STANDING COMMITTEE ON PUBLIC ACCOUNTS
COMITÉ PERMANENT DES COMPTES PUBLICS
Thursday 18 November 2004 Jeudi 18 novembre 2004
SPECIAL AUDIT
REPORT,
PROVINCIAL AUDITOR
MINISTRY OF CHILDREN
AND YOUTH SERVICES
The committee met at 1003 in room 151.
SPECIAL AUDIT REPORT,
PROVINCIAL AUDITOR
MINISTRY OF CHILDREN
AND YOUTH SERVICES
Consideration of the special audit report, intensive early intervention program for children with autism.
The Chair (Mr Norman W. Sterling): Good morning, ladies and gentlemen. My name is Norman Sterling. I am the Chair of the public accounts committee. I see we have a fairly large audience, as expected, here today.
Part of the rules of this Legislature is that the audience does not participate in any way with what goes on, either in the Legislature or in the committee room. So I would therefore ask you to withhold any comment, applause or anything else. Otherwise, I would have to ask you to leave, and I would be forced to clear the room.
At the front, I have the committee clerk and researchers, and on my left, I have Jim McCarter, the acting auditor for the province of Ontario. We have on my right a number of MPPs from the Liberal government, and on my left, I have Julia Munro from the Conservative opposition and Shelley Martel from the NDP opposition.
Normally, when the auditor produces a report, we ask the ministry to come forward and present their immediate response to that report and thereafter ask members of the committee to ask the presenters their questions about the responses to the report.
The report that was done by this committee and ordered by all members -- or asked for by all members of this committee; it was unanimous that every member of this committee wanted this report done by the auditor -- is somewhat unusual. Normally, the activity of this committee is to respond to the annual report of the auditor, which is produced at the end of November or early December, so this is a little different from what we normally go through in terms of our hearings and our considerations.
You should also know that everyone on this committee has wanted to be open with regard to the publication of the report. The publication of the report, upon our receiving it, was also a unanimous decision by all members of this committee. So I believe every member of this committee wants to get to the bottom of this matter and we want to improve upon the situation that we found in the report.
Now, in front of us we have members of the ministry responsible for this area of our government. Therefore, I'm going to ask the members of the panel sitting in front of us from the ministry to present their case. We have two assistant deputy ministers and we have the deputy minister, Jessica Hill. Perhaps I could ask Ms Hill if she would be kind enough to introduce those who are with her and also to indicate if you would like to make an opening response, and would you also tell us the length of that response so we can try to calculate what kind of timing is going to be involved here.
Ms Jessica Hill: Thank you, Mr Chairman, and members of the committee. Today I have with me Trinela Cane, the assistant deputy minister for policy development and program design. I have the assistant deputy minister for the program management division, Cynthia Lees, and the chief administrative officer for the ministry, Bohodar Rubashewsky.
The length of my remarks will be approximately 10 minutes, and then we would like to open the floor to questions and be able to respond to them in a fulsome manner.
The Chair: If you would like to go ahead.
Ms Hill: I'd like to begin by thanking you for the opportunity to address the recommendations in the 2004 Provincial Auditor's report, Intensive Early Intervention Program for Children with Autism. I would like to express our appreciation to the Provincial Auditor for his report. We welcome this process and are confident that it will help us to improve the work we do on behalf of children with autism and their families.
I would also like the committee to know that the regional providers were very open and candid with the auditor on the issues they face. They also take their commitment to delivering services to children with autism very seriously.
I know we are joined today by the parents of children with autism. We recognize that they face many challenges on a daily basis. We keep this in our minds as we work to make improvements.
Although we have made some good progress in improving our support to children with autism, we have many issues to address.
While 40 more therapists and psychologists have been hired as of October 29 to provide intensive behaviour intervention to 20% more preschool-aged children, we still have challenges in recruiting and retaining IBI therapists. Recruitment and retention will take a long-term planned approach.
To increase the number of therapists, we have worked with the Ministry of Training, Colleges and Universities and the Ontario community colleges to create a new certificate program in autism and behavioural science. We expect students to be enrolled in this program starting in the 2005-06 academic year.
Recruitment and retention is an issue in many human services fields.
Let me turn to the question of general accountability. We are working with the agencies to improve their financial and service delivery accountability. The ministry will meet with its lead service providers to review those expectations and to outline how the ministry will continue to monitor their performance.
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The ministry will continue to improve its contract management processes. The lead service provider is responsible for managing the clinical and reporting requirements for the intensive early intervention program. The ministry is currently developing performance measures for the intensive early intervention program as part of the 2005-06 results-based planning process. Information from the performance measures process will also support the ministry's evaluation activities.
