Part 8: The SmartStart Hubs Functions

This section describes what functions the SmartStart Hubs will deliver, and the ministry’s expectations around how the functions will be delivered, to enable CTCs to deliver a consistent and streamlined service experience for families.

The figure below outlines the Hubs functions, which will be described in further detail in this section. It should be noted that the functions are not necessarily linear. Some of the functions may overlap or occur simultaneously. The first four functions involve working primarily with children and families, while the ‘streamline service pathways’ function involves building partnerships with other service providers in the community, and is foundational to the success of the other functions.

Clear Entry

SmartStart Hubs will be a clear ‘main door’ for entry to children’s services for families with concerns about their child’s development and functioning related to development, who do not know where to go for support.

Families may be connected (referred) to the SmartStart Hubs in a variety of ways, including through self-referral (for example, through the Hubs’ website or phone number) or through another service provider in the community, including another children’s service provider, primary health care provider, child care provider and/or school.

Some families may be referred to or access the SmartStart Hubs as part of an ongoing process of early developmental surveillance for optimal growth and development. Partnerships with such child-serving sectors as primary care, e.g. physicians providing the Enhanced 18 Month Well-Baby Visit, early intervention services, e.g. Preschool Speech and Language and Infant and Child Development agencies, and community-based providers, e.g. EarlyON Child & Family Centres, will allow timely referrals to the SmartStart Hubs for families who may have concerns about their children’s development.

For families whose first point of contact with the children’s development services system is another children’s service provider, other than the SmartStart Hub (for example, the Infant and Child Development Program or Preschool Speech and Language provider), that service provider will work to determine whether the child may have additional support needs that cannot be addressed by the services they provide. In such cases, these children/families will be offered a connection with the SmartStart Hub for further exploration. CTCs and other service providers that could be the first point of contact for families should work in partnership to establish protocols for determining when to connect a child/family with a SmartStart Hub. See the Streamline Service Pathways section on page 38 for more information on this function.

In their first connection with the SmartStart Hub, the family will be asked to provide information about their primary concern and should be provided with clear information about next steps. For example, if the first step in the point of entry is completing an online form, the form should allow the family to indicate their primary concern(s), and the family should be provided with information about what the next step will be (for example, an in-person meeting to explore their concerns further).

This initial connection with the SmartStart Hub could involve parent/caregiver completion of the About My Child tool (for example, online prior to meeting with the Hub). However, as some families may not feel comfortable completing the tool without support, this step should be optional. See the page 32 for more information about how the About My Child tool will be used.

If the family has a single concern/service need

At this time, if it is clear what kind of support is required to address the family’s concern (for example, requiring a hearing screening), the child/family will be connected directly with the relevant service or service provider (if not the CTC) to address their concern (e.g. Infant Hearing Program). Prompt connection to services is of particular importance where there are waiting periods for service, to ensure that the child can begin receiving services as soon as possible. No further exploration on the part of the SmartStart Hub may be necessary. Hubs and their partners will need to establish processes/protocols to determine upon intake whether or not a family would benefit from the support of the Hub or would be better served by being connected quickly to an available service for which their child is eligible, when they have a single or specific concern.

For families who may have additional concerns or who would benefit from additional exploration of their support needs

For families of children who would benefit from additional exploration of their support needs, the SmartStart Hub will continue the information gathering process with that family and will engage in an exploratory conversation with the child/family (with consent).

Hubs and partners should connect families to relevant services as early as possible in their service journey. If there is an evident service need or families are seeking a specific service, they should be connected as soon as possible to the appropriate services they may be eligible for, even as other assessments are ongoing, and even if they will also benefit from and receive the exploratory conversation from the SmartStart Hub. Families should receive enough information about the Hub process upfront to help alleviate anxiety and uncertainty, and to prepare them for the next step(s).

Information Gathering

At the information gathering stage, SmartStart Hubs will engage families in an exploratory conversation using the About My Child tool (common across all SmartStart Hubs) to gather information about their child and family, their concerns related to their child’s development, and work with them to develop a plan to address their child’s functional and other needs, based on the child and family’s priorities and goals.

