DOCTOR, STOP TAPPING YOUR FOOT

-->

About a year before Mom died, I wrote this from her hospital room:

Mom was hospitalised just prior to Christmas for respiratory distress. A young, bespectacled respirologist strode into the room. He smiled at Mom and began to make notes on his clipboard.  "Have you ever had trouble breathing before?" he asked.  "Once when I was about twelve, I was at camp..." Mom began.  My eye was drawn to the doctor's foot. His polished loafer began to tap rapidly, but his smile remained fixed.

I thought, "he is trying to have a business conversation here. But Mom thinks this is PERSONAL!"  I jumped in and re-directed Mom to her more recent health history.

Very recently, I observed similar behaviour from a physician who was treating our son in hospital. The doctor was professional, knowledgeable and pleasant. But his foot tapped excessively during our conversation, to the point that his knee was shaking.  This doctor appeared to be listening and he answered all our (very good) questions. But it was hard for me to focus on his words because I was so distracted by his foot and leg.

Here’s what that tapping foot meant to me: “This doctor is worried about his next patient or maybe he’s late for a meeting.” “I need to hurry up and ask my questions. What were my questions again?” “I’m sorry I’m taking up so much time.”

I kept thinking about that tapping foot and so I googled the body language of feet. This is what I found:

"The secret language of feet can reveal a great deal about our personality, what we think of the person we're talking to and even our emotional and psychological state, they are a fascinating channel of nonverbal communication."

"Compiling this research has been a revelation. The reason our feet may be giving us away is that they are part of the body from which we have the least internal feedback."

"The weird thing about feet is that most people know what they are doing with their facial expression, they may or may not know what they are doing with their hands but unless we specifically think about it, we know nothing about what we are doing with our feet."

And from the pen of Dr. Susan KraussWhitbourne, Professor Emerita of Psychological and Brain Sciences at the University of Massachusetts Amherst, writing for Psychology Today:

"Shaking your legs communicates anxiety, and when you shake those legs you inevitably shake those feet.  However, your feet can get you into trouble with your body language all on their own. Tapping your toes is one way to show that you’re in a hurry and anxious to get moving.  You may want to tap your toes if you’re trying to get someone’s attention and don’t want to say something rude. It’s a little way of signaling that you’re feeling time pressured without yelling or engaging in sarcastic eye-rolling. However, you do so at a risk. Either you’ll be ignored or still perceived as rude. Better to handle your feelings of annoyance over being made to wait by politely voicing your concerns."

So here’s my prescription for doctors: For better outcomes, stop tapping your feet when in conversation with your patient and his or her family.

 

THE PHARMACIST: A CAREGIVER'S SECRET, BEST FRIEND

This blog post was featured in the SeniorCare.com Aging Industry Insider.

One of any caregiver's BEST and most SECRET friends is the community pharmacist. Why secret? Because most caregivers aren't aware of all the help that pharmacists can provide. Why best? Let me tell you this story of our pharmacist. 

Our son Nicholas was often ill and in pain. We struggled at home to keep him out of hospital. In those days, our community pharmacy was run by the Silver family - Ron and Janis. I was a regular customer and because the Silvers were our neighbours, they knew the struggles we faced caring for Nick. One Christmas Eve, Janis arrived with our medication order plus cookies she'd baked - she was wearing a Santa hat! (The Silvers are Jewish 😁) Another day, Ron called to ask how Nicholas was doing with his pain. I answered, "Not so great. Some days are better than others." Ron suggested that I try adhesive magnets on Nick painful hip - no charge. "If they don't work, just return them", he said. "If they do, they are my gift." I know that our experience with the Silver family is extraordinary, but I did learn that the pharmacist is a powerful ally for all caregivers. So recently, I came across THIS ARTICLE and decided it was time to sing the praises of community pharmacists everywhere. Here's a list from that link of all the different ways they can help. 

Administering medication
For patients, administering the proper medication at the right time and correctly is an important part of achieving desirable health outcomes. Independent pharmacists can have a positive impact by educating both patients and caregivers on the proper way to take medications.

For example, let’s say someone under a family member’s care is supposed to take a medication three times a day. Does that mean the medication should be taken every eight hours? Or should it be taken with meals at breakfast, lunch and dinner? The community pharmacist can explain the appropriate time to take each medication and explain potentially dangerous or adverse interactions — such as different fruit juices that might increase bioavailability or decrease absorption of certain drugs.

