Educating students who may have otherwise been overlooked or misunderstood

The Azrieli Foundation is committed to supporting initiatives that improve the quality of life and education for children with learning and developmental disabilities. These are three organizations that enable children to achieve their full potential.

As different as each of these organizations is, they all share similar objectives of developing individualized learning delivered by highly trained and certified teachers, integrating their programs with public school curricula, and creating environments that nurture the strengths of every child.

Even though we’re all different, we all fit together

Even before stepping inside the old stone Tudor that is home to The Dunblaine School you know it’s a special place. Above the doorway is a brightly painted mural – the handiwork of the school’s students – and visitors, teachers, students, and families are welcomed with the message, “Even though we’re all different, we all fit together.” The spirit of welcoming and inclusion continues inside, infusing every element of the school.

The Dunblaine School has offered educational services for children with learning disabilities since 1969. Their specialized approach and methodology builds self-esteem and self-confidence, and promotes meta-cognition and self-advocacy. Dunblaine has been “…educating students who may have otherwise been overlooked or misunderstood while striving to reach their true potential,” says the school’s principal, Charleen Pryke.

The nurturing environment that has been created at The Dunblaine School seems the ideal setting for teachers and children alike to engage in the school’s mission, as described by Ms. Pryke, to “…recognize each individual child’s strengths, acknowledge their challenges and develop a specialized approach and methodology that promotes life-long success.”

Looking beyond disability

Inspiring stories often arise from a random situation that inspires ordinary people to achieve extraordinary things. The story of the Donald Berman Yaldei Development Center is no exception. It begins with the unexpected diagnosis received by a young couple from Boisbriand, Quebec that their two children were both profoundly developmentally delayed.

Confronted by the lack of resources and support, the couple soon resolved to create a facility for their children, as well as for other families in the same situation. When the Center – which was named after philanthropist Donald Berman, a Montreal businessman who supported many causes for children – was created in 1997, three staff members would provide intensive treatment to three children in a small private home. Today, the humble facility, located in the heart of Montreal, has become a treatment centre that offers a wide range of clinical, educational and recreational programs and services.

Although autistic children can receive care from the city’s public services for intensive therapy, children with other developmental disabilities do not have the same access to appropriate care. By offering intensive, individualized treatments that are integrated and adapted to the specific needs of every child, Yaldei manages to close the gap. The Center works with more than 25 schools and annually helps more than 276 children to reach their full potential.

Yaldei (which means “the children of” in Hebrew) is a unique centre. It offers early intervention programs as well as a development centre and a specialized school accredited by the Quebec government. Children benefit from treatment follow-up during their studies, as well as programs and services that focus both on their behaviour and their educational goals. Yaldei has a solid reputation for its skilled staff of experts and innovative expertise, in particular through its holistic approach. Yaldei gives the children the opportunity to learn how to walk, speak and play, to attend school and to live productive lives within their community, while improving the quality of their family life.

A new chapter begins

In 2016, Yaldei took on the challenge of renovations, in order to meet the needs of its clients in a modern and appropriate environment. The Azrieli Foundation is helping Yaldei implement three innovative projects: the creation of an industrial kitchen that will enable young adults from the Center to develop professional and social skills; upgrading its facilities so parents can watch their children’s sessions and learn the therapeutic techniques to practice at home and, finally, the purchase of new equipment, including a climbing wall and trampolines for physiotherapy and ergo-therapy.

Over the last 22 years, the Donald Berman Yaldei Development Center has enabled many children with developmental disabilities to beat the odds and reach their full potential. This history is far from being over, and the new Center shows the commitment of a whole community to change the lives of these children and their families.

Putting research into action

Studies have shown that between 5 and 15 per cent of school-aged children around the world have a learning disability or attention disorder, with the most common one being ADHD (Attention Deficit Hyperactivity Disorder). This number is rising globally, but there are organizations working to make educational programs effective for all children regardless of their abilities. Israel is on the cutting edge of this movement.

The Learning Disabilities and Attention Disorders (LDAD) Unit at the Interdisciplinary Center (IDC) Herzliya was established in 2012 by Dr. Daphne Kopelman-Rubin and is a leading institute in providing comprehensive evidence-based solutions.

LDADs impair academic functioning and increase the risk of developing emotional problems, such as stress, anxiety, and depression; social challenges like social exclusion, bullying, behavioural problems and loneliness; and difficulties in feeling a sense of belonging in school.

“Achieving excellence in the 21st century requires that every student is ready to learn, and every teacher is ready to teach.”

– Dr. Daphne Kopelman-Rubin

The “I Can Succeed” (ICS) program goes into schools and trains homeroom teachers to deliver their lessons effectively to students with and without learning disabilities. This takes the onus off the individual schools to have an in-house specialist. The nationwide program is used in more than 60 schools and 50 preschools in Israel. The program, which is enacted by teachers, includes a flexible curriculum based on the development stage of the individual student.

