Celebrating Success: Breakthroughs
for Children with Sensitivities

Heather Holden
Learning Disabilities Association of Ontario
Dr. Bill Mahoney
Special Education Representative, Ontario Medical Association
Ian C. Morton
Ontario Lung Association

Moderated by
Bruce Small, Green Eclipse
representing AEHA-Ottawa

National Conference on Children with Sensitivities
Allergy and Environmental Health Association of Canada (AEHA)
Ottawa Branch

Ottawa, 31 May, 1 June 1996

Greg Booth, President
Allergy and Environmental Health Association:

Unless we get on with prevention of this terrible disease, we're never going to get on top of it. Each of us needs to take control of our lives, families, workplaces, and get these prevention aspects to happen. Without that you can have all the clinics across the country but you're not going to get there.

One of the interesting things I saw on TV a few days ago was Robert Kennedy Jr. on national TV in the United States talking about pesticides and their overuse and urging people to get pesticides under control and to reduce their use and eventually to do away with their use.

Perhaps one of the things I'd like to encourage AEHA Canada to do next year is to invite a high profile TV person who will give us the TV coverage we need - a person like Robert Kennedy Jr. - to come to our meeting and to get the media coverage that these experts we have deserve. Then the rest of the public could become as knowledgeable as we are on the things that need to happen particularly in the prevention field. Without prevention we're never going to make it. I hate to say that but we're not. Some of us will, but most will be going down the tube.

Bruce Small has been a key figure in the development of the indoor air quality movement in Canada since the late 1970s. He has done pioneering research on low indoor pollution design, both for the general public and for individuals who are hypersensitive. As a co-founder of Green Eclipse Incorporated, he has recently established and launched the Envirodesic™ certification program. Bruce is also the author of several publications, the most recent being Environmental Hypersensitivity in the Workplace.

Bruce Small
Green Eclipse Incorporated:

This is where we get to remind ourselves that the whole theme of the conference is "Celebrating Success". I have the honour of introducing some people here who will tell you what successes have been made, and I just wanted to say in overview that we're talking about success not only in terms of healing individuals and bringing them back to health, but in healing us as a community and in healing the structures and the system that we're working with that may have given rise to some of these problems.

Those of us who have been in the field for a long time know that there is now considerable momentum and that there have been massive changes, in many ways, over the years, no matter how much we look forward to more things changing. This is the part of the conference where we'll focus on the success and the positive things that are coming.

Heather Holden has three children with sensitivities, two of whom have learning disabilities. She has been involved with the Learning Disabilities Association at the chapter, provincial and national levels. She has been instrumental in obtaining accommodation for students with environmental sensitivities at the Halton Board of Education and she has assisted with the development of its environmental hypersensitivity policy.

Dr. Bill Mahoney is Chief, Developmental Assessment, at Chedoke-McMaster Child and Family Centre in Hamilton. Clinically he works with children with language, learning and attentional problems. He also represents the Ontario Medical Association on the Ontario Advisory Council on Special Education.

Ian Morton is a personal friend. He has been involved in various environmental activities over ten years or so. Many of you know him as the Director of Environmental Health Programs for the Ontario Lung Association. In that capacity he co-authored The Air We Breathe program. He's created Better Breathing Month and he's written numerous technical and educational reports addressing environmental issues. Most recently he conceived and directed the C.A.N. DO program - the Movement for Clean Air Now.

Heather Holden
Learning Disabilities Association of Ontario:

I guess you'd like to know "What's so great with Halton?". I'd like to give you some background on the program in Halton and how we actually developed a policy that somewhat entrenched the service to these kids in our board. In 1985 a group of parents made a presentation to the Special Education Advisory Committee of the Halton Board. As a result, two Board committees were created.

Parents like myself have been an integral part of those committees since 1985. Many things that happen in education happen internally from education. Other than those that are mandated by law, school boards do things that they think are good things to do. This is a project that clearly came from the community. The interesting thing is that we now see it in the board, being carried and pushed forward by the board. That is very different from many things that happen in education. They usually come from within and stay within and this came from the outside to the inside.