There were a number of recommendations in the auditor's report that dealt with the way the ministry tracks data. The issue of data integrity is one that the ministry is aggressively pursuing. We will continue to strengthen our data collection system so that information is sufficiently detailed, relevant and accurate. As we said in our response to the auditor's findings, the ministry has already begun to take steps to improve the effectiveness of our data collection system by improving the clarity and consistency of data elements and definitions.
The ministry has already held training sessions in August and September of this year to train staff in the Integrated Services for Children Information System, referred to as ISCIS. Training material that clearly defines the various data elements of the information system was provided to training participants. A dedicated help line is available for regional service providers requiring assistance with the information system. The ministry continually reviews any help line questions received in order to determine that the information system is functioning correctly. We are taking the further step of improving ISCIS to make it more user-friendly.
The ministry will also work with regional offices and regional programs to explore ways to improve the current system so that complete, accurate information is available for program monitoring, research and evaluation.
The ministry also recognizes the need to examine the variation in cost per child for similar services among providers. The ministry will meet in December with the service providers to establish a working group. The group will be expected to provide advice to the ministry to make necessary changes to capture better costing information.
By the end of the 2004-05 fiscal year, the ministry will have both an evaluation framework and the appropriate contracts in place to begin an evaluation of this program. The evaluation will investigate aspects of both the design and service delivery model, including its impact on children with autism.
We understand that we have a lot more work to do, and we are willing to do it. We're addressing the issue of under-spending in this program. It has been directly related to the challenges of starting a new program on a province-wide basis where there was very little capacity to build on. There are some program design issues that the Provincial Auditor has identified and recommended we address, such as lost hours, cost of direct service and direct funding, and centre versus home-based services. We will be reviewing these areas.
Mr Chairman, we are committed to continuing the progress that we have made to date so that we can reach even more children with autism. I trust that, along with my colleagues, we can speak to individual questions the committee might have.
The Chair: What I'll try to do, committee members, is to keep the time relative between the parties, with the idea of trying to let everybody participate who wants to participate in the questioning. Perhaps, at the very outset, if the committee members would not mind, there are two definitions that I think are going to be important in our discussions: the direct service option and the direct funding option. Would committee members like the deputy to explain the difference between the two before we enter, or would you just like to get into questions?
Ms Shelley Martel (Nickel Belt): I think we had a fairly significant briefing by the auditor two weeks ago, and we probably all understand that terminology.
The Chair: OK. Questions, then? Ms Broten. Perhaps members of the audience would like members to just name the riding from which they come.
Ms Laurel C. Broten (Etobicoke-Lakeshore): Sure. I'm Laurel Broten, and I'm the member for Etobicoke-Lakeshore.
Mr Chair, before we start, can I just get clarification as to whether I will share some time now with my colleagues, and how long we might have in rotations?
The Chair: If we switch to a member of another party, I'll keep the cumulative time there so your members don't necessarily have to ask the questions all at the same time; you can rotate it around.
Ms Broten: That's fine, thank you.
Good morning. Ms Hill, I'm wondering if we can talk about an issue that is certainly very significant to the parents in my own community, and that is the issue of services being provided to children over age six. I'm wondering if you can talk a little bit about what our government has done and what improvements have been made as part of the minister's plan with respect to dealing with the need in our communities to help those children who are aging out of service, and also to continue with the treatments after age six.
Ms Hill: Thank you for that question. The ministry has initiated a new school support program -- autism spectrum disorder program -- to enhance the skills and knowledge of educators working with students who are moving into the school system. As of November 12, this program has hired 83 autism spectrum disorder consultants, who are supporting the school environment -- teachers, principals, the school setting -- in order that they are able to support children in the classroom.
In addition, we have also increased the number of transition coordinators under the regional programs so that they can help to facilitate that transition for children and their families as well. If you'd like more information about that, I certainly can ask my assistant deputy minister Trinela Cane to speak to it.
Ms Broten: Perhaps what would be helpful is, one, to have a bit of a practical explanation of how the help of a consultant flows in to assist the children. Second, I want to have some information with respect to a historic problem that we understand existed long before we got here, which is the issue of kids who didn't get service while they waited on a waiting list and then turned six. If you could speak to that one as well -- so to those two questions.
Ms Hill: Perhaps Trinela could speak to the first question.
Ms Trinela Cane: Thank you very much for the question. In terms of the school support program for autism spectrum disorder, as the deputy mentioned, 83 new consultants have been hired to serve the 72 boards of education across the province. The way the program works is that currently our regional service providers are engaging in the development of local protocols to govern the types of activities and services delivered by these consultants in the various school boards across the province. There is a core set of services that are expected by each of the consultants. The consultants, I should note, are in place to help support the educators in the system, which means that they are there to support teachers, teaching assistants, principals, other administrators. Many of the consultants who have been hired -- and I have to say we've been extremely impressed by the calibre of the people we've been able to attract in this area -- are, I should note, former teachers themselves. Some are special education teachers, some are retired from the education system, having worked there in a number of different capacities, and a number have many social service and other skills. So we are quite pleased by that.
