Clinical Associate Professor, Pediatrics - General Pediatrics
Board Certification: American Board of Pediatrics, Pediatrics (2021)
Board Certification: Royal College of Physicians and Surgeons of Canada, Pediatrics (2016)
Residency: University of Toronto Hospital for Sick Children (2016) Canada
Medical Education: University of British Columbia Faculty of Medicine (2012) BC
Additional Clinical Info
Comparison of healthcare quality for uninsured and underinsured children through community health centres in Canada and the USA: a scoping review protocol.
2024; 14 (1): e075340
Children and youth who are uninsured or underinsured in Canada and the USA have limited options where they can receive healthcare. In both countries, community health centres (CHCs) have been established as a solution to provide quality care to children without adequate insurance, including those who are newcomers or refugees. However, little is known about how well these models deliver paediatric care. Cross-country analysis provides an important viewpoint to identify areas of success and growth. The purpose of this scoping review is to compare quality of care for uninsured and underinsured children through CHCs in the USA and Canada.This scoping review follows the methodological guidelines from the Joanna Briggs Institute Evidence synthesis. The protocol has been registered with the Open Science Framework Registries and can be accessed online. A search will be conducted in electronic databases of peer-reviewed literature (Ovid MEDLINE ALL, CINAHL Complete via EbscoHost, Scopus; Health Business Elite via EbscoHost and Sociological Abstracts via ProQuest) as well as the grey literature. Two reviewers will review all titles and abstracts for inclusion in full-text review. Studies that meet inclusion criteria will be included in full-text review. Data will be extracted into Covidence, using the Donabedian model as a conceptual framework. Findings will be synthesised in a narrative format.As this study only uses publicly available data, ethics approval is not required. Findings will be shared at national and international conferences and published in a peer-reviewed journal. In addition, findings will be prepared into a policy brief or white paper to be shared with relevant policy stakeholders to advocate for a better model of care for marginalised children and youth.
View details for DOI 10.1136/bmjopen-2023-075340
View details for PubMedID 38176867
Reporting of Ethno-Racial Identity and Immigration Status in Published Studies on Newcomer Children
JOURNAL OF IMMIGRANT AND MINORITY HEALTH
Access to health services can differ greatly based on ethno-racial identity and immigration status. We examined the reporting of ethno-racial data and immigration status in published literature on the health of newcomer children. An integrative scoping review was performed using the methodological framework outlined by Arksey and O'Malley (2005). 4147 articles were identified and 75 studies included in the final analysis. 67% (50/75) did not describe the participants immigration status at all. Most studies (65%, 49/75) also did not report participants' ethno-racial identities. Of those that did, 65% (17/26) reported participant ethnicity alone, and 15% (4/26) reported race alone, while 19% (5/26) reported both race and ethnicity. We found that most studies on newcomer children did not report immigration status or ethno-racial identity. In doing so, studies may ignore the specific impacts of racism and xenophobia on health and access to care.
View details for DOI 10.1007/s10903-023-01539-5
View details for Web of Science ID 001073079200001
View details for PubMedID 37775677
View details for PubMedCentralID 4699522
Interim Federal Health Program: Survey of use of supplemental benefits by paediatric health care providers
PAEDIATRICS & CHILD HEALTH
2023; 28 (6): 344-348
The Interim Federal Health Program (IFHP) provides temporary healthcare coverage to refugees and refugee claimants. Previous research demonstrates that paediatric healthcare providers poorly utilize the IFHP, with low registration rates and limited understanding of the program. The objective of this study was to examine paediatric provider use of IFHP-covered supplemental benefits, and their experience with trying to access these benefits.A one-time survey was administered via the Canadian Paediatric Surveillance Program in February 2020. Of those who had provided care to IFHP-eligible patients, descriptive tables and statistics were created looking at provider demographics, and experience using the IFHP supplemental benefits. A multinomial logistic regression was built to look at provider characteristics associated with trying to access supplemental benefits.Of the 2,753 physicians surveyed, there were 1,006 respondents (general paediatricians and subspecialists). Of the respondents, 526 had recently provided care to IFHP-eligible patients. Just over 30% of those who had recently provided care did not access supplemental benefits as they did not know they were covered by the IFHP. Of those who had tried to access supplemental benefits, over 80% described their experience as difficult, or very difficult.Paediatric providers have a poor understanding of IFHP-covered supplemental benefits, which is cited as a reason for not trying to access supplemental benefits. Of those who do try to access these benefits, they describe the process as difficult. Efforts should be made to improve provider knowledge and streamline the process to improve access to healthcare for refugee children and youth.