Gathering Pre-existing Information

Prior to the engaging with the family in an exploratory conversation, the SmartStart Hub will seek consent from the family to collect existing information from other service providers the child and family are already connected with, to avoid the family having to “tell their story” again. With the family’s consent, the Hub should identify what service providers the child and family are already connected with and obtain relevant information from the service provider(s) about the family’s primary concern that led them to be connected with the SmartStart Hub. For instance, if a child care provider has conducted a developmental screening and identified an area of potential concern, the Hub should make all possible efforts to obtain the results of that screening and not repeat it.

The families' consent to collect information from service providers that the family is connected with could be collected as part of an initial “intake” form, or using another approach determined by the SmartStart Hub and its partners.

Exploratory Conversation

Once existing information has been gathered, the SmartStart Hub will engage the family in an exploratory conversation, using the About My Child tool, to gather current information about the child and family and explore their concerns further.

Modality of the conversation

The exploratory conversation may happen in a variety of ways, including in-person, virtually (online), or by phone. When considering the modality of the conversation, Hubs should ask the family what would help them feel comfortable speaking openly and freely.

SmartStart Hubs will use a variety of methods to communicate with families, including in-person, telephone, virtually (video), email, text message, etc. Wherever possible, Hubs will provide options for families to connect in ways that make the most sense for them.

Families who request an in-person conversation should be accommodated as much as possible. A decision on the modality of the conversation could also consider factors including reducing barriers for families to access services in a timely manner (e.g. reducing the necessity to travel, options for evening appointments); service provider availability or capacity; convenience and/or availability for families (e.g. some families may not have reliable access to high-speed internet to support virtual appointments, or be readily available during conventional working hours, Monday to Friday).

Supports for the Conversation

Prior to beginning the exploratory conversation, Hubs should ask the family whether they would like anyone else to be part of the conversation to provide support/translation. For example, a family may wish to invite a support person (e.g. trusted friend or family member) to help them tell their child’s story.

If a family requires translation services, the Hubs should offer to provide a translator, or the family may prefer to bring a trusted friend, family member, or community member/service provider to provide translation support.

For Indigenous families, Hubs will partner with an Indigenous service provider in the community to ensure that the conversation is culturally safe and responsive, which could include the offer of an Indigenous liaison (or similar resource) to support the family during the conversation with the Hub worker, or to conduct the conversation on behalf of the Hub.

Skillset Required to Conduct the Conversation

The SmartStart Hub worker conducting the exploratory conversation with the child/family should have expertise in child development and familiarity with common pediatric conditions, as well as knowledge of the local service system to support service navigation.

They should exhibit sensitivity to family situations and demonstrate an ability to take a family-centred, strengths-based approach. They should be able to recognize their own biases and be equipped to take an anti-racist, anti-ableist and anti-oppressive approach to service delivery. ^{footnote 17[17]}

The organization in which the Hub worker is located should have the ability to consult with regulated health professionals from the child development sector as needed (from speech and language pathologists, occupational therapists, and physiotherapists at minimum), to provide advice about the most appropriate clinical pathway and next steps for the child, based on the information gathered through the conversation.

Elements of the Exploratory Conversation

The conversation with families will encompass the following elements, which will be described in this section in further detail.

The SmartStart Hubs worker will:

1. Provide a warm and inviting welcome, and explain the purpose of the conversation and what the family can expect
2. Get to know the family and build trust
3. Work with the family to explore the child and family’s strengths, needs and goals, guided by the About My Child tool
4. Provide supported connections to clinical services and Hubs-specific family based supports
5. Provide information to the family about other services that may be available in the community

1. A warm and inviting welcome

The SmartStart Hub will provide a warm and inviting welcome to the child and family. This step sets the tone for the interaction, and is an important step toproviding a sense of safety and comfort, and a positive foundation on which to build a relationship.

The Hub worker will introduce themselves and their job title, and will invite the family to introduce themselves, their child, and any support persons in the room.

The Hub worker will explain the purpose of the conversation If the Hub worker will be taking notes during the conversation, they should let the family know.

2. Getting to know the family and building trust

The intent of the conversation is to help the SmartStart Hub worker understand the child and family, who they are, and what is important to them, as well as what their concerns are related to their child’s development. It is important to set aside biases and assumptions, and to listen with openness and curiosity about the individuality of the child and family.

The Hub worker will start by asking the family what has brought them to the Hub, and about their primary concern related to their child’s development.