Pharmacists can also educate caregivers on administering drugs via syringes, the correct way to measure liquid medications and how to use glucose meters or properly take blood samples. All of this is part of the pharmacist’s duty to thoroughly explain and demonstrate to increase the caregiver’s confidence. 

Stopping potentially dangerous interactions
When patients are taking multiple medications, it can be a challenge for caregivers to keep track of which medication should be taken at what time, while also looking out for potentially dangerous drug interactions. Independent pharmacists should encourage caregivers to come to the pharmacy on designated “brown-bag days.” On such days, caregivers can collect all of the medications currently being taken by the patient under their care — both prescription and OTC —and bring them to the pharmacist for review.

Caregivers may not be aware that OTC medicines can have serious interactions or contraindications with prescription drugs. There’s also the possibility that caregivers use one pharmacy that’s more convenient for him or her, while the patient uses another. Prescriptions could also be filled through mail-order pharmacies. All of this means that it’s impossible for the pharmacist to have a complete picture of all the medications the patient is currently taking. The pharmacist can use the brown-bag day as an opportunity to encourage the caregiver to consolidate all the patient’s prescriptions at a single pharmacy, which will allow the pharmacist to monitor for compliance and potentially dangerous drug interactions more easily. 

How to ease a caregiver’s burden
Between work, family and caregiving, caregivers’ stresses and burdens can seem overwhelming, which is why it’s the duty of a community pharmacy to assist them in their role. 

Pharmacists are an integral part of a caregiver’s support network, and it’s important that caregivers are aware that a community pharmacy can be their greatest resource, where they go for reassurance, to ask questions and to gain insights.

Accessibility
A community pharmacy is the most accessible healthcare provider, on the front lines assisting caregivers with all their questions and concerns. As doctors require appointments and the internet is full of jargon, a community pharmacy could be the only place he or she can turn. This makes it imperative that independent pharmacists let caregivers know they are committed to offering convenient, accessible care. 

Given the busy schedules many caregivers have, which often includes full-time jobs and/or caring for their own children, a community pharmacy’s hours of operation might not be convenient. And if a caregiver has a late-night drug-related emergency, he or she will need to contact a pharmacist. To address this issue, community pharmacies can post an emergency after-hours phone number on their website and entrance that caregivers can call on nights or weekends if an urgent matter arises. 

Delivery services 
One simple way to create convenience and ease caregivers’ burden is by offering free home delivery services. A delivery option can make all the difference in providing caregivers with the resources they need to make sure patients stay compliant and adherent to their prescriptions. It’s this type of above-and-beyond service that makes community pharmacies such valued institutions in their communities.

I CAN'T EXPLAIN WHAT'S WRONG DOC, BUT HERE, LOOK AT MY PHONE

Trying to describe our son Nick's seizures to his neurologist was really difficult until we realized we could film them and use our appointment time to watch the real thing. Nothing captures what really happens during a seizure like recording the event on video. The same goes for unusual or difficult episodes of behaviour in someone with dementia or mental illness. Showing a medical professional what is happening at home with your loved one puts him or her right there in the room as a witness to the event. A professional will diagnose and prescribe more accurately if they know exactly what they're treating.

If you're not sure how to set up for filming a behaviour or seizure, check out this article for some great tips. A moving picture is worth a thousand words.

Using a camera to take photos of skin rashes or bruising is a great way to track recovery and work with a treatment team to get the best results. After all, everyone is looking at the same photo and no one is trying to imagine based on one person's memory. Daily pictures of an infection site can help you determine if a wound is healing or getting worse, too.

Images of skin abrasions or films of concerning behaviours can be shared with the care team so that everyone responds in the same way, according to an agreed treatment plan.

Phones can be a really helpful tool to bridge what's happening at home to the clinic or doctor's office.

POWER DRESSING FOR CAREGIVERS: GOOD OR BAD?

Yesterday I read a fascinating blog post by the wonderful Denise Brown, founder of Caregiving.com.  Her piece is titled Dressing the Part: Family Caregiver, MD. It argues for caregivers to wear a lab coat when we accompany loved ones to medical appointments.  Brown is fed up with clinical professionals not treating family caregivers as the care providers that we are. 

I posted Denise's piece on my Facebook page for caregivers and the conversation that ensued was fascinating. Read the exchange.

