Health Committee on Oct. 3rd, 2024

[The Chair, Liberal, Sean Casey]

He's right; his speaking time is up. Please answer the question briefly, if you could.

[Miriam Beauchamp]

Thank you.

Regardless of where a person comes from, their training or origins, the standardized training and knowledge that we have is beneficial to everyone.

[The Chair, Liberal, Sean Casey]

Thank you very much.

Next is Ms. Sidhu online for five minutes.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Mr. Chair.

Thank you to all the witnesses in this meeting for sharing your experience and knowledge on this important issue.

My first question is for Ms. Pilon.

Following on something that Professor Beauchamp mentioned, what role do you see peer and community support programs playing in a national strategy on brain injuries? What are the best ways to foster that peer support across Canada?

[Elisabeth Pilon]

That's a great question.

Right now I'm reaching out to different peer support programs across the country and in Alaska to understand how they offer the services they offer so we can learn from each other. This way, I can learn from them and continue to improve the services that I offer here in Yukon.

First of all, peer support offers a way of understanding each other with a sense of belonging without having to do the labour of explaining, as I mentioned before, and being able to share the resources and the learnings that we've all accessed in our own journey. That impacts us by giving us a sense of belonging and psycho-education about what's happening to us, as well as different resources, and it's very empowering.

I imagine different peer support networks across the country, and I imagine us all collaborating, with Peer Support Canada being a great model. They trained me in what I'm doing and are mentoring me in my peer support as well. I believe there is already good infrastructure for peer support and for how we can continue to come together, provide feedback, provide experience and experiential data and share our stories to inform all of the directions that things can possibly go.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you.

My next question is for Professor Beauchamp.

Professor Beauchamp, what kind of training do frontline staff need to recognize the signs of brain injury among the most at-risk groups?

[Miriam Beauchamp]

It's a great question, because I think there are different levels of training that we can offer and standardize through this national strategy. Obviously, health professionals and physicians will have more in-depth training in terms of diagnosis, but there are a lot of initiatives at the moment across Canada to offer, for example through massive online courses, training for people who don't have medical expertise or health expertise. These are things that we can come together and collaborate to standardize for people.

I'm thinking here, obviously, in a sports context, of coaches, but also, as somebody mentioned, teachers. This could include teachers, after-school care workers and educators, for example. I mentioned that my work focuses on young children, so this would include day care workers and day camp and summer camp workers. All of these people can be trained to at least recognize when a significant event has happened that could lead to head injury. For many people, it doesn't even cross their mind.

Now we can offer standardization of training for these people.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you.

My next question is for Ms. Biagioni.

I appreciate that you brought up the connection to the issue of intimate partner violence. The Public Health Agency of Canada and other federal health departments have been working to provide funding to support women survivors of gender-based violence who are experiencing traumatic brain injuries.

What more do you think can be done to expand those initiatives?

[Janelle Breese Biagioni]

Thank you. That's a great question.

Again, there's training and education so that the person who's coming in contact with that individual would be able to ask some questions. Also, it's helpful to have people in the public with the ability to understand why this woman may be struggling with different challenges in her life, whether it's parenting, getting to work or keeping her appointments. That public education and awareness can help lead to some pertinent questions that could help link her to services.

I think another critical point is to understand.... A small study was done in Victoria with the Cridge Centre for the Family that looked at the abusers in the intimate partner violence. What they discovered was that the number of abusers who had a brain injury was 100%. Again, it's that prevention, education, awareness, and then providing intervention. We can prevent intimate partner violence by providing those interventions, both for the women so that their life will be thriving, and also for the men and/or women who are the abusers and have a brain injury. We have to have that as one of the pillars.

[The Chair, Liberal, Sean Casey]

That's your time, Ms. Sidhu.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Mr. Chair.

[The Chair, Liberal, Sean Casey]

Next we have Dr. Ellis, please, for five minutes.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Thank you very much, Chair.

I am going to split my time with Mrs. Goodridge.

I have one quick question for you, Mr. Fleiszer. I guess there are two parts. When you look at the research being done in Canada, how do we compare with the rest of the world? I know you talked about some partnerships. Second, I know Ms. Biagioni talked about the incredible prevalence of intimate partner violence and head injury. Certainly, the prevalence is way more than in professional sports. Is the research that is coming out transferable knowledge to other forms of head injury? How are we doing, and is there a transfer of knowledge? Thanks.

[Tim Fleiszer]

I'm proud to say, as a Canadian, that some of our researchers are among the world leaders on this issue. I mentioned specifically the work that's being done at CAMH, looking at radio tracers and PET scans to be able to diagnose chronic traumatic encephalopathy in vivo, which is game-changing when thinking about people who are potentially affected by that disease. It's not just athletes, but also military personnel and survivors of accidents and violence. This is important research for all those different folks affected by brain injury.

I was able to tour Dr. Beauchamp's lab a couple of months ago. Some of the work that she's doing with the pediatric population, again, is world-leading in terms of how we think about that.

There's the work at the Canadian Concussion Centre, which is part of our global brain bank, where they're doing autopsies and looking at CTE. Again, they're leading the world in this.