View details for DOI 10.1093/pch/pxad011
View details for Web of Science ID 000974684300001
View details for PubMedID 37744757
View details for PubMedCentralID PMC10517246
Advocacy in community-based service learning: perspectives of community partner organizations.
Canadian medical education journal
2023; 14 (1): 90-94
Background: Health advocacy is a core competency for physicians, which can be developed through community-based service-learning (CBSL). This exploratory study investigated the experiences of community partner organizations (CPOs) participating in CBSL in the context of health advocacy.Methods: A qualitative study was conducted. Nine CPOs at a medical school participated in interviews on topics pertaining to CBSL and health advocacy. Interviews were recorded, transcribed, and coded. Major themes were identified.Results: CPOs perceived a positive impact from CBSL through student activities and connecting with the medical community. There was no unifying definition of health advocacy. Advocacy activities varied depending on the individual's role (i.e., CPO, physician, and student), which encompassed providing patient care or services, raising awareness of healthcare issues, and influencing policy changes. CPOs had different perceptions of their role in CBSL from facilitating service-learning opportunities to teaching students in CBSL, while a few desired to be involved in curriculum development.Conclusion: This study provides further insight into health advocacy from the lens of CPOs, which may inform changes to health advocacy training and the CanMEDS Health Advocate Role to better align with the values of community organizations. Engaging CPOs in the broader medical education system may improve health advocacy training and ensure a positive bidirectional impact.
View details for DOI 10.36834/cmej.74887
View details for PubMedID 36998499
Exploring the impact of COVID-19 on families of children with developmental disabilities: A community-based formative study
PAEDIATRICS & CHILD HEALTH
2022; 27 (8): 476-481
COVID-19 continues to disproportionately impact families of children with developmental disabilities (DD). There is an urgent need to understand these families' experiences, particularly those that face economic or social marginalization. This qualitative study sought to identify the experiences of families of children with DD during the COVID-19 pandemic.Using phenomenology, in-depth interviews (IDIs) were conducted with caregivers and health care providers of children with DD living in a large urban Canadian city. Interviews were recorded, transcribed, and coded using inductive coding methods by two independent coders. Transcripts were analyzed within and across stakeholder groups using thematic analysis.A total of 25 IDIs were conducted in 2020. 3 main themes and 7 sub-themes emerged related to the experiences of parents and health care providers for children with DD: families reported difficulty adhering to public health measures leading to isolation and increased parental stress; restricted access to in-person services worsened behaviour and development; and worsened household financial security in already marginalized families.Our study demonstrates that families of children with DD have been negatively impacted by the evolving environment from the COVID-19 pandemic, and even more so in those who face social and economic challenges. Public health restrictions have impaired the daily lives of these families and our study suggests that limitations to accessing in-person services may have long-lasting impacts on the well-being of families of children with DD. It is imperative that the unique needs of these families be considered and centred for future interventions.
View details for DOI 10.1093/pch/pxac105
View details for Web of Science ID 000866491600001
View details for PubMedID 36575663
View details for PubMedCentralID PMC9619773
Longitudinal advocacy training for medical students: a virtual workshop series.
Canadian medical education journal
2022; 13 (3): 67-69
Advocacy curricula in Canadian medical schools vary significantly. Expert-led, interactive workshops can effectively teach students how to address social determinants of health and advocate for patients. The Longitudinal Advocacy Training Series (LATS) is a free-of-charge, virtual program providing advocacy training created for Canadian medical students by students. The program was straightforward to implement and had high participation rates with 1140 participants representing 9.7% of enrolled Canadian medical students. As well, the program had high satisfaction reported by 87.6% of participants. The LATS toolkit enables health professional programs to develop similar programs for empowering effective health advocates.
View details for DOI 10.36834/cmej.73640
View details for PubMedID 35875450
Implementation of CDC Guidelines for Recess: A Formative Research Study
HEALTH PROMOTION PRACTICE
2023; 24 (1): 81-91
The American Academy of Pediatrics recognizes recess as an essential part of overall child development in schools, impacting children's cognitive, socioemotional and physical health and development. However, recess is often removed from the school curriculum in exchange for more classroom activities. The Centers for Disease Control and Prevention (CDC) and SHAPE America developed Strategies for Recess in Schools to promote high-quality recess through specific actions, yet is not known how these are successfully implemented, particularly, in underserved settings. This formative research study examined the implementation of the CDC strategy in an urban, inner-city charter elementary school to identify barriers and facilitators to successful recess implementation from the perspective of various stakeholders. Thirteen in-depth interviews and focus group discussions were conducted with parents, teachers, recess monitors, and school administrators. Interviews were recorded, transcribed, and coded for thematic analysis, supported by group discussion and analytic memos. Results suggested that although stakeholders recognized the importance of recess, the implementation of the CDC strategy was neither uniformly understood nor implemented, suggesting that additional frameworks may be helpful in implementing the CDC strategy in schools in underserved communities.
