Treating the whole family at the George Hull Centre
The George Hull Centre for Children and Families, in Etobicoke, Ontario, is one of 400 agencies in the province that support children and youth mental health.
I was familiar with it as my daughter, through a referral from her school, had briefly done speech therapy at the centre as little kid.
As well, a close family friend, Susan Chamberlain, now the Centre’s executive director, worked there. We reached out to her when my daughter first told me she thought she might be depressed.
At the time, Susan kindly recommended a therapist (who recommended a psychiatrist) and we went on our way following whatever breadcrumbs we found along that initial trail to mental wellness.
Recently, I circled back with Susan to find out more about the George Hull Centre and the services they provide, free of charge. Here’s what I learned.
What is The George Hull Centre?
The George Hull Centre is a community-based children’s mental health centre that focuses on children’s mental health from birth to age 18.
They have three areas of service:
- Early intervention services for families with children ages birth to six;
- A community clinic for children, youths, and families;
- Intensive in-home, residential and day treatment programs for youth ages 12-18.
To give you a sense of their size, in 2018, they served 812 clients in individual and family treatment, 21 youth in their residential treatment programs, and another 1500 or so through their group programs and groups and workshops in local schools.
“We haven’t joined a movement to provide a walk-in service,” Susan says. “While I think it’s important for people who need something quickly, it doesn’t provide treatment. We’ve moved too far away from treatment. Long-term treatment. Most mental health needs are kind of chronic in nature.”
Their services generally stop the day before a kid turns 18. The primary reason? Their funding doesn’t cover 18-year-olds.
“Children’s mental health is now under Ministry of Health – we’re hopeful Ministry of Health will be more comfortable with funding adult and children–a blurring of the lines.”
What makes the George Hull Centre unique?
“We believe in treating the entire family,” Susan says. “We know that kids don’t exist in a vacuum and that families have an impact on their ability to heal, and sometimes on the origin of their challenges.”
According to Susan, The George Hull Centre is one of the only service providers that still focuses on family therapy.
“Therapy is most often modelled as DBT and CBT,” she says. “These models work with individuals to change the way they’re thinking, and they give kids really useful skills. But these models often work in isolation.”
At The George Hull Centre, they use a different model called Dyadic Developmental Psychotherapy (DDP). It was created by Dr. Daniel Hughes, a clinical psychologist for the treatment of children who have experienced abuse or neglect and who demonstrate ongoing problems related to attachment and trauma.
“A lot of kids present with trauma,” says Susan. “They present with five or more adverse childhood experiences (ACEs).”
ACEs are negative, stressful, traumatizing events that occur before the age of 18.
Dr. Khush Amaria, who I spoke to about Beacon digital therapy in this post, mentioned ACEs as well. They’re things such as divorce, witness to family violence, emotional or physical neglect, as well as traumas smaller in nature.
The DDP method takes into consideration a parent’s attachment history as well, to find out if there are any relevant life experiences that may be triggered by caring for their children.
It’s then paired with PACE, an approach to parenting that emphasizes Playfulness, Acceptance, Curiosity and Empathy to communicate in a way that makes a child feel safe. You can read more about PACE and ACES and DDP in the links at the bottom of the article.
Is the George Hull Centre only for kids with trauma?
As a non-profit charitable organization, a lot of the kids at the George Hull Centre have come through social services or referrals from family doctors, or teachers.
Susan says they see an incredible range of families, often where child welfare is involved, but they also have kids who self-refer. “Children call on their own sometimes or teens will refer their friends.”
“It’s helpful if there is a family,” she says. “The work moves faster and the treatment outcomes are better. To that end, they try to broaden the definition of family to include aunts, uncles, best friends or boyfriends. Anyone who can support them.
They also encourage parents to bring siblings into therapy.
“We often get really great information from siblings, ” Susan says. “They have a unique insight into what’s going on in the family.”
Siblings, I learned, are often affected by what’s going on in the family, acutely aware of the shift of focus to the child who needs help.