The actual consultants themselves are knowledgeable about applied behavioural analysis techniques. Their role is to work with the educators to promote effective behaviour management in the classroom, to support them in terms of their knowledge and education about autism, and to provide necessary workshops and other supports that the individual schools and school boards find would be helpful. So the goal is to have them developing direct relationships with the educators in the various schools across Ontario and supporting the educators as they work with children in the classroom.
Ms Broten: Thank you.
Ms Hill: In response to your second question, this program responds to all children who have autism and are in the school system. So in response to your question about those who have not had the benefit of having the IBI program in the preschool setting, this program is available to all children and is intended to be, in a sense, a broader support.
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Ms Broten: So this program in the schools obviously is available. But in terms of those children who from ages two to six didn't receive any treatment at all because they were on a waiting list, is there any other program available?
Ms Hill: Is there any other program available for them after six?
Ms Broten: Yes.
Ms Hill: This is the primary program. However, there are supports in the community that I know the regional providers are working with to ensure that families are referred to what supports exist in the community as well.
Ms Broten: At the regional service delivery level.
Ms Hill: The regional service provider and their subcontracted agencies.
Ms Broten: Thank you.
The Chair: I'll let Ms Di Cocco go at this time.
Ms Caroline Di Cocco (Sarnia-Lambton): Thank you, Chair, and thank you for commenting that the committee, I believe unanimously, endorsed having the report done as well as making it public. I think it's critical to understand that the intent of the government and of this committee is to try to understand and to have a critical analysis done so that we can then deal with some of the holes , if you want to call them that, that are definitely in the system. I thank you for that.
Just to reiterate, the critical analysis -- I call it that -- that was done by the auditor is something that, of course -- if we understand what is not working, hopefully we can then take steps to fix it. Just a couple of things. The report went to December 2003, I believe, and the Ministry of Children and Youth Services was just a fledgling -- it was very small -- under the new government. When you have a new ministry, it does take time to put all of the pieces together. Although I say this, I understand that the parents who are dealing with this matter and have been dealing with it for years certainly have every right -- let's put it this way: Their patience certainly is not there, and rightly so. They deal with these issues day in and day out. They need the services, and they require good services.
For me, the important thing that government has to do is to make sure -- the systems may never be perfect. That's just a reality for whoever is running the show. No system is perfect, but that doesn't mean we stop trying to make it better. What is important in all of this is that the dollars and the commitment that have been put in and added to improving the system -- although, again, it's an ongoing process, it's important, according to the auditor's report, that those dollars effectively serve the people who need the services.
I'd like to ask what the ministry is doing to ensure that we're going to have better services for children with autism as we move forward, so that next year, if we have another report, we certainly are able to deal with some of those recommendations so that both the capacity for the autism program is enhanced and we get more children into the service. Again, I don't want to suggest that everything can be 100% or perfect, because I don't know if that's attainable -- but certainly a better service.
I put that forward: What is being done to build capacity in the autism program, and what is being done to get more children to be serviced? Because that's what the money's supposed to be there for.
Ms Hill: Thank you for that question. There is a number of areas where the Provincial Auditor spoke to needing improvements that address that question. I think there are aspects of it that you referred to in terms of capacity building, there are aspects of it in terms of being able to accurately capture the expenditures and ensuring that we're comparing apples and apples -- because currently we are not; the two funding models are quite different -- and the third is ensuring that we have the most cost-effective service delivery model.
What I'd like to do first is have my ADM, Trinela Cane, speak to some of the capacity building as well as the efforts we are making to capture information in a more effective way. Truly, I think what the auditor outlined were some of the challenges we faced in terms of capturing the same information and being able to compare it, which we haven't been able to do to date.
Ms Cane: Thank you very much for the question. I have to say, at the outset of my response, that this is a very challenging area, and I can't presume to begin to understand how parents are trying to cope in this situation. But I do want the committee to know that in terms of building the necessary capacity for the service system for children with autism, we are very committed in that area.
In our discussions with the Provincial Auditor and his staff, a number of suggestions were made that will speak to the need for enhancement of the current program design. We've already made a commitment, as part of our response to this committee and to the Provincial Auditor in his report, that we will be addressing those significant issues and giving them due consideration in very short order. We will be looking at all of those areas that have been flagged in the program design. To some extent, to many parents and others, these are not new issues.
You referenced the new ministry being created. I think that's an important element as we move ahead, where we need to look across the range of children's services to ensure that we are actually looking at children quite holistically. Children with autism are no exception. They require many different types of services, and we want to make sure that children who are in need and at risk have those services available. So I'll just say that at the outset.
