Margaret, not sure if you want to do this as a separate chapter, or just leave it here to die a natural death on the board. Our system is the same in some general ways, but different in some important ones, so I thot I'd jot some notes re how to approach accessing services for Cdn difficult children. START WITH YOUR FAMILY DOCTOR: As a parent, you have general and specific concerns about your child. Educate yourself, make notes if necessary re the child's problems in school, church, group activities, wherever, and share that with your gp. This is a visit where you might not want your difficult child with you. Ask your gp his/her experiences with behaviour disorders, and request your difficult child get a full physical work-up. This will likely include a lab visit, for blood & urine samples to check for thyroid function, blood sugar levels (diabetes), etc. If you suspect that food or environmental allergies may be the source of some of your child's difficulties, ask for allergy screening. If there is incidence of seizure disorders in the family, ask to be referred to local hospital for a sleep-deprived EEG. PHYSICAL TESTS ARE IN - NOW WHAT? This is where you & your gp are going to discuss where to be referred next. If any of the tests are positive, then you're going to need a general pediatrician, or a specialist in the area in which the test results raise questions. Deal with any physical indications first. But what if "all" the tests prove, is that you have a very healthy but still challenging child? Stop and give thanks for your child's physical health. Now, you and your gp can look at resources in your community. If, at this point or earlier, your gp has proved to be not cooperative or indicates that s/he does not agree with your approach, get a new gp. Remember that most, but not all, of your gp's referrals will be covered under your provincial health insurance. Some psychologists, therapists and counsellors will be considered non-medical services, and will not be covered. Psychiatrists will generally always be covered, just as if your gp had referred your child to a surgeon for a tonsillectomy. When in doubt, ask. If you are being referred to a psychiatrist in private practice, ensure that his/her specialty is in at least pediatrics, if not behaviour disorders. Ideally, you want both. A private psychiatrist specializing in teens with eating disorders, or helping adult survivors of child sexual abuse, is a long shot for helping your difficult child. Many teaching hospitals or specialized regional childrens' hospitals will have either an ADD/ADHD or a mood disorders outpatient clinic (BC Childrens' has both). Request, if geographically handy, a referral to a psychiatrist at one of these clinics, even if you think your child doesn't specifically have ADD/ADHD or a mood disorder. difficult children often have an overlap of one or more of these diagnoses, and the staff in these clinics will know what to look for when evaluating your child's behaviour. DEALING WITH THE SCHOOL: You will want your child's teacher's help, and without his/her enthusiastic assistance you aren't going to get very far. The attitude of "your" principal is also important, since an unhelpful principal will stonewall the efforts of all but the most determined teachers. At the board level, you will need to speak with the director of special education. Depending on the size of the board, this person may handle all special needs by him/herself, or may have a staff focussing on individual areas of expertise. Your provincial ministry of education is an invaluable resource. The government of BC maintains a website from which you can download various "chapters" of education policy. Access, print and thoroughly familiarize yourself with the portions that apply to your child - likely these will be those sections dealing with special needs, and Individualized Education Plans (IEPs). Note that giftedness may be included under special needs, but that the general focus of special needs tends to be on assisting children who are behind the learning curve, rather than ahead. At this point, though, your focus is likely to be more on addressing the behavioural aspects of your child's school experience, rather than the academic. It took our family some time to realize that equipping our son with the tools he needed to simply get through an entire day at school, was imperative before worrying about what he was learning there. In a perfect world, all children would have an IEP geared to their unique needs and learning styles and abilities. In the real world, though, be prepared to push for your difficult child's IEP. Your initial request should be to your child's teacher, who should immediately agree. The suggestion will then be taken, by you or the teacher depending on your school's procedure, to the principal and/or the learning assistance teacher. They then arrange with the appropriate board staff, to form a meeting. The minimum attendance at this meeting should include your child's primary teacher(s), any learning assistance or resource room staff located at that school, the principal, someone from the school board's special education department, your child's other parent/step-parent etc., and you. Depending on who else your child has been involved with in the school or in the community, it may be appropriate to invite the school board's psychologist, your social worker, the school counsellor, etc. If your child's class has a teaching assistant or teacher's aide, that person should also attend the meeting. The IEP process in Canada is much like that in the US, so please refer to the material elsewhere in this book. The parents are an important partner in the process, and be prepared (with your well-thumbed and annotated copy of your province's education policy) to negotiate until you are satisfied with the end product. Format for the IEP may vary from one jurisdiction to another, so ask for a blank copy of the form at least a few days prior to the meeting, so that you are able to formulate some ideas. Your "idea session" should culminate in a working draft IEP, on which you, the school, and the board all agree in principle. You should know when you will receive your formal copy for signature, and remember to check it once received, against the draft. Do not sign the IEP if you feel an error or omission has been made. Do not sign the IEP if you do not know how or when progress will be checked against the goals outlined. If your child's school is not supporting this process, your next step is to escalate your request to the school board level. Your first call should be to the special-needs staffer involved in your IEP process. If that person is also stonewalling your requests, or you feel progress towards an IEP is not occurring, then go to his/her supervisor, typically the director of special education. If a reasonable request is still not being met, take your concerns to the superintendent; if s/he is not responsive, try the chairperson of the board of trustees. Remember that in most jurisdictions, this is a locally elected board, and while your trustees may not be specialists in your child's needs, they certainly have an interest in serving a voter! Your last recourse is the provincial minister's office. If you find you must take your request to this level, try to enlist the help of your MLA/MPP, to ensure that your correspondence is seen at the level of the minister's office, and not waylaid somewhere in mid-bureaucracy. The minister's office is not actually equipped to put services in place for your child, but they are ideally suited to place pressure on your local board superintendent to do so, or explain why policy is not being followed.