicial system, or as a means to prevent the usage of other more harmful and addictive substances. Although many of the findings about the physical, and psychological health effects of cannabis usage are limited or are correlational instead of demonstrating causality, this should not serve as a basis to decriminalize cannabis. In Canada, any potential new drug must go through a rigorous screening process including clinical studies that are then reviewed by the Therapeutic Products Directorate of Health Canada and the findings are then assessed for the safety, efficacy, and quality of the drug (Health Canada, 2001). The potential benefits and adverse effects of cannabis have not been rigorously studied to the extent that other drugs have had to undergo when going through the drug review process (Sullivan, 2012). Health Canada states that its first and foremost concern is ensuring the safety and well-being of Canadians, and the current research and findings on long-term cannabis usage must be addressed before any discussion of legalization could take place (Health Canada, 2001). More scientific research is needed for this purpose. There are also a host of other concerns which would emerge if legalization were to happen including whether or not it would increase the number of individuals who become addicted to marijuana, whether accident rates would increase due to cannabis usage particularly in the teenage demographic, and what impacts on health this would have in the long-term.

Cannabis products for medicinal purposes are a widely debated topic in Canada. In 2001, the Supreme Court of Canada ruled that there must be reasonable access to a legal source of marijuana when authorized by a physician, which resulted in the creation of Health Canada’s Marijuana Medical Access Program (Health Canada, 2001). A report published in 1999 by the Institute of Medicine found that marijuana functioned to treat chronic pain and physical symptoms and produced anti-anxiety and sedative effects (Rubens, 2014). Medical marijuana has been shown to benefit patients suffering from chronic pain due to diabetes, multiple sclerosis, and hepatitis, relieves eye pressure caused by glaucoma, increases appetites in patients with AIDS and cancer, and relieves acute anxiety, insomnia and other sleep disorders (Friedman, 2013). The stance of the Government of Canada is that it does not condone the use of marijuana and it has announced that the Marijuana Medical Access Program will end on March 31, 2014 at which point the only legal access to marijuana for medical purposes will be through licensed producers even if you have an authorization to possess or a license to produce the drug (Health Canada, 2013). Many individuals argue that these new laws are unconstitutional because they interfere with the rights of patients to access medication. The Government of Canada has responded that these new laws must be put into place in order to protect public safety, while making sure patients still have access to what they need to treat serious illness (Health Canada, 2013). My belief is that based on current evidence medical marijuana has been shown to effectively treat many health issues and alleviate chronic pain. Medical marijuana should remain legal because of the strict regulations that are in place to prevent misuse and abuse of the system. Government regulations require that a physician prescribe medical marijuana and the new laws will limit the distribution of medical marijuana to licensed facilities only. I believe that the benefits to patients in this case supersede the potential consequences, as those who would qualify would already have chronic and debilitating health issues, and their quality of life would be dramatically improved through the use of medical marijuana. I believe the new restrictions concerning which facilities can distribute medical marijuana will ultimately be beneficial, as the facilities will be regulated by government legislation, and it will ensure that only those who have been prescribed medical marijuana are serviced at these facilities. The Special Committee on Illegal Drugs stated in its report that public policy concerns should not be considered by a physician when making a professional decision on the extent to which and in what circumstances marijuana serves a therapeutic purpose for the patient (Nolin & Kenny, 2002). The legal status of medical marijuana should be continually reviewed and reconsidered based on the most current and up to date evidence on the health impacts of marijuana. The therapeutic value of medical marijuana must always outweigh any potential health impacts for patients suffering from chronic health conditions. One line of research that should be conducted is on the psychological effects of cannabinoids which could lead to undesirable effects for certain patients and could negate any potential medical benefit from its usage (Joy, Watson, Benson, 1999).

In conclusion, my contention is that current research supports the continued illegality of cannabis in Canada. The legalization of cannabis should not occur because of public demand, or as a new source of revenue for the government of Canada, but should only be done on the basis of science. Currently, scientific research has shown many potential adverse effects from the use of cannabis and thus does not support the notion that legalization should take place. To allow legalization to occur at this point would go against the objectives of Health Canada and could potentially jeopardize the health of Canadians and lead to many other unforeseen outcomes. More research must be conducted in this area in order for researchers and policy makers to make an informed decision about whether the legalization of cannabis should take place. Some researchers predict that rates of marijuana usage could double or triple if legalization were to occur, thus it is important to understand what implications this will have on the health of individuals and society as a whole before legalization can occur (Alcoholism and Drug Abuse Weekly, 2014). The lack of scientific consensus on the health impacts of cannabis usage and studies showing correlations of cannabis usage and adverse outcomes have led me to draw the conclusion that cannabis should not be legalized at this time. However, I do believe that an exception for medical marijuana should be made as it has been shown to alleviate chronic pain and benefit patients with certain medical conditions. Unless more research is conducted which shows adverse effects to human health that outweigh the benefits to patients who use medical marijuana to treat their symptoms, the removal of medical marijuana would serve to do more harm than good and would infringe on their constitutional right to life, liberty and security of person. There should be controlled access in this case, regulated by the Government of Canada which bears the responsibility of creating and upholding regulations for medical marijuana production and distribution to ensure access to medical marijuana, while continuing to ensure the safety of the Canadian population as a whole.  It is important to note that my position is based off of current scientific literature, which has not yet drawn conclusions as to the long-term health impacts of cannabis usage and the impacts it will have on society in other aspects. The interest and controversy in the debate on the legal status of cannabis products has not diminished and the next few years may prove critical for reaching both scientific and political consensus on the health impacts of cannabis and what the legal status should be respectively.  In 2013, Uruguay became the first nation to legalize the growing, sale, and smoking of marijuana (Castaldi & Llambias, 2013). There are also other nations and cities known for openly selling marijuana to locals and tourists, including Jamaica and certain “coffee shops” in the Netherlands. In my opinion a lack of aversive consequences in these countries does not help to strengthen the argument that cannabis should be legalized in Canada, as the findings are non-generalizable because of the vast difference in culture, history, society, and other confounding factors. Colorado and Washington are now in the process of legalizing marijuana and are serving as experimental labs for the rest of the United States (Rocky Mountain HIDTA, 2014). The impact of legalization will be heavily studied in the upcoming months and potentially years. This may serve as an unprecedented opportunity for scientists to study the usage of marijuana and cannabis products in cities that more closely resemble Canadian cities and may prove to be key in ascertaining the scientific data needed to make a more informed decision on whether cannabis should continue to remain illegal in the future, or whether we should proceed with decriminalization or legalization.







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