The second step, a crucial step, was that a member of the Allergy and Environmental Health Association was appointed to be a member of the Special Education Advisory Committee (SEAC). It is crucial to have someone on the Special Education Advisory Committee who actually represents the children of parents of this association.

From 1986 to 1989, there were a number of things that went on in the board. A survey was sent to all Halton Schools to identify how many kids out there might be suffering from sensitivities. It was carried out not just by the board but in conjunction with the medical officer of health. We were searching for partners, looking to give this, as a health issue, credibility.

There was a pilot study done over a two-year period. We focused on one child, a child with very significant severe difficulties, trying to keep that child in school. It was extremely successful.

We looked at maintenance practices. We looked at cleaning products. We looked at air filters. We gave in-service training as part of Professional Development Days for teachers; we gave professional development on this topic.

Our board's staff attended conferences. They went to the Waterloo Board and investigated what was already happening.

So in that period of time there were a number of initiatives that were going on, which brought us to January 1989 when the board actually passed a policy. You have to recognize that in education for those things to happen when there is no policy, they happen somewhat because of people's good will. When you actually put a policy in place, it gives the whole issue credibility and it says these things we do and we do them because the policy says we do them, and so you move into a very different form of functioning.

The policy did a number of different things. It set up actual teams of people. Halton is a very large Board geographically and it set up teams of people who actually could support schools trying to work with families and children with this problem. We designated a Kindergarten to grade eight school as our elementary school, and one secondary school as what we call our designated schools for children with environmental sensitivities.

For our secondary school, because we had difficulty finding space, we decided that we would design a portable, which was done with the assistance of Bruce Small to assist that secondary program.

The work over those years showed us two things. For anyone here from school boards, the first thing was that for the most part the needs of these children can be met through regular budget lines. The needs of these children do not cost astronomical dollars over and above anything else.

When you compare it to the other things you can do for children, such as providing home instruction programs for the rest of their education, it's a very cost-effective way of doing things.

For me, as a parent, the other thing that it says is that you can change attitudes, but that it does take time. Being somewhat of a trailblazer with my board, as a parent you often find that the trails you are blazing for your own child, that child does not always reap the benefits of your work, and it's because you clear the path for someone else, that those who come behind you will walk a much easier road. And I think that we should not be discouraged that the changes we are making are not always for our own kids. We're making changes here for the world. You take a long-term view of the problem.

However, in saying that, when I sit on our board committee and the staff from the secondary school come in and say "Well how many kids are we actually working with?", and the school staff says we found a child, it says to me that we are moving this torch from ourselves over to the school staff, and they are identifying children, bringing children into the program, bringing information to parents, and parents are then going out and seeking some medical support.

So it has taken it from out in the community into the schools with us sort of pushing it there, but now it looks as if, in some respects, that torch is being taken up with a very high level of awareness within the school.

Twenty-five years ago families who had children with learning disabilities were facing exactly the kind of barriers that you are facing today. Attitudes have changed for them and they will change for you. But in education let me tell you, there's a reality about change. It's slow. It comes in very small steps. You cannot mandate it by law, although sometimes that does help.

Change really comes with a change in attitude, but that only comes with understanding and caring, and you can't make them do what they don't want to do. Halton Board is not perfect.

I'll tell you a story. I have a younger son who was in the elementary designated school. We were having great concern because he was going to have to be in a portable for one year. They promised me: "We'll put air filters in. We'll let you pick the portable, Heather." You go to this big field and there are twenty portables. We took our son and we walked through every portable and we picked the one we thought most suitable - two windows, two doors, doesn't smell. They brought it on site. Remember we had picked a portable with two doors for cross ventilation. Most portables have only one door. They put the portable on site, and they put the end with the second door up against the wall of another portable. The superintendent of maintenance is sitting at the table and I'm just absolutely fuming, "What stupid fool put this thing, don't you know that we picked it", and he said, "Don't you know that there is a site plan, Heather?" I said, "How would I know that there's a site plan, Gerry?" He said, "Every board has a site plan for how they place portables." Obviously, I didn't ask the right question!