After listening to the family’s concern(s), the Hub worker will explain that the conversation will explore their concerns further to help determine next steps.

The Hub worker will invite the family to begin the conversation by asking them to share more about the child so that the worker can get to know the child. The worker will ask questions based on the first few questions in the About My Child tool, for example: “What does your child enjoy doing? What makes them happy?”

The tool can be used in a free-form way, with the worker asking questions in a way that feels natural and flows from the conversation.

The Hub worker will use active listening techniques such as using verbal and non-verbal cues to indicate listening (e.g. smiling, making eye contact, nodding or verbal affirmations), asking thoughtful questions, reflecting back what is said, and withholding judgment and advice.

The conversation will be relaxed and should not make the family feel rushed. If the Hub worker chooses to take notes, they should take breaks in note-taking to show active listening.

3. Exploring the child’s and family’s strengths, needs and priorities, guided by the About My Child

The SmartStart Hub worker will ask the family the questions as laid out in the About My Child tool in a conversational manner.

The Hub worker should use the questions in the About My Child tool as a starting point and ask probing questions to elicit further information from the family about areas of concern. For instance, if the family indicates that they are concerned about their child’s behaviour, the Hub worker may ask them to elaborate on what their concerns related to behaviour are.

Youth Voice

If the child/youth is older, in keeping with the principles of child-centred service delivery, the Hub worker should also engage with the child/youth to hear directly from them. The Hub worker will use their knowledge of child development to gauge what kinds of questions would be developmentally-appropriate. For instance, a child of seven (or even younger) could be asked, “What do you do for fun?” A child of 12 could be engaged in questions such as, “Of all the things we’ve discussed today, what is most important to you right now?”

Access and Equity

Following the inquiry into the child’s strengths and needs, the Hub worker will ask the family about ways they can support the family to access and participate in services. The purpose of the discussion is to probe whether there might be pragmatic factors (e.g. transportation barriers, language barriers, lack of access to technology) or family factors (e.g. access to child care, family members’ health, employment, housing or food insecurity) that would impact the family’s ability to access and engage with services/supports.

It is important that the Hub worker explain the reason for these questions and take the lead from the family on whether or not they feel comfortable answering.

Connection to Service

4. Provide supported connections to clinical services and Hubs-specific family based supports

Once the SmartStart Hub worker has obtained sufficient information about the child and family’s strengths and needs, they will provide the family with information about the services and supports they would recommend to support their child’s development. These supports may be provided by the CTC or by other children’s service agencies in the community. They will also provide information about the Hubs-specific family-based supports they think the family would benefit from and provide choice when available.

Hubs will support families to make decisions about the services they would like to be connected with, in support of their and their child’s priorities and goals. The Hub worker will confirm with the family that the services and supports that the Hub is recommending are appropriate, from the family’s perspective. The Hub worker will be sensitive to the wishes and capacity of the family to take the lead and will work to empower families to make decisions about the services and supports that would benefit their child.

The SmartStart Hub will provide supported connections for families with the appropriate clinical services and family-based supports in the CTC and in the community to meet their needs and the needs of their child.

To provide supported, or warm, connections, the Hub will work ‘behind the scenes’ to provide the family’s contact information to the service provider to initiate the next steps, as well as share any relevant information gathered by the Hub to help the service provider understand the child, family and their needs, including the results of the common tool. These connections should require no action on the part of the family. The next steps should be handled by the Hub in partnership with the service provider.

It should be clear to the family what the next step is, and when they should expect to be contacted. While SmartStart Hubs are not responsible for wait times for clinical assessments or services, SmartStart Hubs will communicate with the family about next steps, expected wait times, and connect them with family-based supports (see page 36) and/or other available services while they wait.

SmartStart Hubs should also consider connecting families of children with multiple and/or complex special needs, who would benefit from the support of a Service Planning Coordinator, with Coordinated Service Planning. Coordinated Service planning serves children and youth with multiple and/or complex special needs whose need for service coordination goes beyond the scope of inter‐professional collaboration to address and who would benefit from the added support provided by Coordinated Service Planning, due to the breadth and cross-sectoral nature of a child/youth’s service needs and/or potential challenges in coordinating services because of factors affecting the whole family.

