In this blog, I’ll talk about one of the ways in which you can obtain a catastrophic impairment designation, where as a direct result of your motor vehicle accident the impairment you sustained – if you are child – results in a traumatic brain injury.

Catastrophic Impairment Paediatric Traumatic Brain Injuries

A catastrophic impairment designation places you – an auto accident victim – in the highest level of impairment category available under automobile insurance regulations. While not a benefit itself, a catastrophic impairment designation is the gateway or vehicle to access enhanced benefits, where your policy limits increase to $1 million. All other impairments fell under the non-catastrophic and minor injury category.

If you want to learn more about the companion accident benefits claim, and kickstarting the accident benefits application process, then please click the “link” to read my blog entitled “How to Get Your Accident Benefits Application Started”.

The June 1, 2016 amendments to the Ontario Regulation 34/10: Statutory Accident Benefits Schedule (SABS 34/10), issued under the Insurance Act, R.S.O. 1990, c. I.8, introduced a stricter definition of catastrophic impairment. Section 3.1 was added to the SABS 34/10, which provides a tightening of the criteria for determination of catastrophic impairment. 

One of the changes was the introduction into the SABS 34/10 of the use of the King’s Outcome Scale for Childhood Injury (KOSCHI) to determine paediatric catastrophic impairments, as well as the introduction of the new automatic catastrophic impairment designation into the SABS 34/10.

Catastrophic Impairment Paediatric Traumatic Brain Injuries

The stricter definition of catastrophic impairment as it relates to a loss of vision in both eyes can be found subs. 3.1(1)5 of the SABS 34/10, as amended by Ontario Regulation 251/15, reads as follows:

For the purposes of this Regulation, an impairment is a catastrophic impairment if an insured person sustains the impairment in an accident that occurs on or after June 1, 2016 and…:

If the insured person was under 18 years of age at the time of the accident, a traumatic brain injury that meets one of the following criteria:

i. The insured person is accepted for admission, on an in-patient basis, to a public hospital named in a Guideline with positive findings on a computerized axial tomography scan, a magnetic resonance imaging or any other medically recognized brain diagnostic technology indicating intracranial pathology that is a result of the accident, including, but not limited to, intracranial contusions or haemorrhages, diffuse axonal injury, cerebral edema, midline shift or pneumocephaly.

ii. The insured person is accepted for admission, on an in-patient basis, to a program of neurological rehabilitation in a paediatric rehabilitation facility that is a member of the Ontario Association of Children’s Rehabilitation Services.

iii. One month or more after the accident, the insured person’s level of neurological function does not exceed category 2 (Vegetative) on the King’s Outcome Scale for Childhood Head Injury as published in Crouchman, M. et al, A practical outcome scale for paediatric head injury, Archives of Disease in Childhood, 2001: 84: 120-124.

iv. Six months or more after the accident, the insured person’s level of neurological function does not exceed category 3 (Severe disability) on the King’s Outcome Scale for Childhood Head Injury as published in Crouchman, M. et al, A practical outcome scale for paediatric head injury, Archives of Disease in Childhood, 2001: 84: 120-124.

v. Nine months or more after the accident, the insured person’s level of function remains seriously impaired such that the insured person is not age-appropriately independent and requires in-person supervision or assistance for physical, cognitive or behavioural impairments for the majority of the insured person’s waking day.

Therefore, further to subs. 3.1(1)5 of the SABS 34/10, you can see that the catastrophic impairment definition for children, who are 18 years of age and younger and have sustained a traumatic brain injury as a result of satisfying particular criteria, contains five disjunctive parts, which are applicable at different times: (1) hospitalization, in regards to subs. 3.1(1)5i and subs. 3.1(1)5ii; (2) one month, in regards to subs. 3.1(1)5iii; (3) six months, in regards to subs. 3.1(1)5iv; and (4) nine months, in regards to subs. 3.1(1)5v. If a child meets the particular criteria of any of the aforementioned five parts of subs. 3.1(1)5, then the child will be granted a catastrophic impairment.

Catastrophic Impairment Paediatric Traumatic Brain Injuries

In this blog, each of the five parts of subs. 3.1(1)5 will be delved into deeper, which will begin by delving deeply into subs. 3.1(1)5i, which introduces a new automatic catastrophic impairment designation exclusively for children. The focus will be on one of the Superintendent of Financial Services’ issued guidelines entitled No. 01/16: Catastrophic Impairment – Public Hospitals Guideline , which offers guidance on the interpretation and operation of subs. 3.1(1)5i. I’ll then review subs. 3.1(1)5ii, subs. 3.1(1)5iii, subs. 3.1(1)5iv, and subs. 3.1(1)5v will follow, while providing a comprehensive review of the KOSCHI, and the KOSCHI outcome scale that’s published in Marion Crouchman’s journal article entitled “A practical outcome scale for paediatric head injury”. Even though the KOSCHI outcome scale is specifically referenced in only subs. 3.1(1)5iii and subs. 3.1(1)5iv, an analysis of same will be included in the review of subs. 3.1(1)5v as well. The reason is because the language used in the criteria of subs. 3.1(1)5v is influenced by the KOSCHI category definitions, and it covers an identifiable stage in the recovery of a surviving paediatric patient from a head injury that describes a level of a child’s neurological function, which constitutes an outcome that can be captured by the eight-point interval KOSCHI between 1 and 5b.

The New Automatic Catastrophic Impairment Designation for Children: Subsection 3.1(1)5i

After the SABS 34/10 was amended on June 1st, 2016, one of the most significant changes was the new automatic catastrophic impairment definition for children, 18 years of age or younger, who suffer traumatic brain injuries, which is set out in subs. 3.1(1)5 of the SABS 34/10. I’m also going to discuss one of the Superintendent of Financial Services’ issued guidelines that offers guidance on the interpretation and operation of subs. 3.1(1)5i, where I’ll show, among other things, has discriminatory ramifications based on geography for children who live in rural areas.

Subsection 3.1(1)5i of the SABS 34/10, as amended by Ontario Regulation 251/15, reads as follows:

For the purposes of this Regulation, an impairment is a catastrophic impairment if an insured person sustains the impairment in an accident that occurs on or after June 1, 2016 and…:

  1. If the insured person was under 18 years of age at the time of the accident, a traumatic brain injury that meets one of the following criteria:

i. The insured person is accepted for admission, on an in-patient basis, to a public hospital named in a Guideline with positive findings on a computerized axial tomography scan, a magnetic resonance imaging or any other medically recognized brain diagnostic technology indicating intracranial pathology that is a result of the accident, including, but not limited to, intracranial contusions or haemorrhages, diffuse axonal injury, cerebral edema, midline shift or pneumocephaly.

Criteria for Catastrophic Impairment Determination

Therefore, in order for your child child to be deemed to have sustained a traumatic brain injury and granted an automatic catastrophic impairment designation in accordance with subs. 3.1(1)5i of the SABS 34/10, your child would have been 18 years of age or younger at the time of the accident, and as a direct result of the accident, satisfy the following three criteria:

  • In-patient admission to a public hospital in a Guideline;
  • Positive findings of intracranial pathology that is a result of the accident; and
  • The findings of intracranial pathology must be from medically recognized brain diagnostic technology.
Criteria for Catastrophic Impairment Determination

Underlying Rationale for the Three Criteria of subs. 3.1(1)5i

In the aforementioned 2011 Superintendent’s Report on the Definition of Catastrophic Impairment in the Statutory Accident Benefits Schedule, the medical expert panel retained by the Ontario government to make recommendations to the Minister of Finance, offered their underlying rationale for recommending the aforementioned three criteria for the granting of an automatic catastrophic impairment designation to children who suffered a serious brain injury. In regards to the requirement for a child to be admitted as an in-patient to a major trauma centre coupled with positive findings of intracranial pathology, the underlying rationale of the medical expert panel was expressed in the 2011 Superintendent’s Report as follows:

The Panel notes that certain objective markers of serious brain injury due to trauma are correlated to poor outcome. These markers also signal a need for extended rehabilitation resources in order to reduce the eventual impairment. In particular, the Panel finds that positive findings on a brain scan, coupled with admission to a major trauma centre, are good clinical predictors of a prolonged recovery and poor outcome. Similarly, given the careful screening of patients by paediatric rehabilitation centres, the Panel believes that admission to one of these facilities is a sensitive indicator of high risk of poor outcome. I agree with the Expert Panel’s logic on this issue, and recommend that children meeting these criteria be automatically designated as catastrophically impaired in order to ensure early access to necessary rehabilitation.

Therefore, the recommendation correlated with the Ontario government’s intention to rely on more evidence-based medicine and objective, clinical measurement tools to enhance the predictive ability and accuracy of the determinations of catastrophic impairment designations. Even though the criteria, which constitute early objective clinical markers, don’t provide absolute certainty in regards to predicting prolonged recovery and poor outcome, they substantially increase the predictive ability of same. Again, while Dr. Marlon Crouchmen et al. were developing the KOSCHI, they acquired their statistical data regarding the nature of the pathological condition of brain injuries in children at various stages of the recovery, from evaluating approximately 200 head injured children over a period of seven years, and then noted that “More than 90% had severe injury with abnormal intracerebral radiological findings on computed tomography”. Therefore, there is a correlation between severe brain injuries in children and positive findings of intracranial pathology, which justify the reliance on this criterion in subs. 3.1(1)5i as one of the three criteria for providing an automatic catastrophic impairment designation. 

Furthermore, the 2011 Superintendent’s Report echoed another important point from Dr. Marion Crouchman et al. regarding the inability to know early on the full extent of the outcome, and the effects, of a traumatic brain injury in a child, when it noted the following:

The ultimate outcome of brain injuries in children may not become apparent for many years after an accident. The Panel observes that a long period of waiting for a final determination of catastrophic impairment could impose unnecessary stress on parents and families. On the other hand, it notes that an inaccurate determination of catastrophic impairment is not in the best interests of the child or a reasonable burden for the insurer. On balance the Panel concludes that the potential problems arising from an early designation are far outweighed by the benefits to catastrophically impaired children and their families.

Therefore, the risk that an early catastrophic impairment designation may be wrong, is outweighed by the potentially devastating consequences of waiting too long for a catastrophic impairment determination that ultimately denies early access to the highest tier of rehabilitative accident benefits to a vulnerable, severely brain injured child. Again, the gamble is unwarranted when one has statistical data that proves a correlation between severe brain injuries in children and positive finds of intracranial pathology, coupled with the addition of objective clinical markers of prolonged recovery and poor outcome following an admittance as an in-patient into either a major Level 1 or 2 Trauma Centre, or a program of neurological rehabilitation in a pediatric rehabilitation facility. 