So, can you move it? No, they're not going to move it. If it doesn't work, you'll be bussing my kid to Waterloo School Board. And they weren't supposed to clean the carpet but they cleaned the carpet a week before school started. And somebody closed the door so it was very hot and very mouldy. They came back on Monday morning and they went into the portable and I kid you not - without a word of a lie - the portable smelled like something had died in it - and had been dead for along time. Now what do we do?

You can't put my kid in there. There's something dead in there.

And they're looking at me and saying, "Well, we could put new carpet in." "No", I said, "you can't put new carpet in." "Well what do we do, Heather?"

I said, "Well, the carpet comes out, and we will have to take a look at the floor and see whether the floor is mouldy or intact, and then you will glue down a new tile floor." "Well, the teacher won't like a new floor." "Well then, you can't put my kid in a portable with new carpet. And so we picked the tile and we picked the glue, and in the meantime, they sorted it out; they paid for five hours a day of home instruction for my son for thirty days.

Boy what a cost it was to them! Does the system break down? Yes, and sometimes it's a mess, but he went back to school and everything is fine.

Why did it work? It worked because we had a policy. If that had happened before we had a policy, we wouldn't have been able to solve the problem, because the policy gave us a process for solving the problem

The decision making model for students with environmental hypersensitivity, included in your conference kit, is the most valuable piece of paper in the Board, indicating the level of intervention needed and who has responsibility. You can't imagine how long it took to get this one piece of paper. Changes can happen for children with sensitivities and they are happening. But changes will only happen when we all work together - parents, educators, medical and ministry personnel. We need to look for the windows and avoid the locked doors.

I wanted to read a couple of things from the Thomson Report.

"We believe that modest common sense approaches to avoidance of suspected substances, approaches that can be implemented with major costs should not have to wait on verification of all alleged sensitivities. Some of the measures being adopted by specific school boards have been cited as examples. Those who understand the apprehension of patients and seek to provide them reasonable support and assistance are to be commended. We recommend that school personnel in particular be encouraged to help parents in their search for ways to reduce their children's susceptibility to illness" and it's that which we have been able to achieve in Halton. [Report of the Ad Hoc Committee on Environmental Hypersensitivity Disorders, by Judge George thomson and a panel of five teaching physicians appointed by the Ontario Ministry of Health, 1985)

Dr. William Mahoney
Special Education Representative, Ontario Medical Association:

I think one of the celebrations of success is the fact that I'm sitting here, because I think I represent a little bit more the medical establishment, in my orientation and background. The fact that I'm here is due to learning on my part and good phone calls on some of the organizers' part.

I sit on the Special Education Advisory Council of the Ontario Ministry of Education and Training, and I was involved in discussions as to whether or not environmental sensitivities should be acknowledged as a specific exceptionality under the Education Act. Heather Holden talked about it and summarized very well the discussion we had. The issue there was specifically: do we define causes or generic types of disabilities? As Heather indicated, if we take the issue of learning disability, we know that can have multiple causes and associations, which include epilepsy, acquired brain injury, or a child being on certain medications that they have to be on that can lead to academic underachievement. Do we list all the causes which can become quite an inordinate list if you start to think about it? Or, do we have general classes of disabilities that we can have children classified under? Each child will require their individualized program plan and accommodations.

It was that wisdom which was the essence of the discussion because the list can become exorbitantly long. One of the problems that we're dealing with - and Dr. Rapp was identifying clearly - was cost. If we spend all our money assessing all these types of disabilities, then we will have no money left for intervention. We need to have enough assessment so that we know what is happening, and that's where developing cost-effective ways of identifying environmental sensitivities is a scientific imperative.

There is no more money in the bank, certainly in our provinces. So how do we distribute the resources in an intervention kind of way? I think as Heather Holden said, sometimes the interventions are not very costly at all.

Other signs of success that I think are important to mention include something that's fairly simple, and that's peanut allergy. We know that peanut allergy is a common problem; it can be life threatening. I think in the past people did not identify just how significant a problem it is, whereas now Consumer Reports magazine in the United States publishes consumer alerts identifying that certain products that were said not to have any peanuts in them have been found to have peanuts and this magazine is quickly distributing this information. Products are actually being quickly recalled when that occurs, so there is a heightened sensitivity to these issues.