The ground-breaking institute is comprised of four branches:

1. Implementing the ICS intervention program within schools. This program trains homeroom teachers to better understand learning disabilities and become the student’s mentor.
2. Conducting evidence-based diagnosis, individual and family treatment in collaboration with the school.
3. Investigating the impact of emotional, social, and family relationships. This involves ongoing research in the field of learning disabilities and attention disorders.
4. Training professionals such as psychologists, educators, community coordinators and doctors.

Through innovative programming like the ICS program, IDC Herzliya is leading the way in Israel for children with learning disabilities and attention disorders, ensuring that they achieve their full academic potential.

potential

Sharing Jewish traditions, cultures and values through books

Reading to children is vitally important: study after study has shown its impact on a child’s development. Even the mere presence of books in a home increases the level of education they can reach.

But finding the right books and making the time to read as a family can be hard. That’s where PJ Library comes in.

A program of the Harold Grinspoon Foundation, PJ Library sends free Jewish children’s books to families across the world every month. Over 15,000 books a month are sent to PJ Library families in Canada.

Something magical happens when parents sit down together to read with their children.

Something magical happens when parents sit down together to read with their children. PJ Library shares Jewish stories that can help families talk together about values and traditions that are important.

Families with kids ages 6 months through 8 years old with Judaism as part of their lives are welcome to sign up. PJ Library encourages all Jewish families to participate, whatever their background, knowledge, or family make-up, or observance may be. 

PJ Our Way

What happens after children in the PJ Library program turn 8?

PJ Our Way is for kids aged 9 to 11. It is kid-driven: they choose their own books, creating a totally tailored experience based their own interests and reading level. To make the choice easier, the PJ website includes summaries and author bios, along with ratings, reviews, and video trailers created by members themselves. Kids can also take polls and quizzes, participate in monthly interviews and challenges, post their own reviews, and comment on blog posts.

The PJ Our Way site is a completely safe and moderated space, perfect for acclimating older kids to using the web independently. It even has a blog for parents, where they can read about the books on offer for their child, and find family discussion questions for each book. Parents can also find out what values or topics are covered, as well as any content advisories parents or children should know about before choosing a book.

Funds for Fun for First-Time Campers

The Azrieli/PJ Library Campership Incentive Grants are encouraging more families to send their children to Jewish overnight camp for the first time. The program offers grants to offset camp registration costs for PJ Library participants living in cities without first-time camper programs.

Harold Grinspoon, founder of the Harold Grinspoon Foundation and the PJ Library, says, “We believe that the 24/7 camp environment provides a natural extension of the PJ experience, giving young people the opportunity to develop lasting friendships, explore Judaism, and try new things in a safe, nurturing community.”

As a 2018 Azrieli/PJ Library Campership participant enthusiastically said, “I had a very good time at camp and I especially enjoyed going on the go karts. The daily learning was amazing and especially the extra learning on Shabbat. I’m excited to go back next year and have another great summer.”

The Azrieli/PJ Library Campership Program is proud to help a new generation of families send their children to Jewish overnight camp.

Blogs by Dr. Lawrence Rudski, Montreal Jewish General Hospital, and Professor Ehud Raanani, Sheba Medical Center

Update from Dr. Lawrence Rudski, Jewish General Hospital’s Azrieli Heart Centre

This month I had the privilege of travelling to Tel Aviv to represent the Jewish General Hospital’s Azrieli Heart Centre at the Israel Heart Society’s Annual Scientific Sessions. Walking back from the faculty dinner in Sarona, talking to the Senior Leadership of the American College of Cardiology, we came upon a beautiful view of the signature Azrieli Towers, and with great pride, I told them that those were the Azrieli Towers, told them about our Heart Centre, but stopped short of saying that the towers were named after our centre.

The Azrieli family from patriarch to matriarch to children have provided the world with many gifts in the arts, in remembering history – as I write this, it is Yom Hashoah – , in addressing everyone’s special needs, and of course in health care.  My personal world touches on all of these, but institutionally, the JGH is blessed to have been given the gift of the Azrieli Heart Centre. It’s funny – as Director of Cardiology who is responsible for growth but also quality, when I learned that our request was granted – walking back to the airport after presenting to their Canadian and Israeli Board of Directors some 3 years ago in Toronto- I wondered if we were “good enough” to receive this exceptional gift. I was able to “sell,” but was I able to “deliver.”  What I should have appreciated was that donations like this are not meant to reward excellence but to grow excellence. I was finally greatly relieved when the JGH this year was ranked the top hospital in Quebec and amongst the best in the world.