Kim #1: I think it would be better to consider the opinion of the people we are caring for. My first instinct is that some would feel demeaned by this. (Although as the author states, we have the perfect right to a badge or lab coat)

Kim#2: I simply don't work with anyone who doesn't respect my position as a critically significant collaborator when discussing treatment and health care issues .

1. Talk to and gather info from the patient first
2. Talk to and gather info from me.
3. Review any info I bring from any other significant caregiver or collaborator
4. Everyone answer any questions posed letting the patient attempt the answer first but also giving accurate info even if it directly conflicts with patients narrative.

I'm not about identifying my position in my son's life . He would feel like I'm disclosing and I hesitate to do that unless absolutely necessary .
I am all about telling the dr who I am once behind closed doors.
If this were my aging parent or a spouse I might feel differently and I like the concept as a whole as far as its intent.

Manage

The Caregivers' Living Room So interesting and complicated balancing respect for our young adult children with disabilities (and it's no different with my Mom btw) with getting the narrative right with the clinical team. Currently, I'm working on a research project that's developing an app to help young adults with disabilities transition from peds to adult care and have a voice in their own care. It's about education, advocacy and supported decision making. This is really, really tricky. One doctor on a conference call asked, "What if a parent is actually the one using the app in the trial - what if the parent can't let the youth go it alone in the health care system with the app because the parent can't let go or step back? Won't that skew the results of our study?" Another doctor was so embarrassed that the question had been asked because he thought I would be offended or upset. Not at all! I said, "Letting go of our kids' health care is the LAST thing we want to let go of - it's the most important thing and we can't let our kids with disabilities fail in the system for the sake of a research study. So, it's a very good question." I want my son (and my Mom!) to be front and centre - I want them to tell their own story. But as you said, often their story is not accurate. So a lot of diplomacy is required. If I wore a lab coat (and there is a lot a Iove about that idea!), wouldn't that be a way of silencing or diminishing the voice of my son/Mom? It's a tricky balancing act, that is for sure.

Karen: I've seriously considered buying some scrubs and a name tag to wear when I take my parents to their appointments. I've wondered if I would be treated differently. I feel like doctors don't know how to include caregivers. Sometimes we're invisible and sometimes we're scolded for not getting our parents to be compliant. Doctors feel they can say things to us that they'd never say to their patients. If we caregivers admit we're having trouble with compliance there is no understanding. "Why isn't she doing her exercises? It shouldn't be that difficult to get her to do it?" There's a tone that's used that isn't used when they're speaking directly to the patient.

Lisa: Not sure if I would wear a lab coat to appointments, I would feel a bit cos-play doing that. However, I DO dress up for my daughter's appointments which is cos-play I guess! I dress the part of a doctor. I wear nice dress pants and a dressy top and I put my hair into a low ponytail (which I have observed most female doctors seem to do if they have longer hair) and wear light make up. My everyday wear is yoga pants so that is a change for me! I have noticed I get treated with more respect when I am dressed up.

This conversation is fascinating. When I gave a book talk a couple of years ago, a woman of colour put up her hand. She said, "You've told your story of caring, but I would like to know who will tell my story, which is very different from yours. Do you have to put on a business suit to bring your son or your mother to the ER? I do. Because if I didn't, the staff would assume that I am homeless." Everyone (including me) sighed and we shook our heads at the injustices of life for many in our midst. There are optics of power - some that we can control and some that we cannot. Maybe power dressing is a good thing for all of us, but when we had this exchange at my book event, we all felt the double unfairness of being vulnerable AND powerless at a time of need.

Do YOU dress differently for doctor appointments with your loved one? Do you think we should be identified by a badge or uniform as part of the treatment team? How can we signal our important role without diminishing the dignity or independence of our loved ones? 

LISTEN: Our Family Experience With Disability Told to a Med Journal

This is a podcast and article I did for The Canadian Medical Association Journal (CMAJ). The piece is a shorter version of an address I gave at the American Academy of CP and Developmental Medicine Conference in 2016.

What do doctors need to know about the lived experience of parenting a child with severe disabilities? These are my reflections.

WHAT DO CAREGIVERS NEED FROM THE HEALTH CARE SYSTEM?

What do caregivers need from the health care system?  This was the question I was asked at a recent online Town Hall event sponsored by The Caring Experience, a new project designed to collect the stories of Ontario family caregivers and develop policy options that will reflect what families want and need from the health care system.  