Lastly, the 2011 Superintendent’s Report also noted that the long period of waiting for a final catastrophic impairment designation could impose undue stress and hardship on the family, but an early catastrophic impairment designation would have the following positive benefits:

Automatic designation would give claimants immediate access to the appropriate benefits. Furthermore, due to the fact that assessments would no longer be needed, this approach should reduce assessment and other transaction costs to the insurance system. Introduce automatic designation of catastrophic impairment for children (those under age 18) who are suffering from a serious traumatic brain injury and have been admitted to a major trauma centre. Earlier designation would provide the claimant with earlier access to the higher tier of benefits, compared with up to a two year wait, as is commonly the case today. Assessments would not be needed, resulting in lower costs for both the claimant and the insurer.Therefore, since one of the objectives of insurance law is to provide peace of mind to vulnerable insureds, such as children with severe traumatic brain injuries, who have experienced a devastating unforeseen loss, so as to avoid undue stress and hardship, waiting almost 2-years would not only increase that undue stress and hardship of the catastrophically impaired child, but also the child’s parents and immediate family. Furthermore, since the Ontario government also has an interest in maintaining the sustainability of the closed system of its automobile insurance, where drivers are funding the costs of accident benefits, amongst other things, like third-party liability and property damage, an early catastrophic impairment designation rooted in evidence-based medicine that enhances the predictive ability and accuracy, lowers costs because it eliminates the need for a lot of expensive medical expert reports. 

Criteria for Catastrophic Impairment Determination

Therefore, granting an early automatic catastrophic impairment designation to children who meet the aforementioned three criteria of subs. 3.1(1)5i of the SABS 34/10, as amended by Ontario Regulation 251/15, benefits the vulnerable child by ensuring early access to the necessary higher tier of medical rehabilitation and eliminating undue stress on the child’s parents and immediate family. An early automatic catastrophic impairment designation to children also benefits the sustainability of the closed system of Ontario’s automobile insurance and the affordability of insurance premiums by utilizing evidence-based medicine and objective clinical markers to ensure that the higher tier of accident benefits only goes to the most severely injured insureds, and reduce costs by eliminating the need for expensive multidisciplinary expert medico-legal reports.

Conclusion

Therefore, if your child was 18 years of age or younger at the time of the accident, and sustained a traumatic brain injury as a direct result of the accident, where your child:

  • Was admitted as an in-patient to a public hospital in a Guideline;
  • Had positive findings of intracranial pathology; and
  • The findings of intracranial pathology were from medically recognized brain diagnostic technology,

then your child would obtain an automatic catastrophic impairment designation in accordance with subs. 3.1(1)5i of the SABS 34/10, as amended by Ontario Regulation 251/15.

The Meaning of “Guideline”

If you read through the first criterion more closely, then you should identify a single word with such glaring ambiguity that when you try to interpret the first criterion without knowing what it means, it should leave you in a quandary. That word is “Guideline”, as it naturally begs the following question: What Guideline is being referenced, which provides a list of the public hospitals for which in-patient admittance is one criterion for determining whether a child has a traumatic brain injury pursuant to subs. 3.1(1)5i of the SABS 34/10

The 12 Public Hospitals Listed in the Old Superintendent’s Guideline No. 01/16

The Guideline that is being referred to in the aforementioned three criteria of subs. 3.1(1)5i of the SABS 34/10, is the June 2016, Catastrophic Impairment – Public Hospitals Guideline, Superintendent of Financial Services’ Guideline No. 01/16. It was issued pursuant to subs. 268.3(1) and subs. 268.3(1.1) of the Insurance Act. It was incorporated by reference in subparagraph 5i of subs. 3.1(1) of the SABS 34/10, and therefore, it applies to the definition of catastrophic impairment for accidents that occurred on or after June 1, 2016. It has a list of the 12 public hospitals for which in-patient admittance is the first criterion for determining whether an insured child has a traumatic brain injury and a catastrophic impairment.  

The 12 public hospitals in the Province of Ontario listed in the Superintendent’s Guideline No. 01/16 are as follows:

  1. Children’s Hospital of Eastern Ontario (CHEO), 401 Smyth Road, Ottawa, Ontario, K1H 8L1;
  2. Hamilton Health Sciences (Regional Rehabilitation Centre), 300 Wellington Street North, Hamilton, Ontario, L8L 0A4;
  3. Health Sciences North (Sudbury), 41 Ramsey Lake Road, Sudbury, Ontario, P3E 5J1;
  4. Kingston General Hospital, 76 Stuart Street, Kingston, Ontario, K7L 2V7;
  5. London Health Sciences Centre – Victoria Hospital, 800 Commissioners Road East, London, Ontario, N6A 5W9;
  6. McMaster Children’s Hospital, 1200 Main Street West, Hamilton, Ontario, L8N 3Z5;
  7. St. Michael’s Hospital, 30 Bond Street, Toronto, Ontario, M5B 1W8;
  8. Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5;
  9. The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8;
  10. The Ottawa Hospital, 501 Smyth Road, Ottawa, Ontario, K1H 8L6;
  11. Thunder Bay Regional Health Sciences Centre, 984 Oliver Road, Thunder Bay, Ontario, P7B 6V4; and
  12. Windsor Regional Hospital (Ouellette), 1030 Ouellette Avenue, Windsor, Ontario, N9A 1E1.

The aforementioned 12 public hospitals listed in the Superintendent’s Guideline No. 01/16  were essentially taken from the 11 hospitals that the Ministry of Health and Long Term Care designated as Lead Trauma Hospitals (LTHs) in the early 1990s, which are listed as follows:

  1. Windsor Regional Hospital, Windsor, Erie St. Clair (LHIN 1);
  2. London Health Sciences Centre, London, South West (LHIN 2);
  3. Hamilton Health Sciences, Hamilton, Hamilton Niagara Haldimand Brant (LHIN 4);
  4. The Hospital for Sick Children, Toronto, Toronto Central (LHIN 7);
  5. St. Michael’s Hospital, Toronto, Toronto Central (LHIN 7);
  6. Sunnybrook Health Sciences Centre, Toronto, Toronto Central (LHIN 7);
  7. Kingston General Hospital, Kingston, South East (LHIN 10);
  8. Children’s Hospital of Eastern Ontario, Ottawa, Champlain (LHIN 11);
  9. The Ottawa Hospital, Ottawa, Champlain (LHIN 11);
  10. Health Sciences North, Sudbury, North East (LHIN 13); and
  11. Thunder Bay Regional Health Sciences Centre, Thunder Bay, North West (LHIN 14). 

If you compare the list of 12 public hospitals in the Superintendent’s Guideline No. 01/16 to the 11 hospitals that the Ministry of Health and Long Term Care designated as LTHs, the only difference is that in the former, the Hamilton Health Sciences, which is a hospital network comprised of a cancer centre and seven hospitals including the Hamilton General Hospital (Level 1 Trauma Centre), was removed and replaced with two specific hospitals within the network; namely, the Regional Rehabilitation Centre and McMaster Children’s Hospital. Therefore, right off the bat, the Superintendent’s Guideline No. 01/16  list of LTHs in Hamilton, was contrary to the Ministry of Health and Long Term Care’s designation of the Hamilton Health Sciences, in its entirety, as a LTH.

First Major Criticism of the Old Superintendent’s Guideline No. 01/16

However, the first major criticism of the old Superintendent’s Guideline No. 01/16’s list is that there are no public hospitals in rural areas, such as southwestern Ontario and near First Nation reserves, as well as no public hospitals in rural areas that are Level 2 Trauma Centres, which like Level 1 Trauma Centres, provide major trauma care for the most severe injuries. An interpretation of subs. 3.1(1)5i, to mean that a catastrophic impairment designation cannot be given, if an otherwise seriously injured child with a traumatic brain injury, was admitted to certain Level 1 Trauma Centres and paediatric rehabilitation facilities that are located far away from rural areas, is unfair because it is discriminatory towards children, who live in rural communities.

So, for example, If your child and another child suffer a traumatic brain injury from MVAs, in Six Nations of the Grand River and Toronto, they meet the second and third criteria of subs. 3.1(1)5i, but your child is admitted as an in-patient to the Brantford General Hospital (BGH) and then the Hamilton General Hospital (HGH), which is a Level 1 Trauma Centre, and the second child is admitted as an in-patient to one of the three Toronto public hospitals on the list, your child will be denied a catastrophic impairment designation while the second child would be granted it. This creates a problem with outcomes in the catastrophic impairment designation process, which are inconsistent in a manner that is contrary to the intention of the Ontario legislature to use “new measurement tools to improve the accuracy, relevance, clarity, validity, reliability and predictive ability of catastrophic impairment determinations”. This also raises the issue of discrimination based on geography.

Second Major Criticism of the Old Superintendent’s Guideline No. 01/16

The second major criticism is that if the admission of your child as an in-patient to one of the 12 public hospitals on the list, coupled with positive findings of intracranial pathology, are sensitive, objective clinical indicators of prolonged recovery and poor outcome, which was the underlying rationale for the Superintendent of Financial Services recommending to the Minister of Finance the three criteria that now constitute subs. 3.1(1)5i, then the Superintendent’s Guideline No. 01/16 fails to explain why some Level 1 Trauma Centres are on the list and others are excluded. The HGH is a Level 1 Trauma Centre, but it is not on the list. The HGH’s equivalent in London is the London Health Sciences Centre (LHSC), which is also a Level 1 Trauma Centre and is on the list. 

So, for example, if your child and another child suffer a traumatic brain injury from MVAs, but your child is admitted as an in-patient to the HGH in Hamilton with the same positive findings of intracranial pathology as the other child who is admitted as an in-patient to the LHSC in London, then the other child would be granted a catastrophic impairment designation, but your child would not. Again, this creates a problem with outcomes in the catastrophic impairment designation process that are inconsistent in a manner that is contrary to the intention of the Ontario legislature as expressed in the Superintendent of Financial Services’ 2011 Report to the Minister of Finance, and it raises the issue of discrimination based on geography. Your child’s catastrophic determination designation should be determined by using the new, objective measurement tools that the Superintendent of Financial Services recommended to the Minister of Finance in its 2011 Report, in order to ensure that the outcome of the designation process has a medical-evidentiary basis and is fair, accurate, consistent and predictable, and not based on the location of the MVA and its close proximity to the 12 public hospitals on the list.