The Azrieli Heart Centre, through the Azrieli Foundation’s donation, has grown in all key domains in healthcare – compassionate, innovative and expert clinical care through a unique method of care delivery; outstanding teaching to local and international residents and fellows through endowed fellowships and to nurses and allied healthcare professionals through continuous education and training; and cutting edge research that aims to improve the lives of so many, and particularly the frail elderly to whom the JGH provides special care. We support one of the leading programs in pulmonary hypertension in the world. We have initiated a new and unique program in geriatric cardiology, translating basic science to clinical risk prediction to actually modifying one’s risk before invasive procedures. We have initiated a structural cardiology program to complement our leading robotic cardiac surgery program. We will soon be increasing our access to advanced cardiac MRI imaging to make more rapid and accurate diagnosis. And we will be investing in integrating our complex information technology platform through a digital transformation strategy that will bear fruit over the next couple of years, transforming how and where care will be delivered. The central theme of all this is the outstanding patient experience that matter so much to patients and their families.

The Azrieli Heart Centre, the Jewish General Hospital, Montreal, and the international community are so lucky to join the Azrieli Foundation in its 30-year (and counting) mission that we all share – that of Tikun Olam – leaving the world a better place. Toda Raba, Yashar Koach and Mazal Tov on your 30^th anniversary.

Update from Professor Ehud Raanani, Director of the Leviev Cardiovascular and Thoracic Center Sheba Medical Center, Tel Hashomer, Israel

Founded in 2008, the Azrieli Cardiac Surgery Intensive Care Unit at Sheba Medical Center, Tel Hashomer, is one of the largest and up-to-date of its kind in the country, having been designed to provide optimum continuous care. Comprising of nine critical care beds, it is an integral part of the Cardiac Surgery Department which is one of the many departments making up Sheba’s state-of-the-art Cardiovascular and Thoracic Treatment and Research Center and is academically affiliated with the Sackler Faculty of Medicine of the Tel Aviv University. Its current Director is Dr Alexander Kogan.

Some of the most up-to-date treatments include:

• Organ Transplantations: The unit serves as a referral center for heart, heart and lung, and lung transplantations, and has treated thus far many transplant surgeries.
• Extracorporeal Membrane Oxygenation (ECMO): is a life-saving artificial heart and/or lung machine. This is used for recovering heart failure patients, or lung failure or heart surgery or as a bridging option to further treatment, when physicians want to evaluate the state of other organs such as the kidneys or brain before performing heart or lung surgery and to assist during high-risk procedures in the cardiac catheterization lab, as a bridge to a heart assist device, such as left ventricular assist device (LVAD), or for patients awaiting lung transplant. The ECMO helps keep tissues well oxygenated, thereby making the patient a better candidate for transplant.
• LV Assist Device: Left ventricular assist devices (LVADs) are another standard treatment that are used in the unit to treat heart transplant candidates.

Hot-off-the-press 2019 publications on novel and exciting research include:

• The of the implications of early recurrent 1R rejections for long-term outcomes after
  heart transplantation (HT) and evaluation of the prognostic significance of 1990 International Society for Heart & Lung Transplantation (ISHLT) grading 1B/2 versus 1A. The Transplant Immunol publication revealed that early recurrent grade 1R rejections negatively affect long-term outcomes. Adverse outcomes are experienced mainly by 1R patients subcategorized as1B/2 and not 1A.
• Is Axillary Better Than Femoral Artery Cannulation in Repair of Acute Type A Aortic Dissection? This study concluded that emergent surgery for both stable and unstable patients with acute type A aortic dissection demonstrated similar survival rates and significantly less renal impairment when using the femoral cannulation approach
• Another study concluded that Type 2 Diabetes Mellitus is an independent predictor for long-term mortality after isolated AVR surgery.
• Another 2019 publication in the European Journal of Cardiothoracic Surgery suggests that in a real-world setting, only approximately one-half of diabetic patients with multi-vessel disease are referred to surgical revascularization despite guideline indications. Surgical compared to percutaneous revascularization in this population was associated with improved long-term survival that became evident 7 months after the revascularization procedure.

Every individual deserves a life of dignity

There is growing awareness of the challenges that children with Neurodevelopmental Disabilities, such as an intellectual disability, autism or Down syndrome, face. But something is missing: these children with neurodevelopmental disabilities grow up, and these disabilities don’t disappear. Adults with neurodevelopmental disabilities are often ignored by society, and that includes scientists and health care professionals.

Coupled with this lack of research and support is the fact that people with neurodevelopmental disabilities are at much higher risk of developing mental illnesses like depression, anxiety and psychosis. The statistics are startling: about 45 per cent of adults with neurodevelopmental disabilities also have a mental illness or addiction – which is more than 30,000 people under age 65 in Ontario alone.