I believe that caregivers need the health care system to be responsive.  But what does that actually mean?  In our dealings with doctors, nurses in hospitals, outpatient clinics or in home care, we need doctors to know us and to understand us.  

"If you wish to persuade me, you must think my thoughts, feel my feelings and speak my words." Cicero

Medical professionals want to understand what ails our loved one and they want family caregivers to carry out prescribed care plans.  But because the way we feel about our loved one's illness and dependency is so emotionally bound up in our personal histories, it is very difficult for medical professionals to understand what is really going on.  But they must.  We need people working within the health care system to take the time to understand the patient AND the family.  This means knowing what caregiving at home really looks like and what it feels like to the individual caregiver. 

We need medical professionals to listen well and be kind. My son Nicholas has endured multiple surgeries and chronic pain. I remember saying to the doctors "I want to tell you something important about what I need as Nick's mother.  I need you to be nice to me."  I don't recall any doctor understanding the importance of my request.  In order to be a good caregiver, I need exceptional kindness shown to me.  At a time of crisis, I cannot cope with the normal brief and sometimes brusque conversation style typical of hospital bedside chats. I need medical professionals to drop the veneer of professionalism, call me by my name, look at me and even hold my hand. In short, I need a human interaction with my loved one's medical professionals, especially at times of crisis and especially when caring lasts months or years.

We need medical professionals to work with us as consultants would.  My friend and colleague Vickie Cammack has a beautiful analogy about patients and family caregivers in working together in a circle of care.  Vickie says, "When I invite an interior decorator into my home, she asks me about my colour preferences, my favourite pieces of furniture, how we use our rooms and what changes we'd like to make.  Then, she presents me with some options and costs. Then I choose and we agree on a plan.  That's how I would like the medical professionals in my life to work with me."  The analogy of the decorator is an excellent one.  Caregivers need their clinicians to understand the medical and social realities of living with illness and they need options for treatment. Caregivers need support before, during and after taking treatment decisions with or for their loved ones.  

We need medical professionals to be accessible. Caregivers nod their heads in collective understanding when one of their own sighs, "My son has epilepsy and yesterday he had a strange new kind of seizure that worried me. Our next neurology appointment is four months away. I'm not sure what to do or who to tell."  So often caregivers at home with very sick or disabled loved ones have only two options: call 911 or do nothing.  For any frail or complex patient, the emergency room is a risky place to be. But new symptoms that occur can be difficult for caregivers to read - they could be life-threatening or completely benign.  Caregivers need help navigating the system and a health care professional with access to the patient's record should be accessible to give advice. 

We need the medical system to serve the needs of families, not just the systemic need for accountability and resource management. And caregivers want to work in partnership with professionals who have the knowledge and expertise to advise us and support us in caring for the people we love. 

A Tragic Death, A Cautionary Tale and Lessons About Protecting Our Loved Ones

Guy Mitchell.  Guy Mitchell.  Guy Mitchell.  I can't get that name out of my head.  And when I think of Guy, I am afraid for my son, my mother and my future self.  I am afraid for everyone who is at risk of being vulnerable and 'cared for' by the state, behind closed doors.

Guy Mitchell had developmental disabilities and was 38 when he died in 2012.  He drowned in an outdoor cistern of freezing cold water outside his group home in Ancaster, Ontario, as he was trying to retrieve drinking water.  A representative of Hamilton Police said officers reported that the conditions at the Ancaster home were some of the worst they had ever seen. There were signs of neglect everywhere, and they included no heat, or running water; no food in the fridge, soiled clothes all over the floor as well as alcohol bottles and ashtrays everywhere.

Yet, the home received a passing grade from the care agency Choices just days before Guy died. A number of complaints about the home over the year up to his death produced no investigations, no police reports and no reports with the ministry of community and social services.

The story of the Ancaster group home is a sad, cautionary tale of total failure to protect Guy and his vulnerable roommates.  When Guy entered his Ancaster residence twenty-six years ago, Bill and Karen Santor apparently ran a well kept and caring home for their charges until they died and daughter Keri-Lynn Santor assumed her parents' responsibilities.  Now missing, Keri is apparently a heavy drinker with a police record whom another family member says may be paranoid schizophrenic.   An agency called 'Choices' received Ontario provincial funding to operate and oversee this and other group homes in the region.  Two days before Guy died, staff at Choices gave Guy's group home a passing grade.  Dr. Jack Stanborough,  the coroner in Guy Mitchell's case was not impressed by Choices and he said so during his inquest. 

