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Additional file 1: Supplementary File 1. Semi-structured interview guide. This document contains the semi-structured interview guide for interviews conducted with parents before and after the ELEVATE intervention.

Purpose: Persons with a developmental disability have the lowest rate of labour force participation relative to other disabilities. The widening gap between the labour force participation of persons with versus without disability has been an enduring concern for many governments across the globe, which has led to policy initiatives such as labour market activation programs, welfare reforms, and equality laws. Despite these policies, persistently poor labour force participation rates for persons with developmental disabilities suggest that this population experiences pervasive barriers to participating in the labour force. Materials and methods: In this study, a two-phase qualitative research design was used to systematically identify, explore and prioritize barriers to employment for persons with developmental disabilities, potential policy solutions and criteria for evaluating future policy initiatives. Incorporating diverse stakeholder perspectives, a Nominal Group Technique and a modified Delphi technique were used to collect and analyze data. Results: Findings indicate that barriers to employment for persons with developmental disabilities are multi-factorial and policy solutions to address these barriers require stakeholder engagement and collaboration from multiple sectors. Conclusions: Individual, environmental and societal factors all impact employment outcomes for persons with developmental disabilities. Policy and decision makers need to address barriers to employment for persons with developmental disabilities more holistically by designing policies considering employers and the workplace, persons with developmental disabilities and the broader society. Findings call for cross-sectoral collaboration using a Whole of Government approach.Implications for RehabilitationPersons with a developmental disability face lower levels of labour force participation than any other disability group.Individual, environmental and societal factors all impact employment outcomes for persons with developmental disabilities.Decision and policy makers need to address barriers to employment for persons with developmental disabilities holistically through policies guiding employers and broader societal behaviour in addition to those aimed at the individuals (such as skill development or training).Due to multi-factorial nature of barriers to employment for persons with developmental disabilities, policy solutions are wide-ranging and fall under the responsibility of multiple sectors for implementation. This calls for cross-sectoral collaboration using a “Whole of Government” approach, with shared goals and integrated responses. Persons with a developmental disability face lower levels of labour force participation than any other disability group. Individual, environmental and societal factors all impact employment outcomes for persons with developmental disabilities. Decision and policy makers need to address barriers to employment for persons with developmental disabilities holistically through policies guiding employers and broader societal behaviour in addition to those aimed at the individuals (such as skill development or training). Due to multi-factorial nature of barriers to employment for persons with developmental disabilities, policy solutions are wide-ranging and fall under the responsibility of multiple sectors for implementation. This calls for cross-sectoral collaboration using a “Whole of Government” approach, with shared goals and integrated responses.

Additional file 1. NGT steps to prioritise barriers to employment for persons with a developmental disability.