Third Major Criticism of the Old Superintendent’s Guideline No. 01/16

The third major criticism is that if one limits the focus of the first criterion of subs. 3.1(1)5i to a black and white analysis of whether a child is admitted as an in-patient to a public hospital on the list or not, then you ignore other legitimate reasons why children with traumatic brain injuries may have been admitted as in-patients to public hospitals not on the list. You ignore legitimate reasons such as a backlog, limited beds, poor operational and financial performances, or a child dealing with other serious injuries in addition to a traumatic brain injury.

So for example, if your child sustained a traumatic brain injury in addition to multiple fractures in her cervical, thoracic and lumbar spines, right elbow and right hand, but the MVA happened on the Six Nations of the Grand River, which is within close proximity to Brantford, the Six Nations Paramedic Services will bring your child to the BGH, where your child would be admitted as an in-patient. Since your child’s multiple fractures will require immediate orthopedic surgery, it may take priority over the findings of intracranial pathology, and if it does, then it will trigger in-patient protocols within the Hamilton Health Sciences. If your child was admitted as an in-patient to the HGH, then your child would be transferred to the 6 South Surgical Trauma Centre, so orthopedic surgeons could perform immediate surgery on your child’s spine, elbow and hand. Even though your child sustained a traumatic brain injury, your child may not be admitted as an in-patient to the Regional Rehabilitation Centre (RRC), which is on the list of 12 public hospitals, if your child’s spinal surgery is deemed to be a priority. Therefore, even though your child satisfied the second and third criteria of subs. 3.1(1)5i, and was admitted as an in-patient to a Level 1 Trauma Centre, your child could still be denied a catastrophic impairment designation because the Level 1 Trauma Centre that your child was admitted to as an in-patient is not on the list. 

 

Criteria for Catastrophic Impairment Determination

If your child sustained a traumatic brain injury and was admitted as an in-patient to a Level 1 Trauma Centre such as the HGH, your child should not be denied a catastrophic impairment designation because your child had different serious injuries of varying degrees of severity and priorities, which triggered different in-patient admittance protocols within the same hospital network, such as the Hamilton Health Sciences. Doctors and their support staff within hospital networks such as the Hamilton Health Sciences are unaware that their medically sound decision to transfer your child to the HGH to be operated on by orthopedic surgeons as opposed to the RRC for your child’s traumatic brain injury, can potentially jeopardize your child’s insurance claim, in general, and your child’s catastrophic impairment designation, in particular. Again, all of this creates a problem with outcomes in the catastrophic impairment designation process that are inconsistent in a manner that is contrary to the intention of the Ontario legislature as expressed in the Superintendent of Financial Services’ 2011 Report to the Minister of Finance

Furthermore, there are other key factors that exist outside of your child’s control that influence where your child is ultimately admitted as an in-patient within a hospital network. For example, hospitals such as the BGH, which operate in more rural areas, experience all kinds of struggles that negatively impact the operational performance, which in turn interfere with the in-patient admission process. The Investigation Report on the Brant Community Healthcare System, dated June 28, 2017, which was submitted to Dr. Erick Hoskins, the former minister of Health and Long-Term Care, provided statistical data that showed how their health care system has been “struggling in recent years with performance issues, significant financial difficulties, and declining staff and physician morale”. These kinds of struggles ultimately impact the admittance process in hospitals, because they adversely impact both the decision-making process and the execution of decisions made.

In light of the aforementioned criticisms, I knew I had to change the old Superintendent Guideline 01/16.

If you want to learn more about the discriminatory ramifications based on geography, which stem from the Superintendent Guideline 01/16’s interpretation of of subs. 3.1(1)5i, then buy my book entitled Catastrophic Impairment Law in Canada.

The new “Guideline on Public Hospitals and Determination of Catastrophic Impairment”, effective October 17th, 2020.

So, in 2019, after I finally obtained a catastrophic impairment (CAT) designation for my indigenous client, after persuading the insurer to overturn their initial denial of her CAT designation, which increased her policy limits from $65,000 to $1 million; that wasn’t enough for me. It wasn’t enough because I knew other children living in remote and rural areas and sustained severe traumatic brain injuries from MVAs would be negatively impacted by the section, so I vowed to change the Guideline, and in effect, change the law for the entire province of Ontario.

I reached out to the Financial Services Regulatory Authority of Ontario (FSRAO), which is the governing body that replaced the Financial Services Commission of Ontario (FSCO). FSRAO administers, regulates, and enforces the Insurance Act, along with all of its regulations, amongst other Ontario legislation. I proposed all of my recommended changes to the Guideline to properly address the discriminatory ramifications, and ultimately persuaded them to amend the Old Superintendent Guideline 01/16, which will impact the entire province of Ontario. 

The new “Guideline on Public Hospitals and Determination of Catastrophic Impairment’‘ took effect on October 17, 2020. It interprets clause 5(i) of s.3.1(1) of the SABS 34/10, as it applies to “a public hospital named in a Guideline” issued by FSRAO under s. 268.3 (1) of the

Insurance Act. It deems any public hospital designated by the Critical Care Services Ontario (CCSO), in partnership with the Ontario Ministry of Health (MoH), as Lead Trauma Hospitals (LTHs).

However, even though I think the amendment is a great start, I don’t believe it went far enough to remedy the discriminatory issue, because I believe that all Level 2 Trauma Centres – further to the designation by the Trauma Association of Canada – should be included in the new Guideline as well, because they can deal with severe trauma patients too and are closer to the Level 3 Trauma Centres that are located in the rural and remote areas of Ontario.

If you want to learn more about my detailed amendment proposal, as well as more about the discriminatory issue, then read my book entitled “Catastrophic Impairment Law in Canada”, which was published by LexisNexis Inc., where I pointed out this discriminatory issue in much greater detail, both on a provincial and national level — https://store.lexisnexis.ca/en/categories/shop-by-jurisdiction/federal-13/catastrophic-impairment-law-in-canada-skusku-cad-6790/details.  

Admittance to a Program of Neurological Rehabilitation in a Paediatric Rehabilitation Facility: Subs. 3.1(1)5ii

Subsection 3.1(1)5ii of the SABS 34/10, as amended by O. Reg. 251/15, reads as follows: 

5. If the insured person was under 18 years of age at the time of the accident, a traumatic brain injury that meets one of the following criteria:

ii. The insured person is accepted for admission, on an in-patient basis, to a program of neurological rehabilitation in a paediatric rehabilitation facility that is a member of the Ontario Association of Children’s Rehabilitation Services.

Criteria for Catastrophic Impairment Determination

Therefore, in order for your child to be deemed catastrophically impaired pursuant to subs. 3.1(1)5ii, your child has to be 18 years of age or younger at the time of the accident:

  • sustain a traumatic brain injury as a direct result of the accident; and
  •  admitted as an in-patient to a program of neurological rehabilitation in a paediatric rehabilitation facility that is a member of the Ontario Association of Children’s Rehabilitation Services.
Criteria for Catastrophic Impairment Determination

Member of the Ontario Association of Children’s Rehabilitation Services

Since one of the criteria for a catastrophic impairment designation under subs. 3.1(1)5ii, is the requirement that the child, who sustained a traumatic brain injury, is admitted as an in-patient to a program of neurological rehabilitation in a paediatric rehabilitation facility that is a member of the Ontario Association of Children’s Rehabilitation Services (OACRS), it is necessary to have a better understanding of the OACRS.

The OACRS, which is now called Empowered Kids Ontario-Enfants Avenir Ontario (EKO- EAO), is governed by a Board of Directors composed of volunteers, and is a non-profit organization that represents Ontario’s publicly-funded child development and rehabilitation sector. The mission statement of the EKO-EAO is to “promote evidence-based investments, policies and programs enabling smart, innovative approaches and service delivery so kids with special needs and their families live their best lives”. The EKO-EAO represents 29-member organizations, which “provide treatment and support to children, youth and families in every region of Ontario”, and are listed as follows:

  1. Resources for Exceptional Children and Youth – Durham Region (Ajax)
  2. Quinte Children’s Treatment Centre (Belleville);
  3. Landsdowne Children’s Centre (Brantford);
  4. Children’s Treatment Centre of Chatham-Kent (Chatham);
  5. Erinoa Kids Centre for Treatment and Development (Halton-Peel-Dufferin);
  6. McMaster Children’s Hospital: Ron Joyce Children’s Health Centre (Hamilton);
  7. Firefly (Kenora);
  8. Kids Inclusive Centre for Child & Youth Development (Kingston);
  9. Thames Valley Children’s Centre (London);
  10. One Kids Place Children’s Treatment Centre (North Bay);
  11. Grandview Kids (Oshawa);
  12. Children’s Hospital of Eastern Ontario (CHEO) (Ottawa);
  13. Five Counties Children’s Centre (Peterborough);
  14. Centre for Behaviour Health Sciences for Children and Families (Mackenzie Health) (Richmond Hill and Barrie)
  15. Niagara Children’s Centre (St. Catharines);
  16. Pathways Health Centre for Children (Sarnia); 
  17. THRIVE Child Development Centre (Sault Ste. Marie);
  18. Children’s Treatment Network (Simcoe York);
  19. Sioux Lookout First Nations Health Authority (SLFNHA) (Sioux Lookout);
  20. Child & Community Resources  / Ressources pur L’Enfance et la Communauté (CCR/REC) (Sudbury)
  21. Enfants NEO Kids: Children’s Treatment Centre / Centre de traitement pour enfants (Sudbury);
  22. George Jeffrey Children’s Centre (Thunder Bay);
  23. Cochrane Temiskaming Children’s Treatment Centre (Timmins);
  24. Holland Bloorview Kids Rehabilitation Hospital (Toronto);
  25. Lumenus Community Services (Toronto);
  26. Surrey Place (Toronto);
  27. KidsAbility Centre for Child Development (Waterloo);
  28. John McGivney Children’s Centre (Windsor); and
  29. Lake Ridge Community Support Services (Whitby). 