That being said, I will advocate on behalf of our researchers. These folks are doing a lot with a little bit, especially within the context of our neighbours to the south. We work very closely with our U.S. chapter. Obviously, they're dealing with much more resources. However, I'm very proud to say that Canada is absolutely a huge contributor on a global level, and this research is absolutely applicable not just to athletes, but to anybody who's exposed to brain injury and repeated head impacts.

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

I would like to turn to Ms. Beauchamp.

I am a mother of two little boys, who are one and three years of age. You talked about the importance of research on head injuries in children under the age of five.

What do you tell parents to help them monitor their child after they have suffered a head injury so they know when to seek further assistance, go to the hospital or see a doctor?

In many cases, parents don't know what has happened when their child is in crisis. How can parents tell if their child has suffered a head injury and if they need to go to the hospital?

[Miriam Beauchamp]

Thank you for the question. I am also a mother of three. That is where my research work and personal life intersect.

That is a very important question because we need to use very different approaches for young children as compared to older children. A two-year-old can't verbalize what has happened to him or what he feels. A two-year-old can't say he has a headache, for instance, that he feels dizzy or confused.

Just last week, our lab launched a whole series of free tools that we have developed specifically for that population. We give parents and educators tools so they can recognize what's happening by observing the child's behaviour.

If a two-year-old has a headache, for example, he might rub his head or hold his head to show that it hurts. That is just one example, but I think it illustrates the need for different tools at different ages. It underlines once again the complexity of concussions and head injuries.

So we absolutely need a plan and tools for everyone, for all ages. We need different strategies and different tools for all ages, and that requires us to develop, validate and implement them in a clinical setting.

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

Just to have a little on the record in English, are there any resources out there right now for parents with young children to be able to recognize the signs, so they know how to best respond to a potential brain injury?

[Miriam Beauchamp]

I mentioned that we just launched a website that is outward-facing, toward the community, and that has free resources, including a concussion detection tool. It is not a diagnostic tool, but a tool that educators, parents and other significant adults in a young child's life could use to recognize that there might be a worrisome hit to the head or body that could lead to a concussion.

This is work that we've done in Quebec and that we want to disseminate widely, but obviously having collaborations and some strategy nationally would help us to bring those things together and to share them more efficiently.

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Beauchamp.

Next we're going to go to Dr. Hanley, and I think he's splitting his time with Dr. Powlowski.

Dr. Hanley, you have the floor.

[Brendan Hanley, Liberal, Yukon, YT]

Thank you very much. Mr. Chair, I lost my stopwatch, so maybe you can remind me when I'm halfway through.

I have two quick questions.

Mr. Fleiszer, I have a 16-year-old in grade 11 who, to my surprise and somewhat concern, both from my worried parent half and also from my emergency physician background, signed up for the high school football team in grade 11. I'm thinking, of course, of ACL, shoulder dislocation and brain injury.

Maybe you could just briefly reflect on what the best practices are. Are there best practices available for high school football and related sports like rugby?

[Tim Fleiszer]

It's a great question. The way I'll answer that question is that we need to make sure that the coaching staff is paying attention to the total number of impacts that these young players are receiving during the course of the season. One of the things we've been able to figure out in football is that 75% or 80% of the impacts that athletes were receiving were happening in practice. We've counselled football teams. It is good to hear that your son waited until he was a teenager and his brain and body were more developed to be able to better handle the contact.

When it comes to the practising, how they actually practise the games, coaches have gotten much better at coming up with drills where they're minimizing the total number of impacts that are happening. Rather than doing one-on-one blocking, they are using sleds or bags to simulate that blocking and to work on technique, really trying to limit the amount of live action that happens in practice. You need to have some of it to prepare. You don't want to take a kid and put them in the game where they're seeing live action for the first time. There does need to be some of that. Coaches ask, what is the right amount? The answer to that question is to minimize it and use contact only when they absolutely need it and when they truly need to teach a technique that is going to be directly applicable to the field. If your coaches are doing that, you'll have reduced the head injury risk by 75% or 80%.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Fleiszer.

Ms. Kayabaga, you have two and a half minutes.

[Arielle Kayabaga, Liberal, London West, ON]

Thank you, Chair.

I want to echo my colleagues' comments and thank our witnesses for being here today.

A number of people have mentioned the socio-economic impact that is connected, as well as the opioid crisis, and we're seeing people who are living rough. Can you describe how you're able to detect that most people who are on the street have a brain injury? What do you think we, as legislators, could do with that information to improve the experience of people who are experiencing this crisis?

Maybe I'll start with Ms. Breese Biagioni, and perhaps Ms. Pilon could also comment.

[Janelle Breese Biagioni]

What we know is that over 50% of the people who are homeless have suffered a brain injury, and over 70% of that group became homeless after their first brain injury. There's a significant cost to every municipality, province and the country in general in trying to address the situation. I honestly don't think people would get there if we were able to provide peer support, counselling and day-to-day interventions when their injury happened. They wouldn't be spiralling down.

As to what that's costing the country, you would know better than I. That's a really good question. I just know that inaction is far more expensive than taking action. Right now, so many things are very reactive as opposed to being proactive. If we could take some proactive measures, those numbers would come down.