5. Provide information to the family about available services in the community

The SmartStart Hub should provide families with information about other services and supports that are available in the community, that may address other needs, aside from the clinical needs of the child that the family has identified. This may include contact information for the local Indigenous Friendship Centre, EarlyON centre, or other community support to address needs that have surfaced during the conversation (for example, newcomer supports for those who are new to Canada). For these services, a supported connection is not required.

The Hub should provide enough information to equip the family with information about the services in the community that may be helpful to them, but not too much information so as to overwhelm the family. This will require a sensitive assessment of the family’s capacity, and how much stress they seem to be under, to make a judgement call about how much information is enough.

Family-Based Supports

SmartStart Hubs will connect families with family-based supports early, once a family has connected to a Hub (for example, before further assessments or while waiting for assessments/service).

These supports seek to empower families with information and resources to enhance their resilience and strengthen their capacity to support their children throughout their service journey and in planning for their future. For instance, they may provide strategies and resources for families to try at home.

Family-based supports will be offered using a strengths-based approach, recognizing and building on families’ existing capacities. Like Hubs services, these supports will not be diagnosis-specific and will take a good-for-all approach, meaning that they will be relevant to the majority of children and families, regardless of the child’s diagnosis.

SmartStart Hubs will deliver and connect families to supports as appropriate, based on their interest and level of need, assessed based on the information gathered at entry and/or during the exploratory conversation.

CTCs will leverage the existing family-based supports that they deliver to ensure families have access to:

• Information and resources to support parents’ understanding of the role of the Hub and what to expect as part of their service journey as well as information about funding and supports available to complete forms; and information about CTC, school-based and broader community supports and resources.
• Connections with other families, which may include supporting access to, individual and/or group peer mentoring or peer support, and/or parenting support groups (electronic and in-person) to promote family engagement, network and relationship-building and information-sharing to empower and enhance families’ resilience with a focus on safe, constructive and culturally relevant connections.

SmartStart Hubs will engage with families in the design, planning and implementation of these supports to ensure they are responsive to families’ needs and aligned to the child and family-centred, strength-based and evidence informed and equitable and culturally-safe approaches that form the foundation of the Hubs.

Examples of emerging evidence-based practices to support families that have been implemented in some communities are:

• A trained Family Engagement Coordinator who is a staff member and parent of a child with special needs who can offer a range of supports, including helping families connect with school, funding and community resources; facilitating parent groups; and managing a closed online group for families, so they are able share information and experiences; or
• A structured Family Engagement Program through which caregivers can have access to a wide range of supports including online parent support group(s); one-on-one and group peer support; workshops to help families with funding applications and processes; and family networking events.

SmartStart Hubs will also connect families to other local and/or provincial resources and supports:

1. F-words for Child Development training delivered by CanChild – available to all families, as a foundation to enable families to support and participate as partners in their children’s service journeys including in the context of goal setting, service planning and therapeutic interventions.
2. Partners for Planning (P4P)* information, resources and tools – P4P provides resources and tools for families that aim to empower people with disabilities and their families to plan for, and create a full life and, secure futures (e.g., Early-Years Toolkit, Planning Tip Sheets, Introduction to Registered Disabilities Savings Plan). Hubs will connect families of children with disabilities with the P4P Planning Network. they can access information, tools and resources, as early as possible in their service journey.
3. Other existing family-based supports (e.g., supports, training and educational workshops that may be available through the CTC or through other partner providers across sectors.)

Streamline Service Pathways

To ensure clear and streamlined pathways to SmartStart Hubs and seamless and supported connections from Hubs to services in the community, CTCs will partner with local service provider partners. CTCs and their partners will define and clarify service pathways and establish protocols and processes to share information (with consent), including information from assessments, between service providers. This will help to ensure – as much as possible – that families do not have to share the same information again with each new service provider or unnecessarily repeat assessments.

CTCs will lead community engagement efforts to build and/or leverage partnerships and share information with partners about Hubs functions.

CTCs will work with partner organizations to build capacity toward a common service experience across providers (based on the F-words for Child Development) and will work behind-the-scenes to streamline service pathways and related processes for families. For example, where possible, CTCs will work with other children’s service providers in the community to begin collecting information using the common tool.

CTCs will establish formal mechanisms for partnering with other organizations for streamlined and supported connections to and from the Hubs, as well as for the delivery of Hubs functions, where applicable (see Part 9 for more information about partnership requirements and roles and responsibilities).