In regards to the particular child development and rehabilitation services that the aforementioned 29-member organizations provide children, the EKO-EAO noted the following:

  • Physical Therapy;
  • Speech and Language Therapy;
  • Psychology;
  • Infant and child development;
  • Audiology;
  • Respite support;
  • Family education;
  • Service coordination;
  • Community Pediatrics;
  • Developmental Pediatrics;
  • Seating and Mobility services;
  • Special services at home;
  • Occupational Therapy;
  • Social Work;
  • Therapeutic Recreation;
  • Cleft lip and palate clinic;
  • Adaptive equipment;
  • Behavioural Therapy;
  • Consultation and Assessment;
  • Infant Hearing Program;
  • Transition from pediatric to adult care;
  • Blind and Low Vision clinic;
  • Orthotics and Prosthetics service; and
  • Adaptive Augmentative Communication.

The EKO-EAO also noted that the 29-member organizations also provide “access to mental health services for children and youth and to other clinical support programs including gastroenterology, dentistry, neurology, genetics, pharmacology and ophthalmology”

Therefore, further to the criteria set out in subs. 3.1(1)5ii, all of the 29 paediatric rehabilitation facilities, which are members of the EKO-EAO, satisfy the criterion pertaining to providing access to a program of neurological rehabilitation.

Lastly, the EKO-EAO, noted that all of the aforementioned 29 paediatric rehabilitation facilities that they represent “are accredited, publicly-funded organizations that provide services in the ecosystem of child development and rehabilitation supports for kids with special needs and their families” and “are staffed by experienced and licensed professionals”. In order for an organization to become accredited and be funded by the Ontario government, it must meet the best practices in the procurement of their goods and services in accordance with procurement guidelines summarized in The Procurement Guideline for Publicly Funded Organizations in Ontario. Furthermore, publicly funded organizations, such as the 29 paediatric rehabilitation facilities of the EKO-EAO, as well as children aid societies, community care access corporations, hospitals, school boards, colleges, and universities, which receive over $10 million in funding from the Ontario government, also have to implement the Broader Public Sector (BPS) Procurement Directive, pursuant to section 12 of the Broader Public Sector Accountability Act. The BPS Procurement Directive was issued by the Management Board of Cabinet, became effective on July 1, 2011, and is “based on the five key principles that allow Organizations to achieve value for money while following a procurement process that is fair and transparent to all stakeholders”, which include accountability, transparency, value for money, quality service delivery, and process standardization. One of the primary goals of the Minister of Finance is to ensure that publicly funded organizations, such as the 29-member organizations of the EKO-EAO, achieve the maximum value for money when providing a range of child development and rehabilitation services to the public, while using public funds.

Criteria for Catastrophic Impairment Determination

The admission of your child as an in-patient to a program of neurological rehabilitation in a paediatric rehabilitation facility, such as the 29-member organizations of the EKO-EAO, constitutes an objective marker of a serious traumatic brain injury that correlates with a prolonged recovery and poor prognosis. Further to the 2011 Superintendent’s Report, one of the recommendations to the Minister of Finance was as follows:

…certain objective markers of serious brain injury due to trauma are correlated to poor outcome. These markers also signal a need for extended rehabilitation resources in order to reduce the eventual impairment. …given the careful screening of patients by paediatric rehabilitation centres, the Panel believes that admission to one of these facilities is a sensitive indicator of high risk of poor outcome. I agree with the Expert Panel’s logic on this issue, and recommend that children meeting these criteria be automatically designated as catastrophically impaired in order to ensure early access to necessary rehabilitation. 

In other words, if your child, who sustained a head injury, made it through the admission protocols and screening of patients by a paediatric rehabilitation centre that has limited beds, and was admitted as an in-patient into its program of neurological rehabilitation, then that would constitute a reliable, objective indicator. It would constitute an objective marker of a traumatic brain injury that’s severe, and has a high degree of probability that the recovery would be prolonged coupled with a poor outcome for the future.

Conclusion

Therefore, further to subs. 3.1(1)5ii, if your child was 18 years of age or younger at the time of the accident: 

  • sustained a traumatic brain injury as a direct result of the MVA, which resulted in your child being;
  • admitted as an in-patient to a program of neurological rehabilitation in a paediatric rehabilitation facility that is a member of the Ontario Association of Children’s Rehabilitation Services,

then your child would obtain a catastrophic impairment designation in accordance with subs. 3.1(1)5ii of the SABS 34/10, as amended by O. Reg. 251/15.

A Shortcoming of subs. 3.1(1)5ii of the SABS 34/10

One of the recommendations to the Minister of Finance in the 2011 Superintendent’s Report, in regards to the criteria to be met in order for a child to obtain an automatic catastrophic impairment designation, was as follows: “In-patient admission to a publically [sic] funded rehabilitation facility (i.e. an Ontario Association of Children Rehabilitation Facility or equivalent) for a program of brain injury rehabilitation or Ontario Association of Children Rehab Facilities”. If your child is admitted as an in-patient to a facility that is not one of the 29-member organizations of the EKO-EAO, but rather to a facility that is the equivalent, due to his or her residing in a remote, rural area in Ontario, then further to the specific criteria of subs. 3.1(1)5ii, the child would not obtain a catastrophic impairment designation. Therefore, expanding subs. 3.1(1)5ii to also include “equivalent” would capture facilities that are the equivalent of the 29-member organizations of the EKO-EAO.

The King’s Outcome Scale for Childhood Head Injury: Subsections 3.1(5)iii, iv, and v

Subsection 3.1(1)5iii of the SABS 34/10

Subsection 3.1(1)5iii of the SABS 34/10, as amended by Ontario Regulation 251/15, reads as follows: 

5. If the insured person was under 18 years of age at the time of the accident, a traumatic brain injury that meets one of the following criteria:

iii. One month or more after the accident, the insured person’s level of neurological function does not exceed category 2 (Vegetative) on the King’s Outcome Scale for Childhood Head Injury as published in Crouchman, M. et al, A practical outcome scale for paediatric head injury, Archives of Disease in Childhood, 2001: 84: 120-124. 

Criteria for Catastrophic Impairment Determination

Criteria for Catastrophic Impairment Determination

Therefore, in order for your child to be deemed catastrophically impaired as a result of a traumatic brain injury pursuant to subs. 3.1(1)5iii, your child has to be 18 years of age or younger at the time of the accident: 

  • sustain a traumatic brain injury as a direct result of an accident; and 
  • at least one month or more after the MVA, the recovery after the head injury must result in the insured’s level of neurological function:
  • satisfying the grade 2 KOSCHI category definition, and thereby falling into the vegetative outcome category, in accordance with the KOSCHI scale in Marion Crouchman et al., “A practical outcome scale for paediatric head injury,” (2001) 84 Archives of Disease in Childhood 120-124.

Subsection 3.1(1)5iv of the SABS 34/10

Subsection 3.1(1)5iv of the SABS 34/10, as amended by Ontario Regulation 251/15 reads as follows:

5. If the insured person was under 18 years of age at the time of the accident, a traumatic brain injury that meets one of the following criteria:

iv. Six months or more after the accident, the insured person’s level of neurological function does not exceed category 3 (Severe disability) on the King’s Outcome Scale for Childhood Head Injury as published in Crouchman, M. et al, A practical outcome scale for paediatric head injury, Archives of Disease in Childhood, 2001: 84: 120-124.

Criteria for Catastrophic Impairment Determination

Therefore, in order for your child to be deemed to have sustained a catastrophic impairment as a result of a traumatic brain injury pursuant to subs. 3.1(1)5iv, your child has to be 18 years of age or younger at the time of the accident: 

  • sustain a traumatic brain injury as a direct result of the MVA; and 
  • at least six months or more after the MVA, the recovery after the head injury must result in the insured’s level of neurological function:
    • satisfying the grade 3(a) or 3(b) KOSCHI category definitions, and thereby, falling into the disability outcome category, in accordance with the KOSCHI scale published in Marion Crouchman et al., “A practical outcome scale for paediatric head injury,” (2001) 84 Archives of Disease in Childhood 120-124.

Subsection 3.1(1)5v of the SABS 34/10

Subsection 3.1(1)5v of the SABS 34/10, as amended by Ontario Regulation 251/15, reads as follows:

5. If the insured person was under 18 years of age at the time of the accident, a traumatic brain injury that meets one of the following criteria:

v. Nine months or more after the accident, the insured person’s level of function remains seriously impaired such that the insured person is not age-appropriately independent and requires in-person supervision or assistance for physical, cognitive or behavioural impairments for the majority of the insured person’s waking day.

The King’s Outcome Scale for Childhood Head Injury

As was previously stated in my blog entitled “Adult Brain Injuries Extended Glasgow Outcome Scale”, Wilson et al. noted the following about the reliability of the application of the Glasgow Outcome Scale (GOS) and the Extended Glasgow Outcome Scale (GOSE) to children:

…the reliability of the GOS applied to children is unknown; in the case of very young children, the GOS criteria appear to be largely inapplicable. The current approach is designed for use with people aged 16 years and upwards.

Therefore, the GOS and GOSE are not reliable in its application to young children as an outcome measure after a traumatic brain injury, as the criteria is problematic when applied to children due to “the difficulty in developing simple yet meaningful descriptors of outcome” and “describing outcome at the “higher” levels of functional independence or participation in society”

Criteria for Catastrophic Impairment Determination

Of note, irrespective of Wilson et al.’s recommendation that the GOS and GOSE were designed for people aged 16 years and older, the Ontario government still increased the age for paediatric claimants from under 16 to under 18 years of age, and required the use of the KOSCHI scale to determine peadiatric claimants’ level of neurological function for the purpose of a catastrophic impairment designation. The reason for the Ontario government’s decision to increase the age for paediatric claimants, can be found in the 2011 Superintendent’s Report, which explained it was because “of the long-term developmental implications of traumatic brain injuries”, which will be explored in more detail later in this blog. However, first, a brief discussion of the meaning of ‘outcome’ will commence.

In my blog entitled “Adult Brain Injuries Extended Glasgow Outcome Scale” – excluding the category of ‘dead’ – the four primary outcome categories of surviving adult patients with traumatic brain injuries were covered, which were death, vegetative state, severe disability, moderate disability, and good recovery. If you include ‘dead’, then there are five outcome categories in the GOS. The definition of ‘outcome’ was also covered, which is the overall social outcome, and is inclusive of the total effect of all the individual’s psychological, mental and neurological disabilities of function

The thing that adds to the difficulty of a lack of simple descriptors of outcome in a practical outcome scale that can be applied for paediatric traumatic brain injuries, is the inability to know early on the full extent of the outcome, and the effects, of a traumatic brain injury in your child. The brain of a child, who has acquired a neurological or cognitive disability as a result of a traumatic brain injury, is still developing, and will continue to develop into his or her early twenties, so any practical outcome scale for children must necessarily be inclusive of “the special developmental considerations in the assessment of outcome of traumatic brain injury (TBI) in children”. Also, the cognitive deficits of a child who sustained a traumatic brain injury, which typically manifest in the form of learning and behavioral difficulties, will become more apparent as the complexities of societal demands increase as the child matures over many years. Again, this is the primary underlying rationale behind why the Ontario government increased the age for paediatric claimants from under 16 years of age to 18 years of age or younger, in subs. 3.1(1)5 of the SABS 34/10, as amended by Ontario Regulation 251/15.