Also, personally in my practice, I have been involved with children who, as part of their problem, have a peanut allergy and there's no question that schools or preschools have been very good at developing an organized plan on how to deal with that problem within the context of that child's educational environment. The parents don't have to spend much time now in convincing people of the necessity. Now more and more we're seeing people say, "What can we do? How can we accommodate that?" People are listening to what parents have to say as suggestions.

There's a concept that I work with and I promote constantly. The concept is parent as case manager. What that says is that parents really have responsibility and adults as their own advocates, in becoming aware of what their child's difficulties are, interpreting all the reports of the physicians and psychologists and other people and using that information, owning that information and advocating for that child with that information. That's very hard to do. Not all parents can do it all the time.

One of the points that I made in writing to the Ministry of Education and Training is that if you have a parent that also has environmental sensitivity and you're trying to talk to them in the environment that is bothering them, it is really hard for the parent under those circumstances to be a good advocate for the child - logic and common sense.

It's really important that the parents develop that skill if at all possible because if you don't it's very hard to find someone else who can or will.

As Heather Holden mentioned, I work with a lot of children with learning problems. I always tell parents that you do have to visit the school shortly after school starts in the fall. You cannot assume in all cases that information has been passed on to the people who need to know. Sometimes it happens and sometimes it happens exceedingly well. But it doesn't happen all the time.

If you have a child who has a particular need where it's essential that it's identified, it's up to the parent to make sure that information is passed on. Unfortunately when I've talked to some parents they've said for the past few years, "I didn't do that; I thought I would let things occur according to systems." Inevitably they come back and say, "Whoops, it didn't work" - particularly as children get older and you deal with junior high school systems in Hamilton where I work. Children have up to nine different teachers, you have substitute teachers, you have educational assistants, you have lunchroom aides, you have all these people.

Just using the example of perfume, which is a particular issue, how does that information get passed on? And when you deal with complex systems, the more complex it gets the greater the room for error, the greater the probability that Murphy's Law will come true. So it's really up to the parents to develop ways of interacting with systems and taking the responsibility as case manager.

The final point is about communications. Sometimes we have to go ahead in little steps. Certainly there's the perception that the traditional medical system of which I'm part doesn't listen to viewpoints that are quite valid.

One of the things that those of us who work in medical education such as myself realize is that we need to teach physicians and other professionals communications skills. There's increasing evidence that if we can do that, you will have greater satisfaction with your interactions with physicians and with other professionals.

There are certain key things that we've learned that a recent article I was reading really highlighted very nicely.

In order to have effective communication between a parent or a child and a professional - and that professional can be a physician or an educator - it's, first of all, very important to ask the person, if I'm the doctor, "What's your understanding of the problem? That's really important to do. There's evidence in the United States that in the typical medical interaction that the doctor interrupts after about eighteen seconds. It's very hard when you're dealing with complex issues that require understanding to ask further questions with such interruptions.

It's important to ask about the perception of the impact of the problem on that individual's function. It's important to ask how they're feeling about the problem. It's important to show support and empathy. People have discovered that if the patient or client is able to feel and express their feelings that through this process you actually get symptom reduction. If we could just have good processes we could actually make people feel better, which would be partly because people feel they are being listened to.

Ian Morton
Ontario Lung Association

The mere fact that I'm here is somewhat of an achievement. Several years ago we used to be part of the problem and now I hope we're being part of the solution. Much of the work we're doing in this area is about providing solutions for people. It is trying to look on the positive side of a rather serious issue. The evidence is very compelling, and has sent a clear message to the medical arm of the Lung Association of Ontario, the Thoracic Society, that there is very strong evidence linking environmental exposures to impaired respiratory health.

