What is the Complex Care Program?
The Complex Care Program is a coordinated, comprehensive and collaborative model that is designed to fit each patient’s unique needs.
Complex health needs may include:
- Diagnoses that involve lots of body systems.
- Utilizing multiple services and specialists in different locations such as the hospital, home, or school.
- Taking many different medications.
- Often relying on medical technology (such as feeding tube or oxygen) in day to day living.
- Frequently visiting the emergency department or being admitted to hospital.
What we do
The Complex Care Program provides centralized, full-service care, closer to home. We have multiple Complex Care clinic sites that will help oversee your child’s health care needs and partner with you and any health care provider involved in your child’s care.
We are part of the Provincial Council for Maternal and Child Health Complex Care for Kids Ontario strategy to advance province-wide access to integrated medical care and coordination for children with the most complex chronic health care needs.
Expand each section below to learn more about our services.
We will review your needs and work with your family and your child’s other healthcare teams to create a Complex Care Plan. The plan will include your child’s medical information and can be easily shared with other health care providers involved in your child’s care.
We will help develop short- and long-term health care goals with your family to ensure care plans meet your family’s unique needs.
We will provide your child’s health care providers with their Complex Care Plan. This will help ensure your child’s needs are communicated consistently and your child is getting the right care at the right time. When possible, the Complex Care team can help with organizing tests, procedures, and appointments. You will have access to a Patient Information Coordinator who can assist with this.
We will get to know your child and family and will provide support throughout your child’s health care journey.
We will help your family make informed decisions about treatments and plans of care.
We will be there when you need us. Call or email the Paediatric Nurse Practitioner in between visits for any questions or concerns about your child’s health. A Nurse Practitioner is available Monday to Friday during regular business hours.
The SickKids inpatient Clinical Nurse Specialists will collaborate and communicate with the team taking care of your child as well the Nurse Practitioner and Complex Care Physician.
The Complex Care Program is made up of a group of staff paediatricians with an expertise in caring for children with medical complexities.
Advanced practice nurses will be the primary point of contact for patients and families who will work with you and your child to identify and address the medical needs along with clinical nurse specialists, social workers, pharmacists, dietitians, occupational therapists, physiotherapists, information coordinators and a clinical director.
- Kate Langrish – Clinical Director
- Dr. Julia Orkin – Medical Director
- Joanna Soscia – Nurse Practitioner and Clinical Practice Lead
Educating the next generation of healthcare professionals
The Complex Care Program benefits from a strong relationship with Canada’s leading post-secondary institution. Below, learn who shares teaching, assisting and lecturing duties at the University of Toronto, plus other valuable instruction roles in the Department of Paediatrics and Lawrence S. Bloomberg Faculty of Nursing, respectively.
Expand the sections below to find a list of our associated educators.
- Dr. Eyal Cohen – U of T Professor – Department of Paediatrics
- Dr. Jeremy Friedman – U of T Professor and Associate Chair (clinical) – Department of Paediatrics
- Dr. Julia Orkin – U of T Assistant Professor – Department of Paediatrics
- Dr. Carolyn Beck – U of T Associate Professor – Department of Paediatrics
- Dr. Stacey Bernstein – U of T Associate Professor – Department of Paediatrics
- Dr. Trey Coffey – U of T Associate Professor – Department of Paediatrics
- Dr. Zia Bismilla – U of T Assistant Professor – Department of Paediatrics
- Dr. Sanjay Mahant – U of T Associate Professor – Department of Paediatric
- Dr. Michael Weinstein – U of T Associate Professor – Department of Paediatrics
- Sherri Adams (NP) – U of T Adjunct Lecturer- Lawrence S. Bloomberg Faculty of Nursing
- Joanna Soscia (NP) – U of T Clinical Adjunct Appointment - Lawrence S. Bloomberg Faculty of Nursing
- Cathy Daniels (NP) – U of T Adjunct Lecturer - Lawrence S. Bloomberg Faculty of Nursing
- Michelle Ho (NP) – U of T Adjunct Lecturer - Lawrence S. Bloomberg Faculty of Nursing
- Katharine Williams – U of T Adjunct Appointee to the Lawrence S. Bloomberg Faculty of Nursing
- Lianne Dulsrud – U of T – Ajdunct Faculty - Lawrence S. Bloomberg Faculty of Nursing
Electives are available for residents and fellows with the focus on learning about holistic care delivery incorporating the bio, psycho, and social domains, during routine scheduled clinic visits, acute care clinic visits, home visits and hospitalizations. For information on electives for residents, please see the University of Toronto's Core Paediatric Residency Program.
The complex care fellowship is under the Division of Paediatric Medicine and fellows can select a clinical focus in complex care through the community paediatric, academic general paediatric and departmental fellowship programs. For information on a fellowship in complex care, please visit the Paediatric Medicine fellowship training program page.
Jason Buera, Complex Care
The late Dr. Norman Saunders started The Complex Care Program in March 2006 to help children and families with rare or undiagnosed complex chronic diseases. He recognized that these patients and families faced insurmountable challenges, and the structure of the prevailing system was not serving their needs well.
While each patient had a unique circumstance or underlying disease, together, they had many unifying characteristics – complex, chronic conditions – a reliance on assistance from a technological device like a feeding tube, disability and functional impairment, an endless list of medications, and the need for intensive care co-ordination. Their families were tasked with the challenging duty of keeping it all together so their children could receive care by many different health care providers in many different places over time.
The Complex Care Program provides holistic wrap-around care for children with medical complexity, and their families. Our program leverages partnership with parents and families to provide goal-oriented, clinical care and a medical home for children who are technologically dependent, with multiple medical needs.
Working in collaboration with satellite partners, we have grown to include seven satellite clinics (Michael Garron Hospital, North York General Hospital, Credit Valley Hospital, Orillia Soldier’s Memorial Hospital, Royal Victoria Hospital, Peterborough Regional Health Centre, and Timmins Hospital) and care for over 500 children across the region.
We are a partnership program with Complex Care Kids Ontario, developing standards and clinical pathways for children with medical complexity.