Therefore, in order to overcome the two aforementioned obstacles, in particular the major one pertaining to the lack of simple descriptors of outcome, Dr. Marion Crouchman et al. developed the King’s Outcome Scale for Childhood Head Injury (KOSCHI), as a:

…specific paediatric adaptation of the original adult Glasgow Outcome Scale (GOS). The KOSCHI expands the five category GOS to provide increased sensitivity at the milder end of the disability range. The GOS category of “persistent vegetative state” was replaced by “vegetative”. “Good recovery” was allocated two categories, in acknowledgement of the long term importance of relatively minor sequelae in a developing child. … The KOSCHI provides a practical scale for paediatric head injury which will enable clinicians to describe the rate and extent of recovery, and evaluate the effects of service and research interventions. … We set out to produce a modification of the GOS which would provide a robust, simple scale for short, medium, and long term paediatric head injury outcome. Our requirements included compatibility with the GOS to allow comparison with adults, and facilitate the transition of follow up into adulthood; applicability at all ages; and simplicity of use. 

Therefore, since the KOSCHI scale provides a simple description of outcome for children who sustained a traumatic brain injury in the short, medium, and long term, coupled with a measure of children’s level of functioning at a specific time, plus it gives special consideration to the aforementioned developmental concerns pertaining to the ongoing development of a child’s brain, it is a more robust, simple scale for determining a paediatric head injury outcome.

Dr. Crouchman et al. refined the KOSCHI scale by obtaining statistical data pertaining to a pathological condition resulting from a traumatic brain injury in the short, medium, and long term, from observing:

…inpatient management and outpatient follow up of approximately 200 head injured children admitted to the paediatric wards of King’s College Hospital and the paediatric neurosurgical unit over the period 1990-1997. More than 90% had severe injury with abnormal intracerebral radiological findings on computed tomography. … An hour long semistructured interview was held with the parents of six of the more severely injured children (aged 6-14 years) being followed three to five years after TBI to assess the extent and nature of problems encountered in the longer term. On the basis of this experience we modified the five categories of the GOS to produce the King’s Outcome Scale for Childhood Head Injury (KOSCHI). 

Of note, is the statistic regarding the correlation between severe injury and abnormal intracerebral radiological findings on computed tomography, because one of the three criteria of the new automatic catastrophic impairment designation for children, which was discussed earlier in my detailed review of subs. 3.1(1)5i of the SABS 34/10, is positive findings of intracranial pathology on medically recognized brain diagnostic technology.

Dr. Crouchman et al. describes the KOSCHI scale as follows:  

…a short hand description of the child’s level of functioning at a point in time. As such it provides a useful clinical tool for documenting recovery in the individual child, as well as for monitoring the burden of disability caused by TBI, for service planning, and for evaluating rehabilitation programmes and the effects of service and research intervention. 

The usefulness of the KOSCHI scale as a clinical tool for documenting recovery in paediatric claimants, as well as for monitoring the burden of disability caused by TBI, for evaluating programs of neurological rehabilitation, such as the ones provided by the 29 paediatric rehabilitation centres represented by EKO-EAO, is one of the primary reasons why the Ontario government incorporated it into subs. 3.1(1)5iii and subs. 3.1(1)5iv, in particular, as one of the new measurement tools to enhance the accuracy, clarity, predictive ability, relevance, and reliability of catastrophic impairment designations.

Criteria for Catastrophic Impairment Determination

So, for example, if as a direct result of your child’s TBI, your child tragically died, and your child’s death was “directly attributable to the head injury and includes brain stem death”, then your child’s level of neurological function would satisfy the grade 1 KOSCHI category definition, and thereby, fall into the death outcome category. If as a direct result of your child’s TBI, your child was “breathing spontaneously”,  had “sleep/wake cycles”,  “non-purposeful or reflex movements of limbs or eyes”,  but there was “no evidence of ability to communicate verbally or nonverbally or to respond to commands”, then her level of neurological function would satisfy the grade 2 KOSCHI category definition, and thereby, fall into the vegetative outcome category. If as a direct result of your child’s TBI, your child was “at least intermittently able to move part of the body/eyes to command or make purposeful spontaneous movements” and was “fully conscious and able to communicate but not yet able to carry out any self-care activities such as feeding”, then your child’s level of neurological function would satisfy the grade 3(a) KOSCHI category definition, and thereby, fall into the lower level of the severe disability outcome category. It’s important to note that subs. 3.1(1)5iv of the SABS 34/10 doesn’t specify a requirement for either the 3(a) or 3(b) grade. If as a direct result of your child’s TBI, your child had “a continuing high level of dependency” but could “assist in daily activities”,  and was “fully conscious” but still had “a degree of post-traumatic amnesia”, then your child’s level of neurological function would satisfy the grade 3(b) KOSCHI category definition, and thereby, fall into the upper level of the severe disability outcome category. Again, it’s important to note that subs. 3.1(1)5iv of the SABS 34/10 doesn’t specify a requirement for a 3(b) or 3(a) grade. If as a direct result of your child’s TBI, you child was “mostly independent but needs a degree of supervision/actual help for physical or behavioural problems”,  and had other particular “overt problems” described and outlined in the KOSCHI definition, then your child’s level of neurological function would satisfy the grade 4(a) KOSCHI category definition, and thereby, fall into the lower level of the moderate disability outcome category. If as a direct result of your child’s TBI, your child was “age appropriately independent” but had “residual problems with learning/behaviour or neurological sequelae affecting function”, your child “probably should have special needs assistance” but your child’s “special needs may not have been recognised/met”,  and your child presented with “symptoms of post-traumatic stress”, then your child’s level of neurological function would satisfy the grade 4(b) KOSCHI category definition, and thereby, fall into the upper level of the moderate disability outcome category. If after your child sustained a TBI, your child’s head injury eventually “resulted in a new condition which does not interfere with” your child’s “wellbeing and/or functioning”, then your child’s level of neurological function would satisfy the grade 5(a) KOSCHI category definition, and thereby, fall into the lower level of the good recovery outcome category. If after your child sustained a TBI, and a neurological evaluation coupled with the information from both medical and non-medical resources, provides evidence that supports your child “has made a complete recovery with no detectable sequelae from the head injury”, then your child’s level of neurological function would satisfy the grade 5(b) KOSCHI category definition, and thereby, fall into the upper level of the good recovery outcome category.

Therefore, as we can see from analyzing the KOSCHI scale, three of the five KOSCHI outcome categories (severe disability, moderate disability, and good recovery) have each been divided into two subcategories, or lower and upper levels, which like the GOSE, allow for a “more sensitive measure of recovery in patients who regain consciousness”, which means in essence, “it is reasonable to treat KOSCHI categories (1 to 5b) as an eight point interval scale, should this be required”

Dr. Crouchman et al. comments on the unidimensional nature of the KOSCHI scale, where over time a child could slip in and out, or up or down from one grade to the next, as either serious cognitive deficits are revealed as the child’s mind develops and the societal demands increase as the child matures, or the child seemingly recovers in the short-term, as follows:

Injuries to the frontal lobes of the brain are common after TBI, although they may not manifest until puberty. There is increasing awareness of the long term hidden effects of this type of damage to immature brains. For example, a child who has been allowed to return to mainstream school and apparently “fully recovered” (category 5a and 5b) may start to fail as educational expectations and demands increase, the impact of the injury of learning becomes apparent, and he slips back into category 4b. The development may contribute to this decline in school achievement.

This is why it is essential to use the KOSCHI scale on a child who sustained a TBI at different stages of his or her life, as the brain continues to develop, and the child faces new societal demands that manifest cognitive deficits.

As Dr. Crouchman et al. commented on the possible challenge to the unidimensional KOSCHI scale, in terms of its ability to measure the recovery of a surviving paediatric patient following a head injury, we get a deeper understanding of the categories, as he points out key differences between the grades, or outcome categories, as follows:

The difference between KOSCHI grades 1 (dead) and 2 (vegetative) is one of physiological function; between 2 and 3a, a matter of awareness of and response to external stimuli; and between grades 3b to 5a essentially degree of functional independence.

As Dr. Crouchman et al. discussed a test they used to establish that the KOSCHI scale had construct validity, they identified the underlying factors that determine KOSCHI scale assignments in terms of the level of recovery of a surviving paediatric patient following a TBI, which were as follows: (1) Mobility, in terms of whether the child is normal, impaired, or fully dependent; (2) Communication, in terms of whether the child is normal or is impaired or has very limited communication; (3) Mood, behaviour, and personality, in terms of whether the child is normal or has problems arising; (4) Disinhibition, in terms of whether the child is absent or present; (5) Danger awareness, in terms of whether the child is aware or unaware; (6) Self-care, in terms of whether the child has age appropriate independence, needs assistance, task medication, or prompts, or is fully dependent; and (7) Cognition, memory, and concentration, in terms of whether the child is normal, has minor problems, or has marked problems

It’s these seven factors that the KOSCHI scale emphasizes as it is being used to measure the level of functioning of a child who sustained a TBI.

