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Speech-language pathologists (SLPs) meet children when they are very young, as signs of differences or delays in communication can be observed very early in development. And with research demonstrating an inverse relationship between early childhood trauma, attachment disruption and communication development, SLPs are in a unique position for early identification and referral to/collaboration with mental health services for these particularly vulnerable children and families.

At the George Hull Centre we are in the midst of a clinical research pilot, universally screening all clients entering the preschool speech and language program for potential trauma exposure. In this presentation we will share what we’ve learned from this research and clinical service in terms of caregiver’s experience of being screened, practitioner’s perceptions about screening, and impacts to service, as well as what this means for early identification of trauma and attachment disruption, early access to mental health services and advancing collaborative practice. We will describe the barriers and challenges that exist in the ideal implementation of this service, how collaboration benefits families and their interventions, and discuss the potential opportunities and extensions of this model of service.

While barriers and challenges still exist, undertaking this clinical pilot has shown what we believe is an opportunity for early identification, early access and integration of SLP and mental health practice, not just improving access to care but also the quality and effectiveness of both types of early intervention with potential to significantly change a child’s future.


Leticia Gracia, M.S.W., R.S.W., is the Director of the Institute of Childhood Trauma and Attachment at The George Hull Centre, a large, community-based children’s mental health centre.  Having worked with children and families for 25 years, Leticia has extensive clinical experience with a focus on treating trauma and attachment difficulties. Leticia has a passion for developing and implementing high quality clinical programs to treat the most complex of cases.  Leticia was instrumental in obtaining significant Innovation Grants from the Ontario Centre of Excellence for Child and Youth Mental Health to implement Dyadic Developmental Psychotherapy in the Community Clinic, and to develop a school-based socio-emotional learning program in partnership with the Toronto Catholic District School Board.  Leticia is highly respected by her colleagues and peers in the children’s mental health sector and her excellence in clinical leadership was recognized by the Hospital for Sick Children with the Elizabeth Manson Award (2017). She speaks nationally and internationally on trauma and attachment.

Elina Di Luca is the Director of the Community Clinic at the George Hull Centre for Children and Families, a children’s mental health agency in Toronto, Ontario. She has provided assessment and family/individual therapy for children with a range of social, emotional and behavioural issues, including many facing issues related to attachment and disrupted care. Elina has a Master of Social Work, and a Bachelor of Laws from the University of Toronto. She previously worked as a lawyer at the Children’s Aid Society of Toronto from 2002 until 2010.

Anna Rupert is a speech-language pathologist, health and social care manager, researcher, and consultant in Toronto. Anna currently works as the Manager of Special Projects & Program Design with the Institute Childhood Trauma and Attachment at the George Hull Centre. Anna holds master’s degrees in Speech-Language Pathology and International Health Policy from the University of Toronto and the London School of Economics, respectively. Anna’s research and consulting has focused on the inclusion of rehabilitation and social services in global health systems, health system funding and planning, and the relationship between early childhood mental health, childhood trauma, and communication development. Through her career, Anna has worked with a wide variety of clinical populations, in many different systems and practice settings. All of her work has been fueled by the belief that communication is central to who we are and at the core of the most important and protective factor in our lives – our relationships.

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