The medical staff at the Center for Pediatric Excellence is led by the medical director, Dr. Judy van Stralen. Dr. van Stralen works alongside two physician assistants and a family doctor whose practice at CFPE is focussed on ADHD. The medical staff’s role is to work with children, youth, and their families to complete comprehensive diagnostic assessments and create evidence-based treatment plans. The team sees patients not yet diagnosed and those with complex cases. To be seen by our medical team, we require a referral from your family doctor or primary care physician. Although we do offer specialty follow up care, your family doctor remains the primary care provider. Your family doctor is also sent an update after visits.
Treatment plans may include any combination of:
- Recommendations for further diagnostic assessments such as psychology, occupational therapy or speech therapy
- Recommendations for counselling and/or parenting support
- Provision of resources to support treatment
- Advocacy in the educational system such as letters of diagnosis and recommendations and assistance in advocating in the education system
- Medication including understanding medication options, doses and side effects
Medical assessments are usually covered by OHIP and are comprehensive assessments for ADD/ADHD, Autism (ASD), School difficulties, Motor/Coordination difficulties, Anxiety, Depression, Tic disorder/ Tourette and other behavioural concerns. Our clinicians will complete an assessment, make treatment recommendations, and complete follow up care. We will work with you to advocate for you and/or your child in all settings.
Here are questions we are often asked about our medical services along with our answers.
What ages do you see?
Although our clinic originally started as a pediatric clinic, it has expanded to include assessments and treatment for adults. For medical services, Dr. Michelle Mcbride is our family physician who predominantly sees patients who age out of Dr. van Stralen’s services. All of our psychologists will see adults for both assessments and treatment.
How do I schedule a medical appointment for my child?
Children and teens are referred to the Center for Pediatric Excellence for assessment by their family doctor or primary care physician. We triage the referrals we receive and will notify your family doctor about whether or not we can accept the referral as well as the anticipated wait-time.
Do appointments require a doctor’s referral?
Yes. Appointments that are covered by OHIP require a referral from your family doctor or primary practice physician. As we are consulting specialists, your family doctor remains your primary contact for all other issues. The referring doctor will also be updated with respect to appointments, diagnoses and treatment plans so that there is a continuum of care.
What do I do once I’m on the waitlist?
One of our staff will be in contact when we are able to schedule an appointment for your child. In the meantime, if you are looking for advice or recommendations, family doctors are always welcome to contact Dr. van Stralen either directly or via e-consult. Unfortunately, we are not able to provide advice directly to patients or parents until you are seen at CFPE.
What to expect before my child’s first appointment?
Closer to your appointment time, our administrative assistant will contact you to complete questionnaires. Your appointment will not be scheduled until the questionnaires are completed. If, for any reason, you are not able to complete the questionnaires please contact the office for further instructions. Completing these questionnaires in advance allows us to ensure we have all the information required and maximize the time spent with the clinicians.
How long are appointments?
Initial appointments are approximately 90 minutes- please be sure to schedule accordingly. Sometimes we are not able to complete all the assessment at the first appointment. Follow-up appointments are 15-30 minutes unless otherwise indicated by your clinician.
What to expect at my child’s first appointment?
Initial assessment appointments with Dr. van Stralen are booked for 90 minutes. In most cases you will first meet with a physician assistant who will begin the intake interview, review all the questionnaires and in some cases provide some education. They will then review this information with Dr. van Stralen along with the additional questionnaires and school information provided. Finally, your care team including Dr. van Stralen, a physician assistant (Gabrielle Culka or Katrina Pullia, you, and your child will develop a treatment plan.
What to expect at follow up appointments?
Follow up appointments are considerably shorter than the initial assessment. In most cases one of our highly trained physician assistants will begin the intake interview. We ask parents and children to consider their goals of treatment and goals for the appointment. Being prepared with this information can make the most of the appointment time. When seen by a physician assistant, all treatment plans are reviewed with Dr. van Stralen. After that, the time spent directly with Dr. van Stralen will depend on the individual patient situation.
What is a Physician Assistant?
