Persistent Concussion Services at Holland Bloorview: Building Evidence-based Practice for Youth with Concussion


  • Nick Reed
  • Andrea¬†Hickling
  • Sabrina¬†Agnihotri
  • Shannon Scratch


  • To review concussion clinical services at Holland Bloorview
  • To provide a comprehensive overview of an interdisciplinary team assessment pathway for youth with persistent concussion symptoms and their families
  • To detail the health economics and utilization of the Persistent Symptoms Clinic


Goal: The Persistent Symptoms Clinic at Holland Bloorview is the only publicly-funded service of its kind in Ontario. We will outline our service delivery model and unique interdisciplinary approaches for providing care to youth with persisting symptoms post-concussion. Particular emphasis will be placed on outlining our novel interdisciplinary team assessment pathway and a health economics/utilization analysis of the clinic.

Presentation 1:An overview of concussion services at Holland Bloorview
Presenters: Dr. Nick Reed, Ph.D, MScOT, OT Reg (Ont), Dr. Shannon Scratch, Ph.D., C.Psych.

This presentation will discuss the development of the clinic and our current practice within the context of the Ontario Neurotrauma Foundation (ONF) Standards for Post-concussion Care, as well as recent Canadian legislative changes. Case studies will be reviewed and preliminary data discussed.

Presentation 2:Pathways for progress: The impact of an interdisciplinary team-based assessment for youth with concussion and their families
Presenters: Andrea Hickling, MScOT, OT Reg. (Ont.), Dr. Shannon Scratch, Ph.D., C.Psych.

This presentation will begin with a comparison between multidisciplinary and interdisciplinary practices. The rationale and model for the novel interdisciplinary team-based assessment will then be described, as well as current utilization in practice and the inclusion/exclusion criteria. Preliminary results from a study that explored the experiences and acceptability of this pathway for youth with concussion and their families will also be discussed.

Presentation 3: Healthcare costs and utilization associated with assessment and treatment of persistent post concussive symptoms in a pediatric population in Ontario, Canada
Presenters: Dr. Sabrina Agnihotri, Ph.D., Dr. Shannon Scratch, Ph.D., C.Psych.

This study was the first to examine the healthcare costs of youth with persistent post-concussive symptoms. Using a retrospective chart review, this study aimed to: (1) describe the demographic and clinical characteristics of clients and families accessing the Persistent Symptoms Clinic at Holland Bloorview; and, (2) conduct a multidimensional assessment of healthcare costs and utilization. Preliminary results from this study will be discussed as well as potential healthcare system implications.

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