“If you can improve the quality of care upstream at the primary care level, and by working more closely with people with disabilities and their caregivers, then you can address health issues early and prevent more serious health issues from emerging.”

– Dr. Yona Lunsky, Director, Azrieli Adult Neurodevelopmental Centre, CAMH

As a result of not knowing how to offer appropriate support, these adults are more likely to end up either in the criminal justice system and/or in the emergency health care system. In addition, those with NDD and mental health issues are far more likely to be overmedicated or to turn to self-medication.

The first steps in helping those with this dual diagnosis lies in teaching those on the front line – for instance family doctors and emergency room staff. That is what the Azrieli Adult Neurodevelopmental Centre at CAMH is doing.

Directed by Dr. Yona Lunsky, this centre is built upon four pillars: Clinical Innovation, Research Excellence, Education and Training and Knowledge Exchange.

Dr. Lunsky explains, “To start to change the way we deliver care, we have to train the mental health providers of tomorrow—nurses, doctors and a range of health students. Through this Centre, we’ll actually see people trained with new skills in the next 10 years and working across the country.”

She continues, “If you can improve the quality of care upstream at the primary care level, and by working more closely with people with disabilities and their caregivers, then you can address health issues early and prevent more serious health issues from emerging.”

Tips for Front-line Workers

From “Raising Awareness about Autism: Some tips for clinicians” by Centre for Addiction and Mental Health.

How accessible are mental health services to autistic people? The research tells us that mental health issues are quite common, but that mental health providers don’t feel competent to provide them. It might be okay for clinicians to say: “I can’t provide this sort of service, you need to see a specialist,” as long as there are specialists. But what happens when there is no one else to go to? Either we need more specialists, or we have to become more specialized ourselves.

CAMH is both advocating and building the capacity for more mental health specialists in autism, and at the same time improving staff skills. The starting point is learning directly from those with autism and their families.

Identify that autism is part of the presenting picture

We need to be more skilled at recognizing autism in mental health care. Not all individuals will have a diagnosis pinned to their sleeve. And if they think making this diagnosis known will prevent them from obtaining services, they will not want to share that information. It is ok to ask about autism in our assessments, especially if patients understand that sharing this information will lead to a more supportive encounter.

Recognize mental health issues early

Autism in itself should not be thought of as a mental health problem. But having autism in environments that are not accommodating can lead to mental health problems. About 70% of autistic youth have an associated emotional or behavioural problem, or would meet criteria for a psychiatric condition. These issues are also prevalent in over 50% of adults, with depression and anxiety being the most common presenting concerns. We need to talk about and promote mental health before serious issues develop. This means being responsive to family needs, making our schools safe and supportive places, nurturing friendships and preventing isolation. It is about building on strengths, and not just focusing on problems.

Be aware of overlap between physical and mental health concerns

Mental health and physical health issues overlap with one another. Long term use of psychotropic medications, commonly prescribed to people on the spectrum, can lead to physical health problems, and so can inactivity, and poor diet. Left untreated, physical health problems like an ear infection or an abscessed tooth can lead to some distressed behaviours in someone who is not very skilled at communicating their internal experiences. Mental health assessments need to recognize how closely tied the physical and emotional can be.

Treat every interaction as a therapeutic encounter

It is hard for anyone to ask for help, but having a traumatic health care experience can make asking for help a second time even harder. In our research with families we learned that parents of youth don’t seek mental health services because the steps to do so are too overwhelming, and because they hope that things might resolve on their own. In contrast, parents of adults don’t see mental health services because of how poor their experience was previously. As clinicians, we need to recognize that every interaction with the health care system is a therapeutic intervention. There are a few simple things we can do, even if we don’t feel like the expert, that can make an experience more positive and promote future service use.

Be sensitive to the senses and reduce overstimulating environments, particularly when someone with autism is under stress

Take note of lighting, sounds, and crowds. Allow for and encourage different tools to cope with sensory overload (sunglasses, headphones).

Make more time

This doesn’t mean speaking slowly or louder but means checking that what you are saying is understood and that you are understanding what is said.

Listen: you aren’t the only expert in the room

Because people on the spectrum experience the world in unique ways, they can teach us about what works best for them, and so can their loved ones.

Admit what you don’t yet know

If you have seen one autistic person, you have seen one autistic person. Mental health presentations are complicated and require knowledge of what is typical and atypical for that one individual. You might feel a pull to have a quick answer or solution, but recognizing that it will take some time to figure  out, communicating that and creating a space to do so can be very validating for the person, and serve them better in the long run.

Healthcare tools and guidelines can help providers offer more proactive care for this vulnerable and under-served population. Some of these tools can be found here:

www.hcardd.ca

www.ddprimarycare.surreyplace.ca

www.nutsandboltstools.com