Early Childhood Caries (ECC) is a serious disease that is about much more than cavities on baby teeth. In Canada, it is a growing public health problem with adverse long-term effects on children's physical, emotional and intellectual well-being. The failure to invest in preventive care has resulted in reactive, rather than proactive, measures against this disease. These measures are expensive and a needless drain on costs in the public health-care system. Children with severe ECC end up in hospital; in fact, in Canada, this disease is the most common reason children undergo day surgery. From 2010 to 2012, one in 100 children under age five required day surgery for ECC, with approximately 19,000 of these surgeries performed each year on children under age six. Canadian hospital costs for ECC day surgery in children aged one to five ranged from $1,271 to $1,963 per child, totalling $21.2 million between 2010 and 2012. Children from low-income families, along with aboriginal, immigrant and refugee children are disproportionately affected by dental disease, with between 50 per cent and 90 per cent of suffering from some form of ECC. This compares to an average of 57 per cent of children affected in the general population. A recent Alberta study indicates that when municipalities cease fluoridating their water supplies, children suffer increased levels of tooth decay. This has reignited the discussion around whether municipalities should add fluoride to the drinking water, or reinstate it in places where the water used to be fluoridated. While fluoridation can be an effective prevention strategy, this study also shows that fluoride alone is not enough. To reduce the costs and developmental consequences associated with severe ECC and improve well-being, oral health policies focused on disease prevention and health promotion are still necessary. This briefing paper provides background on the etiology, risk factors and prevalence of ECC in Canada to provide scope for the magnitude of this preventable disease in children. To address the avoidable socioeconomic costs, three areas require policy development. First is the need for increased public education and access to ECC prevention services for at-risk populations. Parents need to know they should reduce their children’s intake of sweet drinks, and avoid filling bottles with sugar water, juice or soft drinks, especially at night. They should also clean an infant’s gums with a soft toothbrush or cloth and water starting at birth. When the baby’s first tooth erupts, parents should commence daily brushing with toothpaste and book a first dental visit. Second is the need to empower health-care professionals to integrate ECC prevention in their early visits with parents of young children. Such visits are more common in family medicine, and these primary care providers can play a critical role in educating parents and promoting children’s oral health. Curriculum and continuing education for these health professions should be enhanced to emphasize ECC’s long-term health effects. Third, government should invest in preventive oral health services for children rather than relying on emergency dental care. Children should have access to early preventive dental services to instill in them habits for lifetime oral health. Provinces without universal public funding for children’s preventive dental health should remove the access barriers that children without dental insurance face., The School of Public Policy Publications, Vol 9 (2016)

WHY IS THIS AN IMPORTANT ISSUE? An estimated 1 in 86 children are diagnosed with Autism Spectrum Disorder (ASD)1 making it the most commonly diagnosed childhood neurological condition in Canada.2 Adults living with ASD3 have the poorest employment outcomes of those with disabilities. Most earn less than the national minimum hourly wage, endure extended periods of joblessness and frequently shuffle between positions, further diminishing their prospects. These poor employment outcomes result in lower quality of life and often lead to steep economic costs. WHAT DOES THE RESEARCH TELL US? Employment success increases quality of life Employment enhances quality of life, cognitive functioning and overall well-being of persons with ASD by increasing economic self-sufficiency, financial security, independent living, community participation and self-esteem.4, 5, 6 Unfortunately, employment outcomes for those living with ASD are poor; only 25 per cent of adults with ASD are employed, most of this group is considered high-functioning and only six per cent are competitively employed.7, 8 Success in employment is attributable to a combination of individual characteristics, external supports and policy enabling employment opportunities., The School of Public Policy Publications, Vol 9 (2016)

Key points: The ventilatory response to reduced oxygen (hypoxia) is biphasic, comprising an initial increase in ventilation followed by a secondary depression. Our findings indicate that, during hypoxia, astrocytes in the pre-Bötzinger complex (preBötC), a critical site of inspiratory rhythm generation, release a gliotransmitter that acts via P2Y1 receptors to stimulate ventilation and reduce the secondary depression. In vitro analyses reveal that ATP excitation of the preBötC involves P2Y1 receptor-mediated release of Ca2+ from intracellular stores. By identifying a role for gliotransmission and the sites, P2 receptor subtype, and signalling mechanisms via which ATP modulates breathing during hypoxia, these data advance our understanding of the mechanisms underlying the hypoxic ventilatory response and highlight the significance of purinergic signalling and gliotransmission in homeostatic control. Clinically, these findings are relevant to conditions in which hypoxia and respiratory depression are implicated, including apnoea of prematurity, sleep disordered breathing and congestive heart failure. The hypoxic ventilatory response (HVR) is biphasic, consisting of a phase I increase in ventilation followed by a secondary depression (to a steady-state phase II) that can be life-threatening in premature infants who suffer from frequent apnoeas and respiratory depression. ATP released in the ventrolateral medulla oblongata during hypoxia attenuates the secondary depression. We explored a working hypothesis that vesicular release of ATP by astrocytes in the pre-Bötzinger Complex (preBötC) inspiratory rhythm-generating network acts via P2Y1 receptors to mediate this effect. Blockade of vesicular exocytosis in preBötC astrocytes bilaterally (using an adenoviral vector to specifically express tetanus toxin light chain in astrocytes) reduced the HVR in anaesthetized rats, indicating that exocytotic release of a gliotransmitter within the preBötC contributes to the hypoxia-induced increases in ventilation. Unilateral blockade of P2Y1 receptors in the preBötC via local antagonist injection enhanced the secondary respiratory depression, suggesting that a significant component of the phase II increase in ventilation is mediated by ATP acting at P2Y1 receptors. In vitro responses of the preBötC inspiratory network, preBötC inspiratory neurons and cultured preBötC glia to purinergic agents demonstrated that the P2Y1 receptor-mediated increase in fictive inspiratory frequency involves Ca2+ recruitment from intracellular stores leading to increases in intracellular Ca2+ ([Ca2+]i) in inspiratory neurons and glia. These data suggest that ATP is released by preBötC astrocytes during hypoxia and acts via P2Y1 receptors on inspiratory neurons (and/or glia) to evoke Ca2+ release from intracellular stores and an increase in ventilation that counteracts the hypoxic respiratory depression.