"I think Choices and its conduct is shameful," he said angrily in the morning to a courtroom full of lawyers while the jury was absent. "To hide material and produce it halfway through the inquest is shameful.

"I don't understand the disrespect for Guy Mitchell, for his family, for society, for this process ... Am I upset? Darn right I'm upset."

The sad case of Guy Mitchell is terrible but it teaches us lessons about protecting our loved ones who are vulnerable, including seniors in residences where abuse might occur. Guy Mitchell lived in deplorable conditions and died because no one was really looking at his home environment: no one in the government ministry that funded his home, no one in his family, no one in his neighbourhood, no one in the agency that operated the home. No one saw and no one knew.  

If we want to protect vulnerable people from the isolation that can lead to exploitation, we need to create models of support that ensure caring and responsible eyes are on our loved ones and their care providers.  Agencies and governments will not love our loved ones and sometimes, tragically, they will not protect them.  Parents of children with disabilities and children of the vulnerable elderly need to visit often, ask questions, drop in, check the fridge, look at bank statements, inspect cupboards, examine medications and ask to see written records.  We need to look carefully at our loved ones and ask them questions.  If we can't be there in person, we need to assign oversight responsibilities to others and then keep in close touch.  One Vancouver-based friend had a father in Scotland whose health was failing.  It was a visiting osteopathic therapist and a neighbour who became my friend's eyes and ears.  My friend used the same online care coordination tool that we use in my family, Tyze Personal Networks, to watch over his Dad and keep him safe.  Read my friend's story in the Toronto Star HERE.  It's a much more hopeful and reassuring story than poor Guy Mitchell's.  

If those providing care to a vulnerable loved one won't share information or allow unscheduled visits, there is something very wrong.  We ALL have a role in being vigilant to protect our family members, neighbours, friends and colleagues receiving care. We need to advocate for support systems, businesses, governments and municipalities to make it easier, not harder, to befriend those who are isolated in our midst.  Lives depend on it. 

Post-script:  Every member of our son's staff shares information and updates with us on a daily basis.  Drop-in visits and phone calls are encouraged and regular planning meetings include family.  My Mom's paid helpers have become friends and share information with me and my sister on a daily basis.  I can't say that accidents will never happen to my son and my Mom, but I know that everyone who cares for and about them talks to each other in a coordinated circle of care. And if something bad happens, it will be an accident despite best efforts to provide excellent care.

LIFE GETS EASIER WITH CONNECTION TO A CIRCLE OF CARE

This week, I was honoured to contribute an article to The Home Care Technology Report, a publication of Rowan Consulting Associates.  Tim Rowan is a consultant and information broker on everything to do with home care and technology.  I'm pleased to tell you that I've had a huge and positive response to this article from caregivers and health providers alike.  Thanks, Tim!

CLINICIANS IMPROVE OUTCOMES BY CONNECTING TO A CIRCLE OF CARE

Today, my family uses technology to coordinate our son’s complex care in the community, but it wasn’t always so. Nicholas is 26 years old and resides in a small care home in our neighborhood. He is non-speaking and medically complex, requiring one-to-one nursing care 24/7. For the first 22 years of his life, Nick lived at home with us and I struggled to communicate important messages between home and the multitude of home care workers and medical professionals who were part of his care team.

I do not have that struggle anymore. A software program called Tyze Personal Networks now effectively connects everyone who cares for and about Nicholas. Tyze is owned and offered by Saint Elizabeth Health Care, a Canadian not-for-profit organization that has been supporting people at home for more than a century. Tyze is a private and secure online network that was developed to combine the efforts of family members, friends and professional supports in a circle of care. It is free to individuals but becomes more valuable when supported by a healthcare organization.

Each personal Tyze network is password-encoded and not publicly searchable. It has enough data storage to allow for a virtual filing cabinet of medical records and even highly sensitive documents such as wills and end of life directives.  Healthcare provider organizations in Canada, the US, and beyond use Tyze to reach out to their clients, inviting them to start their own care networks. Most importantly, Tyze gives organizations the ability to share information with all network owners – for example, education materials, newsletters, videos, updates, and events.