Recently we've seen, internally, some very good strides forward in this area, and I think that's very positive. The campaign that I'm working on is called C.A.N. Do, the Movement for Clean Air Now, and some of you might have thought that was sponsored by Atomic Energy of Canada. In contrast to that, the main sponsor of our program is Health Canada. This is an interesting linkage as I would have said that Health Canada has been part of the problem as well. They have been very proactive in helping us to do a bit of outreach to actually say that "Yes, there is a connection between air quality and respiratory health, and indoor environments and overall health." And we think a program which is helping empower people to create healthy indoor environments is very important.

C.A.N. DO! is just as it says. We believe that there are things that people can do to make a difference, and it is targeted at helping empower people. The information is targeted to help people make decisions which we believe will have a positive influence on their health. The movement for clean air now is the concept of creating a social movement. Many of you have been involved in this issue for quite some time so I'm pitching to the converted. Participaction served as a useful model because Participaction was very effective in mobilizing people to get active, and become physically fit. We thought that we also wanted to get people active and we felt we've been part of the problem but we wanted to be part of the solution and maybe we can work with other partners and get active and get moving on this issue.

And the canary, as some of you may have seen, has a very meaningful story. Canaries used to be in mines and when the levels of gas got too high and the canaries expired, the miners then got out of the mines. I think canaries also have a meaningful story for us as we've often felt like canaries in buildings that have often been engineered and designed for other reasons other than human health. So this is the brand and the feel behind what we're doing.

It's sort of a special anniversary for us. The Clean Air Now program is only about a year old. It was launched on May 30th of last year. We've produced a wide assortment of good information on what people can do. We've also produced a series of fact sheets, which when I started at the Lung Association I thought would never materialize, on issues like pesticides and carpets - not only new carpets but also old carpets. We talked about new carpets but old carpets are definitely part of the problem as well. Healthy air, friendly household products, biological agents - a whole variety of topics which influence environmental health.

We've also partnered with other issue experts other than Health Canada. We're working closely with the @@@[email protected]@@ Waste Management Association. I'm pleased to announce that we are doing a program with the CMHC, hopefully launching a partnership this fall - educational and research based to better understand the relationships between indoor environments and health, and to increase awareness and understanding of this issue.

We facilitated, with AWMA, Health Canada, CMHC, and a few other partners the Indoor Environment Summit held in Toronto. It dealt with the reality that many of the issues around healthy indoor environments and healthy outdoor environments fall between many jurisdictions, and as a result we get a lot of buck passing.

We get a lot of buck passing between ministries and what ultimately happens is nothing gets done. People's minimum time and health often get abused, and the issue has never really moved forward. And so the Indoor Environment Summit was really an opportunity to put some of the issues on the table and to discuss them in a round table format. It was a very effective day, and the proceedings for that are on our world wide web site for those of you who are interested.

One of the tings we're trying to do is to outreach to the medical community. We've partnered with the Ontario College of Family Physicians and in the next three weeks we're going to be doing a package that goes out to all the doctors with this guide on what you can do indoors. We're also having one that we're just finishing on what you can do outdoors. We've also worked with the College on producing a fact sheet for doctors on the issue of air quality and health. And that's written by the College for physicians and that's going out to all family doctors right across the province.

We also know that education doesn't just start by giving them a pamphlet and hoping that the problem will be solved. We're going to do an ongoing health education program with physicians that will be offered to them, so that they can better understand this issue and there will be sort of an ongoing campaign to educate them on the various issues related to this subject area.

Another very exciting development. A lot of people when we've asked them to use alternative products, have asked what can you do? That's great, what is there out there that we can already use? One of the exciting product developments is the whole Envirodesic™ process which looks at products from a health perspective . We now have, through this process an endorsed multipurpose cleaner. There are samples here. It has no perfumes, dyes, VOCs, chelators, preservatives, you name it. It's not in here. It's a very effective cleaner. I use it around my home. The gentleman who actually manufactures this product suspects that it in undiluted form may control mould as well. This is very important because a lot of the products that are used right now to control mould have very strong fumes which can be a significant problem for people who have asthma or sensitivities. This product is carried by Home Hardware which has a lot of bad things on their shelves. We're trying to get in there and say how we can work on the positive - clean air begins at home - and get them as a proactive partner in this whole process.