View details for DOI 10.1177/15248399211036718
View details for Web of Science ID 000700357200001
View details for PubMedID 34549644
Exploring Stakeholder Service Navigation Needs for Children with Developmental and Mental Health Diagnoses
JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS
2021; 42 (7): 553-560
Service navigation programs are necessary for children with neurodevelopmental and/or mental health diagnoses to facilitate access to specialized therapies, social services, and community programs, especially those who are socially and economically marginalized. Few studies have included diverse stakeholders in the development and implementation of such programs in resource-limited settings. In this qualitative formative study, we aimed to explore stakeholder experiences after the implementation of a pilot service navigation program in resource-limited settings and identify the perceived elements of an effective service navigator, to develop a revised service navigation program for this patient population.A novel navigation pilot program was implemented in an urban inner-city setting. Using phenomenology as a methodology, we conducted qualitative in-depth interviews with patient caregivers, pediatricians, allied health staff, clinic administrators, and the patient navigator. Data were analyzed within and across stakeholder groups using thematic analysis and supported by group discussion.Twenty-five stakeholders participated. All stakeholders reported challenges with accessing services before the implementation of the navigation program. Caregivers expressed frustration navigating a fragmented health care system, while providers felt limited by time and knowledge. The navigator's role was described as multifaceted: finding and completing applications for funding and programs, offering emotional support, liaising between physicians and patients, and advocating with schools and agencies. Based on stakeholder input, a revised service navigation model of care is proposed.Caregivers and providers face immense barriers trying to help children with mental health and developmental diagnoses access necessary services and funding. Service navigation programs can be effectively embedded within pediatric clinical teams to improve access to required services for this patient population.
View details for DOI 10.1097/DBP.0000000000000924
View details for Web of Science ID 000711749800005
View details for PubMedID 34518497
Interim Federal Health Program: Survey of access and utilization by paediatric health care providers
PAEDIATRICS & CHILD HEALTH
2022; 27 (1): 19-24
The Interim Federal Health Program (IFHP) provides health care coverage to refugees and refugee claimants, yet remains underused by providers. The objective of this study was to assess Canadian paediatricians' current understanding and utilization of the IFHP, and perceived barriers to utilization.A one-time survey was administered via the Canadian Paediatric Surveillance Program in February 2020. In addition to descriptive statistics, multinomial logistic regressions were built to examine paediatrician use of the IFHP, and characteristics associated with registration and use.Of the 2,753 physicians surveyed, there were 1,006 respondents (general paediatricians and subspecialists). 52.2% of respondents had provided care to IFHP-eligible patients in the previous 6 months. Of those participants, only 26.4% were registered IFHP providers, and just 16% could identify 80% or more of IFHP-covered services. Knowledge of 80% or more of IFHP-covered services was associated with registration status (adjusted odds ratio [aOR] 1.92; 95%CI 1.09 to 3.37). Among those who knew they were not registered, 70.2% indicated they did not know they had to register. aOR demonstrated that those with fewer years of practice had higher odds of not knowing that they had to register (aOR 1.22; 95%CI 1.01 to 1.49).We demonstrate that IFHP is poorly utilized by paediatric providers, with low registration rates and poor understanding of IFHP-covered supplemental services, even among those who have recently provided care to IFHP-eligible patients. Efforts to improve registration and knowledge of IFHP are essential to improving access to health care for refugee children and youth.
View details for DOI 10.1093/pch/pxab045
View details for Web of Science ID 000765474400007
View details for PubMedID 35273668
View details for PubMedCentralID PMC8900698
Supporting children and youth during the COVID-19 pandemic and beyond: A rights-centred approach
PAEDIATRICS & CHILD HEALTH
2020; 25 (6): 333-336
The COVID-19 pandemic is an unprecedented global crisis, affecting millions globally and in Canada. While efforts to limit the spread of the infection and 'flatten the curve' may buffer children and youth from acute illness, these public health measures may worsen existing inequities for those living on the margins of society. In this commentary, we highlight current and potential long-term impacts of COVID-19 on children and youth centring on the UN Convention of the Rights of the Child (UNCRC), with special attention to the accumulated toxic stress for those in difficult social circumstances. By taking responsive action, providers can promote optimal child and youth health and well-being, now and in the future, through adopting social history screening, flexible care models, a child/youth-centred approach to "essential" services, and continual advocacy for the rights of children and youth.