Teen violence in dating and peer relationships has huge costs to society in numerous areas including health care, social services, the workforce and the justice system. Physical, psychological, and sexual abuse have long-lasting ramifications for the perpetrators as well as the victims, and for the families involved on both sides of that equation. An effective violence prevention program that is part of a school’s curriculum is beneficial not only for teaching teenagers what is appropriate behaviour in a relationship, but also for helping them break the cycle of violence which may have begun at home with their own maltreatment as children. The Fourth R program is an efficacious violence prevention program that was developed in Ontario and has been implemented in schools throughout Canada and the U.S. Covering relationship dynamics common to dating violence as well as substance abuse, peer violence and unsafe sex, the program can be adapted to different cultures and to same-sex relationships. The program, which gets its name from the traditional 3Rs — reading, ’riting and ’rithmetic — offers schools the opportunity to provide effective programming for teens to reduce the likelihood of them using relationship for violence as they move into adulthood. The federal government has estimated that the societal costs of relationship violence amount to more than $7 billion. These costs can continue to be incurred through the legal and health-care systems as the ripple effects of violence play out over the years, even after a relationship has ended. Other types of violence are also costly to society and not just in terms of dollars, but in young lives diverted into criminal activity. Up to 15 per cent of youth who become involved with the justice system grow into serious adult offenders who develop lengthy criminal careers. Yet, research shows that if prevention programs such as the Fourth R can deter just one 14-year-old high-risk juvenile from a life of crime, up to $5 million can be saved in costs to society. Research involving 1,700 Grade 9 students in 20 schools showed that those who did not take the Fourth R programming had a rate of relationship violence 2.5 times greater than those who did, and that the program had the greatest impact on boys, who are the most frequent perpetrators. There was also a significant reduction in violence towards peers, especially for youth who were at risk to be violent because they had experienced previous child abuse. Students likewise became more aware of violence and its impacts on others, and they gained a greater command of coping strategies. The program’s start-up costs vary depending on the school’s geographical location. This paper shows that the program’s costs per student are small compared to the savings to society in terms of violence avoidance. In a large Ontario school board, costs were down to $5 per student. In the Northwest Territories, smaller class sizes and bigger geographic distances make implementing the program more expensive, but still only $15-33 per student. The authors calculated savings based on costs avoided related to dating and peer violence at $2,101 per student. Violence prevention is an ethical imperative and it must start with teenagers. In an era of fiscal restraint and demand for more financial accountability, the Fourth R has proven to be a pro-active success in terms of saving both public money and young lives from the deleterious effects of violence., The School of Public Policy Publications, Vol 10 (2017)