The other exciting achievement is that our own medical arm, the Ontario Thoracic Society [OTS] is now speaking out on this issue. Two days from now,the medical director of the OTS will be speaking about the implications of air quality on health at a large forum in Toronto. And the Thoracic Society just recently approved funding of environmental health related scientific works. This is a major step because more science and research needs to be done in this area.

At the community level, we've done some really exciting things - five of them.

In London, we partner with the Green Community Initiative in CMHC to do a project which targets mould in people's homes and it was tied into the home visitations. And so we were actually trying to get into people's homes and to raise awareness about the connection between mould and their health and to give them some of the tools that they could use to actually prevent mould from occurring in their home

In Owen Sound, this summer we're going to be doing a door-to-door campaign on healthy alternatives to many of the conventional cleaning and household products, things such as pesticides and cleaners.

In Oshawa, we just last Sunday had a major conference on asthma and the environment where we had some respirologists and some other people talking about this issue and we had over 150 community members turn up and get involved about this whole concern about asthma and the environment.

In Nova Scotia, we've partnered with the Home Builders Association, and we're promoting actions that can be taken to create healthier indoor environments. We've also done some work in New Brunswick and we're working closely with CMHC on a mould research project linking mould and adverse health affects which Debora Wright might elaborate on.

Finally, we're also this week meeting with Peel Memorial Hospital. We're targeting hospitals because often times people go in for rehabilitation, and they go in and they get sicker. What we'd like to work with some of the people who are taking care of those hospitals to be sensitive to the needs of people who have asthma, allergies and chemical sensitivities and they're very receptive to this as well. I wouldn't just say that this program has been peaches and cream. We've had a few of our challenges. Recently the major challenges are coming from the Canadian Carpet Institute, Crossley and Peerless in particular who have really attacked us with regards to our positions on carpet, which, for many of you, would be rather conservative in themselves. But we're not going to be backing down. And as more of us become more proactive, it will separate the wheat from the chaff because we have to make manufacturers more diligent when it comes to their products and prove that they're not going to have any adverse health effects.

Bruce Small

There are many issues to tackle to design residential space properly for children with sensitivities. The basic strategy consists of minimizing exposure to particulates, biological agents such as mould, bacteria and dust, volatile chemicals and even trace odours, and electromagnetic trigger agents. This alone, however, does not create a home that is tailored to a child's particular needs, and that will be adaptable enough as the child grows older.

One factor to take into account is that the rest of the family may not be sensitive to environmental exposures, or may be less sensitive than the child who may be receiving medical attention because of his or her environmental reactivity. Some 15 per cent of the population in North America is estimated to have some significant sensitivity. Approximately 41 per cent of North American households contain at least one member who can be considered sensitive. This means that almost every second home contains someone who is sensitive. It also means that there may be many homes where sensitive individuals may be present, but in which they are a minority. Designing a home to respond to everyone's needs can be a challenge. Dividing a home into distinct zones that are separately heated and ventilated can provide the flexibility needed to accommodate family members with widely varying levels of environmental sensitivity or hardiness.

The physician may help to determine an appropriate environmental strategy to address a child's sensitivities. This may include modifying the home considerably to provide a margin of safety against adverse chemical and other environmental exposures outside the home. Depending on the particular array of sensitivities, different factors in the child's environment may be more or less important. One child may require a meticulously dust-free environment to stay symptom-free, while another may have little difficulty with normal house dust, but rather could be very reactive to the odour of cleaning compounds and perfumed personal products.

It can make sense to concentrate on those environmental factors which, if controlled or avoided, will afford the greatest margin of safety. At the same time, when other factors can be minimized at a practical cost, it can make equal sense to buy a little insurance by reducing all potential environmental factors, allowing for possible changes in a child's reactivity over time, and recognizing that total load can be important even if some factors do not trigger immediate symptoms.

For a child, it can be very important to appear normal among his or her peers. A strategy which is sufficiently stringent at home may allow a child a wider array of activities outside without triggering symptoms, whereas a strategy at home that inadequately reduces exposures may leave the child more vulnerable to outside exposures, and therefore unable to participate as fully at school or in the neighbourhood among peers.