“The kid who is not symptomatic is often worried, and it’s helpful for them to talk about their worries,” Susan says. “And it’s helpful for the child who’s having the symptoms to hear it.”
And while they do see some kids with more complex mental illnesses such as schizophrenia, the most common presentation now, she says, is anxiety.
What are the wait times?
Before I spoke to Susan, I saw in their annual report that wait times had been eliminated between January 2017 and November 2018.
When I asked her how they did it, she prefaced her remarks to say that that said wait times have crept up again—they’re back in the six-month range, but she noted the four changes they made that made a big impact in reducing wait times:
- They instituted an appointment reminder system. Clients get a text message reminding them of their appointment. It allows them to cancel without having to call or explain why they’re cancelling, and it’s done far enough in advance that they can pencil in another client;
- They triage their waitlist. People on the waitlist, she says, are generally able to manage. In an earlier post about what to do while waiting for help, I mentioned that it’s important to keep service providers updated on any changes in your child’s health. If your child can no longer manage, raise the alarm;
- If you’re on the waitlist, they allow you to call and get an appointment within a week. You can do this up to three times. I love this idea given the alternative is often the emergency room;
- They implemented an SOS system, a sort of safety net for both clients and staff. The Supporting our Services system allow staff to close files if they think regular treatment is no longer needed, with the caveat that clients could call back and see someone within a week up to a year following their discharge.
“We’re a long term treatment facility,” Susan says, “But we’ve become very good at finding ways to move clients through treatment.”
Does it work?
Nine years ago, the George Hull Centre received a $100,000 innovation grant from the Centre of Excellence for Children’s Mental Health to do research in an area of their choosing.
“This set us on a path to look for outcomes,” Susan says.
And according to the 2018 Annual Report, the outcomes are pretty good:
- 90% of parents said the Help I Have Teens group improved their relationship with their teen
- 86% of youth and 100% of parents rated DBT Teen Talk Group as good or excellent
- 83% of youth improved in feeling useful and in making up their own mind
- 67% improved in their ability to be close to others and do well with problems
- 100% of students said the Day Treatment Program helped them reach their academic goals
In the inpatient program, 100% of parents surveyed after six months of treatment agreed they had seen positive changes in their child and family.
They use a number of clinical assessment tools to measure outcomes, including The Child and Adolescent Functional Assessment Scale (CAFAS).
CAFAS assesses how a client is functioning with regards to school, home, self-harm, community, substance abuse, behaviour to others, and rational thinking. It also assesses the caregiver with regards to material needs and social support. It was developed by Multi-Health Systems, and is backed by twenty years of research.
Of those who completed the CAFAs upon exit from The George Hull Centre, 77% had a lower score at exit in the community clinic and 92% had a lower score at exit from the intensive programs (residential and day treatment). Lower scores are good.
“I’m very proud that we’re an organization that cares about getting kids better and providing treatment that actually works,” Susan says. We work with very complex situations and we can actually help those families improve and get better.”
How can they do more?
The George Hull Centre relies heavily on funding from the Ontario provincial government.
According to their 2018 Annual Report, they received nearly $6.5 million from the Ministry of Children, Community and Social Services, almost $2.8 million from the City of Toronto, and just over $,1.1 million from other funding, expense recoveries and donations.
Sixty-three percent of their annual budget goes to their Intensive Services (Residential, Day Treatment) and their Outpatient Services (individual, family and group treatment).
More money would help.
Susan remarks that while there has been more support from both levels of government for mental health, the money is going into Youth Hubs.
Youth Wellness Hubs reflect a partnership between the Ministry of Health and Long-Term Care and the Ministry of Child and Youth Services, with support from the CAMH Foundation and Graham Boekh Foundation.
Susan acknowledges that everything helps, but argues a youth hub is not a clinical service. “It’s not mental health clinical intervention,” she says. “That’s where they need to put their money.”