LIFE BEFORE TYZE
Before we were introduced to Tyze, Nicholas had a bedside, hospital-style chart where caregivers recorded both health and personal information. There was also a separate drug chart where staff signed for medications given. If Nicholas’ morphine dose changed, I couldn’t be sure that staff would see the notation in the bedside charts, so we installed a white board above Nick’s bed. There, we wrote important messages in large red lettering, hoping that new directives begun by one caregiver would be followed by the next one, especially if I was not home to point them out at shift change. Too often, a part-time health aide would give the old dose of anti-seizure medicine or morphine, assuming that nothing had changed since the previous week. They simply didn’t see the notes we had left.

LIFE AFTER TYZE
Today, we still use the bedside charting, but we do not rely on it to communicate messages of change in care protocols or important appointments coming up in the diary. Tyze Personal Networks shifts the responsibility for care from an individual model to a network model. A traditional, individual model of care looks like this:

An individual model of care assumes autonomy on the part of an able-bodied patient – someone who is verbal and capable of following through on measures for treatment compliance at home. This was not the case for Nicholas.  No single individual could keep Nick alive and healthy – he needed a team. Tyze gave us the communication tool we needed to effectively function as a network of care, which looks more like this:

The home page of Nicholas’ Tyze site includes all his front-line workers, members of our immediate family, executive staff members at the care home where Nick resides, and his family physician. Staffing agency case coordinators are part of the Tyze network too, and when there are last minute HR issues to be solved, everyone can offer to help and stay in the loop.

Tyze has many features that enhance both social opportunities and continuity of care. For example, specialist medical appointments as well as recreational outings are entered into the calendar feature and network members receive timely reminders on their smartphones. Network members report feeling group solidarity because everyone has shared and equal access to information about Nick. Tyze has made it easy to share resources, to ask for help and problem-solve within the group.

OVERCOMING BARRIERS & ACHIEVING SUCCESS
"How did you persuade medical professionals to be part of a Tyze network?" is a question that many curious friends ask. The answer is not straightforward. In the case of Nick’s GP, he understood immediately that an online tool would help him to manage complex care involving multiple players but he was concerned that he would be bombarded with messages. He was relieved when we assured him that only the head nurse would send him private messages via the Tyze site.  Plus, recent changes in allowable physician billing codes mean that our doctor can now be paid for the time he engages with Nick’s Tyze network.

The trickier barrier to getting Tyze up and running was compliance on the part of frontline care staff, especially after Nick moved out of our home and into a care facility. Every agency or institution has its own in-house communications linkages such as an intranet. At first, it was necessary to remind staff that their intranet excluded Nick’s family members but, eventually, everyone realized that the corporate knowledge of complex care was better managed as an integrated team with equal access to information shared by family and paid staff. Everyone began to appreciate the benefits of a single communication tool.

Like any tool, Tyze is only helpful if users populate it with pertinent information. When frontline staff members forgot to input appointments, I reviewed all my communications strategies and looked for ways to improve compliance. I realized that posting ‘need to know’ information on Tyze, such as staff shift rotas and holiday schedules would draw people to Tyze. Eventually, Tyze became the go-to site for all Nick-specific information. Now, if Nicholas has an emergency hospital admission, his network members know they have access on their phones to his medications list as well as his care plan.

Nicholas does not use Tyze himself, but it is only because he would rather use his laptop and iPad as sources of sports news and social media. Still, Nick reaps the benefits of being cared for by a well-coordinated team of people who love him and share his care. And for that, we are all grateful to Tyze.

Donna Thomson began her career as an actor, director and teacher.  In 1988, when her son Nicholas was born with severe disabilities, Donna embarked on her second career as a disability activist, author, consultant and writer. She is the Special Advisor for Caregiving at Tyze Personal Networks and is the International Advisor to the PLAN Institute for Caring Citizenship.  She is the co-founder of Lifetime Networks Ottawa, a PLAN affiliate and is a member of the Cambridge University Capability Approach Network.  Donna is also an instructor at the Advocacy School (Ottawa, Canada), teaching families how to employ best practice political advocacy tools when advocating for care. Donna holds degrees in Fine Art (Theatre), Education and Theatre in Education.  Donna’s interest in new modes of social engagement for marginalised families led her to sit on numerous boards such as the London International Festival of Theatre, Women for Women International Leadership Circle and Dovercourt Community Association. Donna can be reached at donnathomson.com. For more about Tyze Personal Networks, visit tyze.com.

BUY MY BOOK AT ALL MAJOR BOOKSELLERS IN THE USA AND CANADA!