Children tend to be involved in a world of play involving toys, stuffed animals, dolls, games, all in all presenting the child with a complex set of chemical and particulate exposures. Parents may find that if treated early enough, a child may become used to playing with alternative materials (wood and metal, for example, instead of plastic) and may be satisfied with "alternative toys". Other children will feel left out, through peer pressure, if they cannot partake of toys that are popular with friends. Arranging convenient storage so that it is at least theoretically possible to keep some toys confined while others are receiving attention may help to minimize the child's exposure to contaminants. Ventilated play areas can also make a big difference.

Two periods in particular present design challenges which cannot be avoided if the basic trigger avoidance strategy is successful. One is the transition from childhood to adulthood, with a period of changing interests. During this period the toys may change, and the type of activities may be more consistent with exercising more independence. A child who was content to stay with the family while younger may be eager to spend time at summer camp or in canoes and tents with his or her peers. There may be more school trips and other excursions such as music exchanges with students in other cities or countries. Each new activity may present an environmental challenge to overcome, and the successful home will have prepared the child by allowing sufficient margin of safety to help bring the sensitivities to a manageable level before this stage of independence begins.

In addition, children may go through periods where their long-term ecological management appears to be threatened by their short-term success. If they feel better and their bodies become somewhat less sensitive, they may want to expand their activities into areas that present greater environmental hazards, now that they can do so with less penalty than previously. Being able to allow expanded activity without expanded exposures can be tricky both from the physical side and in negotiations.

Ventilation and storage are two key strategies that allow some of the flexibility that these situations demand. If there are places in the home that items can be stored such that no odours from them enter the general indoor air, then hobby materials that can be tolerated on a periodic basis can be stored safely and ventilated to the outside, without affecting anyone in the home (provided there is enough room in the home for this strategy).

Changing economic and social circumstances can also wreak havoc with a home environmental strategy, unless the design foresees a need to accommodate such changes. For example, consider a home where standard high-emitting materials are chosen for interior finishing, but they are offset by extensive central charcoal air filtration to remove odours. At the time of design, there might have been enough funds to consider low-pollution material, or a central air filter, but not both. Such a home will not help a family weather a recession, particularly if family income were to drop during such a period. Not being able to afford replacement filter media will leave a family without an environmental strategy at a time when the overall stress would require even more careful environments.

The bottom line in complex design is co-ordination and integration. Many factors must be taken into account at once in order to make things work. The goal in designing healthy housing for a child with sensitivities is to return the child to full working order as quickly as possible, and to enable as normal and as full a life as can be achieved without triggering chronic illness. Design for a family with varying degrees of sensitivity requires sufficient zoning and ventilation to allow everyone else to lead normal lives, in addition to the sensitive child.

Questioner #1: While all the science continues to be developed in the background, what do each of you think is the most important thing that will help along this process of personal, professional, institutional or social healing?

Heather Holden: As a parent, you build your partnerships. You collaborate. You learn how to be an effective advocate. And you gather data, especially as it relates to the school system. How does the system really work for other people and can I make that work for me? You learn good advocacy skills. In some cases that means hooking up with the Learning Disabilities Association and learning how they train many of their parents to be advocates. LDA in Ontario is looked at for its ability to advocate through the school system. We run courses for parents in learning how to be an advocate and we have some publications that would be very helpful to you.

Dr. Bill Mahoney: Try and be patient with science. There are definite attempts to answer some of the questions and it will be important that people look at those answers and build on knowledge. The other is the development of good communications skills, on the part of people on my side but also you folks as well - to be affirmative and effective. Heather Holden has demonstrated what can happen with people who won't let go but who pursue it in ways that people can listen. And that's very important. In my business - most people want people to feel better - that's what we're in this business for and so being effective in communicating to us can be very important.

Ian Morton: Speak out and get active. Make your elected officials respond to your concerns. Right now my big concern in my community is the whole cosmetic pesticide use; it is completely ridiculous and unnecessary. Follow your intuition as well.

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