Criteria for Catastrophic Impairment Determination

Conclusion

Subsection 3.1(1)5iii of the SABS 34/10

Therefore, further to subs. 3.1(1)5iii, if your child was 18 years of age or younger at the time of the accident: 

  • sustained a traumatic brain injury as a direct result of the MVA; and
  •  at least one month or more after the MVA, the recovery after your child’s head injury resulted in your child’s level of neurological function:
  • satisfying the grade 2 KOSCHI category definition, and thereby falling into the vegetative outcome category, in accordance with the KOSCHI scale in Marion Crouchman et al., “A practical outcome scale for paediatric head injury,” (2001) 84 Archives of Disease in Childhood 120-124,

then your child would obtain a catastrophic impairment designation in accordance with subs. 3.1(1)5iii of the SABS 34/10, as amended by O. Reg. 251/15

Subsection 3.1(1)5iv of the SABS 34/10

Further to subs. 3.1(1)5iv, if your child was 18 years of age or younger at the time of the accident: 

  • sustained a traumatic brain injury as a direct result of the MVA; and
  •  at least six months or more after the MVA, the recovery after your child’s head injury resulted in your child’s level of neurological function:
  • satisfying the grade 3(a) or 3(b) KOSCHI category definitions, and thereby falling into the severe disability outcome category, in accordance with the KOSCHI scale in Marion Crouchman et al., “A practical outcome scale for paediatric head injury,” (2001) 84 Archives of Disease in Childhood 120-124,

then your child would obtain a catastrophic impairment designation in accordance with subs. 3.1(1)5iv of the SABS 34/10, as amended by O. Reg. 251/15

Subs. 3.1(1)5v of the SABS 34/10

Further to subs. 3.1(1)5v, if your child was 18 years of age or younger at the time of the accident: 

  • sustained a traumatic brain injury as a direct result of the MVA; and
    • remaining seriously impaired such that your child is not age-appropriately independent and requires in-person supervision or assistance for physical, cognitive or behavioural impairments for the majority of her waking day,at least nine months or more after the MVA, the recovery after your child’s head injury resulted in your child’s level of neurological function:

then your child would obtain a catastrophic impairment designation in accordance with subs. 3.1(1)5v of the SABS 34/10, as amended by Ontario Regulation 251/15

If we had to grade the level of neurological function described in subs. 3.1(1)5v, in terms of where on the spectrum KOSCHI scale it falls on from 1 to 5(b), based on the relative closeness of the description of the outcome in subs. 3.1(1)5v to the eight different KOSCHI category definitions, then it would fall somewhere between the lower moderate disability outcome category (grade 4) and the upper severe disability outcome category (grade 3(b)).

Request to Conduct a Study on KOSCHI’s Reliability for Assessing Paediatric Head Injuries

Lastly, it is important to note that due to the aforementioned possible challenges mentioned by Dr. Crouchman et al. to the construct validity of the KOSCHI scale, one of the recommendations in the 2011 Superintendent’s Report to the Minister of Finance was “that the Holland Bloorview Kids Rehabilitation Hospital be requested to conduct a study on KOSCHI’s reliability for assessing paediatric head injuries”.

Additional Resources

Provincial

Ontario Brain Injury Association

The Ontario Brain Injury Association (OBIA) is a “provincial head injury association because health care, housing and service provision issues related to brain injury were largely provincial matters”. They offer a wide array of useful resources, which range from concussion resources for both adults and resources, statistical information on acquired brain injuries (ABI), caregiving after a brain injury, and the learning needs of children with disabilities during COVID-19, to educating educators about ABI, OBIA webinars/seminars, a bookstore, a directory of ABI services and finding a qualified trauma lawyer such as myself. Please visit their website for more information at the following URL address:

https://obia.ca/ 

Empowered Kids Ontario – Enfants Avenir Ontario (EKO-EAO)

formerly known as Ontario Association of Children’s Rehabilitation Services (OACRS)

Empowered Kids Ontario (EKO) “represents Ontario’s publicly funded child development and rehabilitation sector – the centres that help kids with disabilities and their families live their best lives”. Further to their website, their “member organizations provide leading clinical treatment and support programs to children, youth and families in every region of the province”. They “promote investments, policies and programs based on the best research and thought leadership available, from sources all over the world”. They “look for smart, innovative approaches to care at home, in schools and in communities across Ontario”. Their “members are publicly funded organizations providing child development and rehabilitation services for kids with disabilities and their families”, which “include research centres and academic hubs dedicated to improving our understanding of childhood disabilities and advancing innovative clinical care”. Their “member organizations are staffed by experienced and regulated health professionals who work with kids and their families to build a sound foundation for development so kids with disabilities can live their best lives” and “They provide a range of services based on the needs of their community”. Their services can include, but are not limited to, the following: “Physical Therapy, Occupational Therapy, Speech and Language Therapy, Behavioural Therapy, Social Work,  Therapeutic Recreation, Psychology, Infant and Child Development, Respite Support, Family Education & Coaching, Service Coordination, Community Pediatrics, Developmental Pediatrics, Special Services at Home, Family and Peer Mentoring, Sibling Workshops, Specialty Clinics, Diagnostic Clinics, Audiology, Cleft lip and palate clinic, Adaptive equipment, Seating and Mobility Services, Consultation and Assessment, Infant Hearing Program, Blind and Low Vision Clinic, Orthotics and Prosthetics Service, Adaptive Augmentative Communication, Counseling and Therapy, Caregiver Skills Building, Prenatal and Nutrition Services, Transition Supports”, and “Youth Support Groups”. Please see below for a list of their member organizations. Please visit their website for more information at the following URL address:

https://empoweredkidsontario.ca/default.aspx?lang=1&seo=home 

National

Brain Injury Canada

The Brain Injury Canada is a “national charitable organization focused on education, awareness, and advocacy for the brain injury community”. They have a great resource website with an interactive service directory, which is designed for the brain injury community, and gives you access to the new services, organizations and associations that over acquired brain injury and traumatic brain services, as well as many other resources. Their website is “overseen by a Scientific Advisory Committee of physicians, clinicians and researchers from across Canada”. They support “those living with acquired brain injury, their families/caregivers and health care professionals by providing current, evidence-based information about brain injury, treatment, rehabilitation and recovery”. Please visit their website for more information at the following URL address:

https://braininjurycanada.ca/en/node/3 

March of Dimes Canada’s Brain Injury Services

March of Dimes Canada’s Brain Injury Services “provides experienced and flexible care for people dealing with the effects of brain injury”. They “offer rehabilitation and social support services” and their goal is to help you “regain your purpose and become as independent as possible”. They are the “largest national organizations for people living with disability in Canada”. Please visit their website for more information at the following URL address:

https://www.marchofdimes.ca/en-ca/programs/abi 

Empowered Kids Ontario-Enfants Avenir Ontario (EKO-EAO) Member Organizations

Ajax

Resources for Exceptional Children and Youth – Durham Region
Resources for Exceptional Children and Youth – Durham Region
865 Westney Road South
Ajax, ON L1S 3M4
Tel: 905-427-8862
Fax: 905-427 3107
Toll-free: 1-800-968-0066

The Resources for Exceptional Children and Youth’s mission is “Advancing an inclusive community for children and youth with exceptional needs and their families”. Please visit their website for more information at the following URL address: 

https://www.rfecydurham.com/ 

Belleville

Quinte Children’s Treatment Centre
Quinte Health Care
265 Dundas Street East
Belleville, ON K8N 5A9
Ph: 613-969-7400
Fax: 613-968-9154

Quinte Children’s Treatment Centre

Quinte Children’s Treatment Centre’s mission is to “provide a range of rehabilitation services and programs to children and youth with multiple disabilities, residing in Hastings and Prince Edward Counties”, where “Each child is viewed as part of a larger network, with home, school, hospital and community partnering to establish goals and produce change”. Their “centre will serve as a primary resource for information and advocacy in our community”. Please visit their website for more information at the following URL address: 

https://quintectc.com/ 

Brantford

Lansdowne Children’s Centre
39 Mount Pleasant Street
Brantford, ON N3T 1S7
Ph: 519-753-3153
Fax: 519-753-5927

Lansdowne Children’s Centre

Lansdowne Children’s Centre is committed to  advancing “equity, quality, access and safety of services”, by, amongst other things improving “ease of services access for families”, supporting “the age continuum of children and youth with quality, evidence-informed services”, and advocating “around appropriate operating and capital resources”. Please visit their website for more information at the following URL address: 

http://www.lansdownecentre.ca/centre/ 

Chatham

Children’s Treatment Centre of Chatham-Kent
355 Lark Street
Chatham, ON N7L 5B2
Ph: 519-354-0520
Fax: 519-354-7355

Children’s Treatment Centre of Chatham-Kent (CTC-CK)

Children’s Treatment Centre of Chatham-Kent ​​(CTC-CK) “has served the community for 71 years as a non-profit treatment centre with an elected board of directors”. Further to their website, their mission is “Providing specialized therapy and innovative programs to empower children, youth and their families to reach their individual potential”. Please visit their website for more information at the following URL address: 

https://ctc-ck.com/ 

Halton-Peel-Dufferin

ErinoakKids Centre for Treatment and Development
1230 Central Parkway West
Mississauga, ON L5C 0A5
Ph: 905-855-2690
Fax: 905-855-9404

ErinoakKids Centre for Treatment and Development

ErinoakKids Centre for Treatment and Development “is Ontario’s largest children’s treatment centre, providing a broad range of medical, therapeutic and support services to children and youth with physical and developmental disabilities, autism, communication disorders, and children who are deaf or blind”. Their mission is to “help children and youth with physical, developmental and communication disabilities achieve optimal levels of independence, learning, health and well-being”. Please visit their website for more information at the following URL address: 

https://www.erinoakkids.ca/ 

Hamilton

McMaster Children’s Hospital
Ron Joyce Children’s Health Centre
Hamilton Health Sciences
325 Wellington Street North
Hamilton, ON
Ph: 905-521-2100
Ext: 44446
Fax: 905-318-2805

Ron Joyce Children’s Health Centre

Ron Joyce Children’s Health Centre is “a site of McMaster Children’s Hospital”, and “is home to a range of outpatient services focused on child rehabilitation and developmental health”. Please visit their website for more information at the following URL address: 

Ron Joyce Children’s Health Centre

https://www.hamiltonhealthsciences.ca/about-us/our-organization/our-locations/ron-joyce-childrens-health-centre/ 

McMaster Children’s Hospital “has been providing care to children from across the region since 1988”. Their patients range “in age from infancy to 17 receive care through a family-centred approach that accounts for the child’s emotional, mental and physical well-being”. Further to its website, it “is home to the fastest-growing kids-only emergency department in Ontario, one of Canada’s most advanced neonatal intensive care units, and a range of programs and clinics with unique expertise in a number of areas including children’s cancer, digestive diseases, and mental health”. Please visit their website for more information at the following URL address: 

McMaster Children’s Hospital

https://www.hamiltonhealthsciences.ca/mcmaster-childrens-hospital/ 

Kenora

Firefly
820 Lakeview Drive
Kenora, ON
P9N 3P7
Ph: 807-467-5437
Toll-free: 1-800-465-7203
Fax: 807-467-5553