View details for DOI 10.1093/pch/pxaa086
View details for Web of Science ID 000593143500001
View details for PubMedID 32959001
View details for PubMedCentralID PMC7454866
- A Little Hurts a Lot: Exploring the Impact of Microaggressions in Pediatric Medical Education PEDIATRICS 2020; 146 (1)
Patient Navigation for Improving Outcomes in Child and Youth Development and Mental Health: A Prospective Cohort Study of Patients Who Did Not Receive Navigator Services After Program Referral
LIPPINCOTT WILLIAMS & WILKINS. 2020: S17
View details for Web of Science ID 000526852800039
- The Paediatrician's role in understanding and supporting parenting practices through a health behaviour lens BMJ PAEDIATRICS OPEN 2019; 3 (1): e000560
Patient navigators: Mapping the route toward accessibility in health care
PAEDIATRICS & CHILD HEALTH
2019; 24 (1): 19-22
Children and youth with developmental and mental health conditions require a wide range of clinical supports and social services to improve their quality of life. However, few children and youth are currently able to adequately access these clinical, community and social services, and newcomers or those living in poverty are even further disadvantaged. Patient navigator programs can bridge this gap by facilitating connections to social services, supporting family coping strategies and advocating for patient clinical services. Although there are few paediatric-focused patient navigator programs in the literature, they offer the potential to improve short and long-term health outcomes. As social and clinical services, particularly for developmental and mental health conditions, become increasingly complex and restricted, it is important that physicians and policymakers consider implementing patient navigator programs with a rigorous evaluation framework to improve accessibility and health outcomes. This can ultimately facilitate policymakers in creating more equitable resources in challenging fiscal climates.
View details for DOI 10.1093/pch/pxy057
View details for Web of Science ID 000462553300012
View details for PubMedID 30792595
View details for PubMedCentralID PMC6376308
Xenophobia as a determinant of health: an integrative review
JOURNAL OF PUBLIC HEALTH POLICY
2018; 39 (4): 407-423
Though xenophobia has become increasingly relevant in today's political climate, little is known about the impact of xenophobia on health. While some studies have shown that xenophobia, in local contexts, may contribute to worse mental health outcomes, none have attempted to review the published literature to integrate these findings. This integrative scoping review examines the strength of these publications, then synthesizes their findings to provide a global perspective on xenophobia. The results show that it is not merely a political threat, but also has real, negative impact on the health of individuals and their communities. Given the multiple negative effects on individual and community health, xenophobia warrants more attention from both a public health and political perspective. Policies that promote cultural integration and understanding are essential to improving community health.
View details for DOI 10.1057/s41271-018-0140-1
View details for Web of Science ID 000451199400002
View details for PubMedID 30177729
Early life environment and social determinants of cardiac health in children with congenital heart disease
PAEDIATRICS & CHILD HEALTH
2018; 23 (2): 92-95
Congenital heart disease is a significant cause of infant mortality. Epidemiology and social context play a crucial role in conditioning disease burden and modulating outcomes, while diagnosis and treatment remain resource intensive. This review will address the role of social demographics, environmental exposure, epigenetics and nutrition in the aetiology of congenital heart disease. We then discuss the determinant effect of social factors on the provision and outcomes of care for congenital heart disease and implications for practice. It is our hope that enhanced knowledge of the intersection of social determinants of health and congenital heart disease will facilitate effective preventative strategies at the individual and population levels to optimize heart health outcomes across the life course.
View details for DOI 10.1093/pch/pxx146
View details for Web of Science ID 000430496000003
View details for PubMedID 29686491
View details for PubMedCentralID PMC5905484
- INTEGRATED SYSTEMATIC REVIEW OF NONPRESCRIPTION STIMULANT USE AMONG UNDERGRADUATE AND MEDICAL STUDENTS: A META-ANALYSIS AND META-SYNTHESIS ELSEVIER SCIENCE INC. 2016: S140-S141
- Adolescent Health and Nutrition in the US and Canada: An Overview of Issues and Determinants KARGER. 2015: 27-48
Insulin mediates actin remodeling leading to GLUT4 translocation through Rac and cofilin in L6 muscle cells
AMER DIABETES ASSOC. 2006: A35
View details for Web of Science ID 000238055800151