A Physician Assistant (PA) is an advanced health care provider who works under the supervision of a physician. PAs can collect medical histories, perform physicals, order and interpret investigations, diagnose, and create treatment plans. At the Center for Pediatric Excellence PAs will also perform diagnostic assessments, discuss treatment options, and prescribe medications. Our PAs are invaluable resources that allow CFPE to expand the number of patients we can accept into the clinic, shorten waitlist times, and conduct clinical research trials. Dr. van Stralen has worked in a number of different health care models. She researched different international models of care delivery for ADHD and integrated PAs based on a program in Scotland which was shown to improve access to care and outcomes.
Do the doctors only prescribe medication?
No. Medication is only one of the tools we use. Depending on the case, medication may not even be part of your child’s treatment plan. Our clinicians also provide non-pharmacological resources including:
- Referrals to other clinicians, like psychology and occupational therapy
- Books, websites, and virtual programs
- A list of local resources for support
- Information to advocate for school accommodations
Psychotherapy and other talk- or skills-based treatments are not usually done by physicians and are not covered by OHIP, but we can certainly make referrals for these services.
If my child is prescribed medication, will it be covered?
If you have private insurance, most medications prescribed by our physicians will be covered by your insurer. If you do not have private insurance, children and young adults in Ontario have prescription coverage until the age of 25 through OHIP+. To see a complete list of medications covered by OHIP+ click here. Should you ever have any concerns about coverage, please discuss this with our clinicians.
Are medical assessments covered by OHIP?
In most cases these assessments are covered by OHIP. A valid health card number must be provided at the time of assessment. If there is no valid OHIP number, fees are the responsibility of the patient/family and are billed according to the Ontario Medical Association uninsured services fee recommendation.
Does Dr. van Stralen become my child’s doctor once they are referred?
No. Your family doctor or primary care pediatrician is still the main contact for your child in most urgent situations. Your child will continue to see their family doctor or pediatrician for any medical care not related to the issue for which your child was referred. Physicians at the Center for Pediatric Excellence will provide regular written updates to the referring doctor and will eventually refer your child back to their referring doctor with recommendations for ongoing management.
How long will Dr. van Stralen follow my child?
Dr. van Stralen and the medical team will continue to see your child until they are stable, or they turn 18. At that time, they will be referred back to their family doctor for on-going care. In some circumstances, Dr. McBride, our family physician, will provide care for older teens or more stable children and youth.
How do I know if I need a medical assessment or a psychology assessment?
There is some overlap in services provided by our medical and psychology teams. For example, both can do diagnostic assessments for ADHD and mental health concerns. Medical assessments can screen for learning disabilities and strengths and weaknesses but cannot diagnose them and cannot provide counselling services. If needed, the medical team will recommend resources and/or refer your child to a psychologist. Because the Center for Pediatric Excellence is a multidisciplinary clinic, in many cases we work as a team. This means that your child may see more than one clinician (i.e. psychologist, occupational therapist, and/or physician). Medical services are covered by OHIP. Psychology and occupational services are not covered by OHIP but may be covered by private insurance.
Can assessments and follow-up appointments be done remotely?
Yes, in many cases. Most of the time, the initial assessment is done virtually through video conferencing. You will receive an email with a link from the Ontario Telemedicine Network in the days before your appointment. For follow-up appointments, the team will take into consideration their initial assessment, the necessity to do any in-person assessment(s), and your preference in booking virtual or in person appointments. If you have a preference for a delivery of care please make sure we are aware of this, and, where appropriate, we will attempt to provide services this way.
Can you provide video assessments and follow up outside of Ontario?
No. Our physicians are licensed in Ontario and health care is provincially funded.
You say you are a multi-disciplinary clinic. Does that mean my child has to see every discipline at the clinic?
No. The benefit of a multi-disciplinary clinic is that we have multiple types of services and professionals under one roof. This allows us to collaborate more easily with other professionals who are a part of your child’s care team and to share electronic medical records. For example, if your child has a psychoeducational assessment done then the medical team will offer to attend a joint feedback session with you, your child, and the psychologist to ensure the best integration of care between disciplines. The clinicians will make recommendations for other services on a case-by-case basis. You can choose to have these services at the Center for Pediatric Excellence or elsewhere.