Firefly

Firefly “is a multi-service, non-profit organization providing a wide range of services for children, youth, and families in communities across Northwestern Ontario”. They “are dedicated to supporting and strengthening the health and well-being of families, children, and youth through emotional, physical, developmental, and community services”. Further to their website, their mission is to provide “children’s emotional, physical, developmental and community services”, and they are “dedicated to supporting and strengthening the health and wellbeing of children, youth and families across Northwestern Ontario”. Please visit their website for more information at the following URL address: 

https://www.fireflynw.ca/ 

Kingston

KidsInclusive Centre for Child & Youth Development
Kingston Health Sciences Centre – Hotel Dieu Hospital
166 Brock Street
Kingston, ON K7L 5G2
Ph: 613-544-3400 Ext: 3175
Fax: 613-545-3557

KidsInclusive Centre for Child & Youth Development formerly known as the Child Development Centre

KidsInclusive Centre for Child & Youth Development “is located at the Hotel Dieu Hospital site and is one of 21 Children’s Treatment Centres in Ontario”. Further to their website, “For over 45 years” they “have proudly provided rehabilitation and support services for children and youth with physical, neurological and/or developmental challenges in the Kingston, Frontenac, Lennox and Addington counties as well as communities in Lanark, Leeds and Grenville counties”. Their mission is to foster “the potential of children and youth who have physical and/or developmental challenges”, “in partnership with families and communities”. Please visit their website for more information at the following URL address: 

https://kidsinclusive.ca/ 

London

Thames Valley Children’s Centre (TVCC)
779 Base Line Road East
London, ON N6C 5Y6
Ph: 519-685-8680
Fax: 519-685-8699

Thames Valley Children’s Centre (TVCC)

Thames Valley Children’s Centre (TVCC) “works to support children and their families to achieve the highest possible quality of life”. Further to their website, they serve “around 11,000 children, youth and their families every year through a wide range of services”, where many of their services are “provided in all ten counties in Southwestern Ontario”.  Their “Clients range in age from birth to 19”, and their “Services offered support a range of special needs / disabilities including physical disability, communication disorders, developmental delays and autism spectrum disorders”. Their mission is to “provide rehabilitation services which support participation in all areas of life for children, youth and young adults with physical, communication or developmental needs, and their families, living primarily in Southwestern Ontario by: focusing on the strengths of individuals and their families at home, school, workplace and community, pursuing research, education and advocacy”, and “partnering in a local and regional system of services”. Please visit their website for more information at the following URL address: 

https://www.tvcc.on.ca/ 

North Bay

One Kids Place/La place des enfants
400 McKeown Ave.
North Bay, ON P1B 0B2
Ph: 705-476-KIDS (5437)
Fax: 705-498-6708
Toll-Free: 866-626-9100

One Kids Place/La place des enfants

One Kids Place/La place des enfants “is a charitable, non-profit organization”. Further to their website, their mission is to work “Together with families and partners” in order to “help make a difference in the lives of children and youth with special needs in the Districts of Muskoka, Nipissing, and Parry Sound”. They noted that “Through the delivery of inter-disciplinary supports, services, and therapy”, their “expert team of professionals empower every kid to reach their full potential and create a place of belonging in our communities”. Please visit their website for more information at the following URL address: 

https://www.onekidsplace.ca/ 

Oshawa

Grandview Kids
600 Townline Rd South
Oshawa, ON L1H 7K6
Ph: 905-728-1673
Fax: 905-728-2961
Toll-Free: 800-304-6180

Grandview Kids

Grandview Kids “is an independently operated not-for-profit organization”. Further to their website, they “are the only Children’s Treatment Centre in Durham Region, providing specialized programs, outpatient clinical treatment and support to thousands of children and youth with physical, communication and developmental needs and their families”. They “Assess, diagnose, prescribe and provide clinical treatment, specialized programs and therapies, and

specialized equipment for children and youth with communication, physical or developmental needs; Provide access to specialists, consultation and support for families; Build capacity in the community through information, knowledge exchange and consultation to professional and other organizations;” and “Participate in research activity and teaching in the field of children’s rehabilitation”. Their mission is to ensure “Every child and youth” is “living life at their full potential”. Please visit their website for more information at the following URL address: 

https://grandviewkids.ca/ 

Ottawa

 Children’s Hospital of Eastern Ontario
401 Smyth Road
Ottawa, ON K1H 8L1
Ph: 613-737-0871

Children’s Hospital of Eastern Ontario (CHEO)

Children’s Hospital of Eastern Ontario (CHEO) is “Dedicated to the best life for every child and youth, CHEO is a global leader in pediatric health care and research”. Further to their website, they are: “a specialized acute-care hospital, a school and preschool, an autism service provider, a child and youth mental health agency, a children’s treatment centre, a research institute, a rehabilitation service, a pediatric palliative care hospice, a school health provider, a service coordinator with community providers, a genetics program”, and “a training and education centre for health professionals”. They are “a founding member of Kids Health Alliance”https://www.cheo.on.ca/en/about-us/kids-health-alliance.aspx, which is “a network of partners working to create a high quality, standardized and coordinated approach to pediatric health care in Ontario that is centred around children, youth and their families”. Further to their website, “Every year, we help more than: 500,000 children and youth from Eastern Ontario, western Quebec, Nunavut and Northern Ontario”. Please visit their website for more information at the following URL address: 

https://www.cheo.on.ca/en/index.aspx 

Peterborough

Five Counties Children’s Centre
872 Dutton Road
Peterborough, ON  K9H 7G1
Ph: 705-748-2337
Fax: 705-748-3526

Five Counties Children’s Centre

Five Counties Children’s Centre Five “has offices in Minden, Campbellford, Cobourg, Lindsay and Peterborough to serve children in the counties of Haliburton, Northumberland, Peterborough and the City of Kawartha Lakes”. Further to their website, “For over 45 years” they “have provided therapy services that assist children who are delayed in their development to build the skills they need in everyday life such as walking, talking and activities of daily living”. Their mission is “dedicated to working with families and community partners to provide innovative, evidence-based care for children and youth with physical, developmental and communication needs; enhancing their independence and enriching their quality of life”. Please visit their website for more information at the following URL address: 

https://www.fivecounties.on.ca/ 

Richmond Hill and Barrie

Centre for Behaviour Health Sciences for Children and Families
Mackenzie Health
Pateras Plaza
13311 Yonge Street, Suite 115
Richmond Hill, ON L4E 3L6
Tel: 905-773-2362
Fax: 905-773-8499

Centre for Behaviour Health Sciences for Children and Families (Mackenzie Health)

Centre for Behaviour Health Sciences for Children and Families (Mackenzie Health) “provides care for individuals living in York Region or Simcoe County who have a developmental disability with a significant cognitive delay, autism or are living with the effects of an acquired brain injury”. Further to their website, their “Services are offered within the community to individuals living in York Region or Simcoe County”. Please visit their website for more information at the following URL address: 

https://www.mackenziehealth.ca/programs-services/mental-health/centre-for-behaviour-health-sciences-for-children-and-families 

Mackenzie Health Mackenzie Health “is a dynamic regional healthcare provider serving a population of more than a half million people across York Region and beyond”. Their mission is to “Relentlessly improve care to create healthier communities”. Please visit their website for more information at the following URL address: 

https://www.mackenziehealth.ca/about-us 

St. Catharines

Niagara Children’s Centre
567 Glenridge Avenue
St. Catharines, ON L2T 4C2
Ph: 905-688-3550
Fax: 905-688-1055
Toll-Free: 800-896-5496

Niagara Children’s Centre

Niagara Children’s Centre “is recognized throughout the Niagara Region as the provider of rehabilitation and support services to children and youth with physical, developmental and communicative delays and disabilities”. Further to their website, their “Core services include physiotherapy, occupational therapy, speech and language services, augmentative and alternative communication, family services and therapeutic recreation”. They serve “children and youth (up to age 19) with a wide range of needs”, inclusive of “children with developmental disabilities and delays related to premature birth, medical syndromes, genetic disorders and autism; physical disabilities such as cerebral palsy; muscular dystrophy; spina bifida; cancer; and communication difficulties in language, articulation, fluency and voice”. Please visit their website for more information at the following URL address: 

http://niagarachildrenscentre.com/ 

Sarnia

Pathways Health Centre for Children
1240 Murphy Road
Sarnia, ON N7S 2Y6
Ph: 519-542-3471
Fax: 519-542-4115

Pathways Health Centre for Children

Pathways Health Centre for Children “is a family-centered community agency that serves Lambton County children and youth with physical, developmental and communication needs and their families, as well as adults for some specialized services”. Further to their website, they are “one of a large group of Children’s Treatment Centres in the province of Ontario”, which “provides a continuum of rehabilitation and support services in the community as well as an on-site integrated child care service”. Their mission is to “deliver defined services to children, youth and young adults with physical, developmental and communication needs, to help them

achieve their potential for a better quality of life”. Please visit their website for more information at the following URL address: 

http://www.pathwayscentre.org/ 

Sault Ste. Marie

THRIVE Child Development Centre
74 Johnson Avenue
Sault Ste. Marie, ON P6C 2V5
Ph: 705-759-1131
Fax: 705-759-0783

THRIVE Child Development Centre

THRIVE Child Development Centre “helps children and youth with diverse abilities to achieve their highest potential”. Further to their website, they are “One of twenty-one children’s treatment centres across Ontario”, and they “support children & youth from 0–18 years of age who are impacted by differences in physical, perceptual, communication and/or developmental trajectories”. Their mission is to empower “children and their families to reach beyond what is expected toward the extraordinary”. Please visit their website for more information at the following URL address: 

https://www.kidsthrive.ca/ 

Simcoe York

Children’s Treatment Network
13175 Yonge St.
Oak Ridges, ON  L4E 0G6
Ph: 905-773-4779
Toll-Free: 877-719-4795
Fax: 905-773-7090

Children’s Treatment Network (CTN)

Children’s Treatment Network (CTN) “supports over 23,000 children and youth with disabilities and developmental needs in their homes, communities and schools”. Further to their website, they “provide intake, service navigation and coordinated service planning, assessment and diagnostic services, specialized clinics and rehabilitation services, including physiotherapy, occupational therapy and speech language therapy”. They offer “services through contracted public and private partner organizations in the education, health and community sectors”. They support “families in York Region and Simcoe County for all services through 10 shared service sites, offers school-based rehabilitation services in an expanded catchment area including Central and West Toronto and also offers assessment and diagnostic services within Dufferin, Halton, Peel, Waterloo and Wellington”. Their mission is to “nurture a dynamic network that improves the lives of children and youth with disabilities and developmental needs by providing a range of integrated, family-centred services”. Please visit their website for more information at the following URL address: 

https://www.ctnsy.ca/ 

Sioux Lookout

Sioux Lookout First Nations Health Authority
61 Queen Street
PO Box 1300
Sioux Lookout, ON
Phone: 807 737 1802

Sioux Lookout First Nations Health Authority (SLFNHA) 

Sioux Lookout First Nations Health Authority (SLFNHA) “serves 33 First Nation communities in the Sioux Lookout region in Ontario, Canada”. Further to their website, they are “Mandated by the leadership in these communities”, and their “organization is dedicated to strengthening First Nations by contributing in unique ways to a strong health system for the Anishinabe”. They note the many parts of this health system, which include “First Nations with their primary responsibility for their people’s health”; “the secondary responsibilities of the Tribal Councils”; “the on-going Treaty responsibilities of the Government of Canada”; and “the support of the Nishnawbe Aski Nation and other health organizations”. Their mission is “transforming the health of Anishinabe people across keewaytinook by providing community-led services a strong voice for their community health needs”. Please visit their website for more information at the following URL address: 

https://www.slfnha.com/ 

Sudbury

Child & Community Resources
662 Faconbridge Road
Sudbury, ON P3A 4S4
Tel: 05-525-0055
Toll free: 1-877-996-1599

Child & Community Resources / Ressources pur L’Enfance et la Communauté (CCR/REC)

Child & Community Resources’ “services are based on expertise in applied behaviour analysis, early child development, and on supporting your child or youth with transitioning to various settings and life stages”. Further to their website, they offer “a wide range of services for children, youth, families and professionals, to support the inclusion, integration, and wellbeing of children and youth throughout the North”. Their wide range of services include, but are not limited to, the following: “Behavioural Consultation, Behavioural Treatment, Respite, Workshops”, and “Group Services”. Their publicly funded services include, but are not limited to, the following: “EarlyON Child and Family Centres”, “Early Learning and Child Care Services and Respite Services”, “Diagnostic Assessment Services – Sudbury / Manitoulin District”, “Regional Diagnostic Hub”, and “Respite”. Please visit their website for more information at the following URL address: 

https://www.ccrconnect.ca/ 

Sudbury

NEO Kids
Children’s Treatment Centre/Centre de traitement pour enfants
Southridge Mall
1933 Regent St, Unit 46F
Sudbury, ON P3E 5R2
Phone: 705.523.7120
Fax: 705.523.7157

Enfants NEO Kids, Children’s Treatment Centre/Centre de traitement pour enfants (NEO Kids CTC)

Enfants NEO Kids, Children’s Treatment Centre/Centre de traitement pour enfants (NEO Kids CTC), in association with The Health Sciences North, “is a family-centered community-based rehabilitation facility providing assessment, treatment, consultation, and education to children and young adults with motor and communication impairments”. Further to their website, they strive “for the best quality of life and health for its clients by enhancing their self-esteem and facilitating their function, independence, and community participation”. Their mission is to “a caring, unique, and innovative paediatric rehabilitation facility” that serves “the Manitoulin Sudbury Districts” and work “in partnership with families and community agencies to help children achieve their optimal potential”. Please visit their website for more information at the following URL address: 

https://www.childrenstreatment.ca/ 

Thunder Bay

George Jeffrey Children’s Centre
200 Brock St. East
Thunder Bay, ON P7E 0A2
Ph: 807-623-4381
Fax: 807-623-6626

George Jeffrey Children’s Centre (GJCC)

George Jeffrey Children’s Centre (GJCC) “is a paediatric outpatient health facility located in Thunder Bay, Ontario”. Further to their website, they “have been meeting the communication, developmental, and physical needs of children for over 60 years; providing services to infants, children, and adolescents aged from birth to 19 years”. Their mission is to enrich “lives by delivering specialized rehabilitative and interprofessional services in client-centred environments”. Please visit their website for more information at the following URL address: 

https://georgejeffrey.com/ 

Timmins

Cochrane Temiskaming Children’s Treatment Centre
733 Ross Avenue East
Timmins, ON P4N 8S8
Toll-Free: 800-575-3210
Fax: 705-268-3585

Cochrane Temiskaming Children’s Treatment Centre (CT CTC)

Cochrane Temiskaming Children’s Treatment Centre (CT CTC) “is a bilingual, not-for-profit organization, funded by the Ministry of Children and Youth Services”. Further to their website, they “provide specialized programs and services, outpatient clinical treatment, and support to children from birth to 19 and up to 21 years of age (if attending a Ministry of Education sanctioned program) and their families/support systems”. Their mission is to be “committed to providing quality rehabilitation and other supportive services to Children and their Families in the Districts of Cochrane, Temiskaming and other geographical areas as deemed appropriate by the Board of Directors”. Please visit their website for more information at the following URL address:

https://www.ctctc.org/ 

Toronto

Holland Bloorview Kids Rehabilitation Hospital
150 Kilgour Road
Toronto, ON M4G 1R8
Ph: 416-425-6220
Fax: 416-425-6591
Toll-Free: 800-363-2440

Holland Bloorview Kids Rehabilitation Hospital

Holland Bloorview Kids Rehabilitation Hospital provides “both inpatient and outpatient services”, as well as “exceptional care for clients and families”. Further to their website, they “care for kids with disabilities, kids needing rehabilitation after illness or trauma, kids whose medical complexity requires a kind of care they can’t get elsewhere”. Their mission is “unparalleled partnership with children, youth and families”, “deliver outstanding personalized, inter-professional care; maximize function through cutting-edge treatment and technology; co-create groundbreaking research, innovation and teaching; connect the system; and drive social justice for children and youth with disabilities”. Please visit their website for more information at the following URL address:

https://hollandbloorview.ca/ 

Toronto

Lumenus Community Services
1126 Finch Avenue West Unit 16
Toronto, ON M3J 3J6
Tel: 416-222-1153

Lumenus Community Services

Lumenus Community Services is the amalgamation of “four legacy agencies” as follows: “Adventure Place, The Etobicoke Children’s Centre, Griffin Centre and Skylark Children, Youth & Families”, which “United as Lumenus”. Further to their website, “the commitment and expertise of each legacy agency remains and now a new, more seamless continuum of care and support is provided to existing and future client”. Please visit their website for more information at the following URL address:

https://www.lumenus.ca/ 

Toronto

Surrey Place
2 Surrey Place
Toronto, ON M5S 2C2
Tel: 416-925-5141

North Satellite Office
Unit E6-2 Champagne Dr.
North York, ON M3J 2C5
Tel: 416-925-5141

Surrey Place

Surrey Place “provides specialized clinical services that are responsive to individual’s needs and promote health and well-being in the Toronto region”. Further to their website, they “help children and adults living with developmental disabilities, autism spectrum disorder and visual impairments reach their full potential”. Furthermore, they “offer a variety of groups and workshops for clients, families and caregivers, as well as extensive education and consultation services to community agencies”. They have comprehensive programs and services, which “ range from assessment, diagnosis, and one-on-one treatment, to family counselling and group support and is provided by a broad network of clinicians and professionals”. They are “affiliated with the University of Toronto and other academic institutions and is a teaching site for students in a variety of health care professions”, and “accredited by Accreditation Canada with Exemplary Standing (2012-2016)”. Their mission is to “help people of all ages with developmental disabilities and autism spectrum disorder to lead healthy and socially inclusive lives using our exemplary skills in interdisciplinary clinical services, education and research” and “provide many of our clinical services in both official languages”. Please visit their website for more information at the following URL address:

https://www.surreyplace.ca/ 

Waterloo

KidsAbility Centre for Child Development
500 Hallmark Drive
Waterloo, ON N2K 3P5
Ph: 519-886-8886
Fax: 519-886-7292

KidsAbility Centre for Child Development

KidsAbility Centre for Child Development is “Funded through the Ministry of Children, Community and Social Services, purchase-service options and the generous support of” their “community”, and their “goal” “is to get the right help to the right child at the right time and donations help to make that possible”. Further to their website, they “engage their community partners, individuals and groups to help make a difference in children’s lives”. Their mission is to empower “children and youth with special needs to realize their full potential”. Please visit their website for more information at the following URL address:

https://www.kidsability.ca/ 

Windsor

John McGivney Children’s Centre
3945 Matchette Road
Windsor, ON  N9C 4C2
Ph: 519-252-7281 Fax:519-252-5873
Toll-Free: 800-976-5622

John McGivney Children’s Centre

John McGivney Children’s Centre maintains “a strong commitment to children with special needs and their families, fulfilling the Centre’s mission of helping them reach their full potential”. Further to their website, their mission is to provide “family-centred holistic care to the community, enriching the lives of children and youth with special needs by helping them reach their full potential”. Please visit their website for more information at the following URL address:

https://jmccentre.ca/ 

Whitby

Lake Ridge Community Support Services
900 Hopkins Street, Unit 8
Whitby, ON, L1N 6A9
Tel: 905-666-9688

Lake Ridge Community Support Services

Lake Ridge Community Support Services “use evidence-based, individualized behaviour therapy (ABA) services to help children, youth and adults with autism spectrum disorder and/or intellectual disabilities maximize their potential in the community”. Further to their website, they “offer a range of Funded and Fee for Service Behaviour Therapy Services, including”, but not limited to, the following: “Intensive Behaviour Intervention (IBI), Applied Behaviour Analysis (ABA) Behaviour consultation, Caregiver training, Family/Caregiver education, Social skills groups, Adult education groups”, and “Professional education”. Of note, they state that “All services are based on evidence-based interventions and individualized to the client’s needs”. Their mission is to ensure that “All individuals will have the opportunity to reach their unique potential”. Please visit their website for more information at the following URL address:

https://www.lrcss.com/ 

Please keep in mind that these aforementioned services may or may not be regulated in Ontario. You can contact the Consumer Protection Ontario to help you ask the right questions before you choose any of their services. If you have a concern or serious complaint about any non-regulated service, then please visit www.ontario.ca/page/consumer-protection-ontario/ for further information.

I hope you found this information valuable. Rudder Law Group’s website is your one-stop source for answers to all of your legal questions concerning catastrophic impairment law and personal injury law.