In terms of the capacity building, I think what we will have, and do have already, is a series of shorter-term and longer-term initiatives. The shorter-term initiatives that I will mention and that the deputy has mentioned: in the area of IBI, an immediate $10-million infusion to enhance service in that area. I am pleased to report that there has been significant progress in the hiring of therapists, which, as many of the committee members will know from their in-depth briefing, has been a serious issue in program start-up and ongoing expenditure planning. We have now 53 new therapists and three psychologists that have been hired in addition to the staffing that has continued over quite a period of time. I think we are making demonstrated progress in that area. Our commitment is to serve at least 100 more children by year-end with that infusion, and that we will do.
I should also mention that we've taken some shorter-term initiatives around capacity building, particularly in the recruitment area, where we've actually had on our Web site information encouraging people to enter this profession. This is a very challenging profession and there is such a need for resources in this area. We've actually taken quite a pre-emptive step in terms of trying to give people information about the nature of this profession, because I think many people are not aware of this line of work, and those who are certainly are very committed to it. We are continuing that effort in terms of ongoing recruitment on the ground.
In addition, we have taken two other steps that were announced last spring. One is the development of a grant assistance program, which will be available beginning in January, to allow people who have received necessary training in a number of related professions to receive reimbursement for their educational training, both in the past, if they've managed to be retained for one year in their current position, and also for ongoing training that they may undertake in the future. I think that's going to go some distance toward some of our recruitment issues, but certainly our retention issues, which are equally important.
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In addition, I should comment that we've been working with a few community colleges to build immediate capacity to train folks in the behavioural science area, and autism specifically, and we have had some take-up in that area. In addition, we've put an RFP on the street and have selected a consortium of colleges that are currently developing the curriculum that the deputy mentioned and which will be up and running by the fall of 2005. Our first graduates from the certificate program will be available to our service system in 2006.
So I think there are some exciting pieces on the recruitment and retention issue, which has been a particular challenge for us, but also in terms of capacity building in the current IBI programs that we have today.
I should mention one other thing; I would be remiss if I didn't. As parents are on waiting lists, it has been a considerable issue that while they're waiting for IBI, parents also have a need for other types of services and supports. In some cases, we're making additional referrals to the types of ancillary services that I talked about. In addition, we're offering, and every service provider is offering, a range of programs, and we've been meeting with them over the past several months to not only encourage this but direct that service providers make a range of supports available to parents, including everything from parent information to parent support groups to group sessions on specific topics. Some service providers have actually developed a fairly sophisticated multi-level approach to address parents at various stages in the process.
If that's helpful to the committee, those are a number of the steps that have been taken to build capacity.
Ms Hill: Perhaps I could just add one other aspect of the changes in our preschool guidelines, which was to set an expectation that the eligibility assessments would be done in four to six weeks, which will certainly speed up the process, because our goal is to ensure that the families get the supports they need as quickly as possible.
Ms Di Cocco: Thank you. Chair, I forgot to mention -- you suggested that we say who we are and where we're from, and I didn't do that. I'm Caroline Di Cocco, and I'm a member from Sarnia-Lambton.
The Chair: I think we're going to go through this rotation twice. I'm going to call on Ms Martel to put forward some questions, and then I'll ask Ms Munro.
Ms Martel: Shelley Martel, Nickel Belt. Because neither the ministry nor the auditor have actually intervened to clarify the report, my understanding is that the audit dealt with information and a review of the ministry to the end of September 2004, not December 2003.
Mr Jim McCarter: Yes, that's correct. We essentially did most of our fieldwork -- it took us a bit of time to get the information from the ministry, and we did most of our fieldwork in July, August and September.
Ms Martel: Right. Thank you for that. So it would really be an observation or critique of what's happening now, currently under the Liberal government. That raises my first concern, as noted by the auditor on page 5, where the auditor said, "Overall, the ministry does not yet" -- and remember, this is quite current -- "have adequate oversight procedures in place to ensure that external service providers are spending funds provided to assist autistic children and their parents in the most cost-effective manner." The current administration has to bear significant responsibility for that, given when the audit was complete.
Let me make a second observation about the school support program. I think it's important to get on the record that this is not a treatment program. It is nothing like a treatment program. The folks who will be going into the school setting wouldn't even have a requirement to have IBI training. So it makes Laurel's question important; I am not going to suggest this was where she was going, but this is where I'm going. For those kids who never got a single day of IBI treatment, this school support program is going to do zip, zero, nada for them. Most of those kids aren't even in the school system because they can't function in the school system because they didn't get that grounding in IBI in the first place. They need IBI in order to learn in the school system, and this support program is going to do zero for all those children who got cut off arbitrarily at age six, before they should have been, when they still needed IBI, or for all those kids who never got a day's worth of IBI. It would be interesting to find out where most of those kids are right now, because I can tell you they're not in a regular classroom, integrated or learning.
That is the shame of this particular program, because we should be doing something for those kids who got cut off and we should be doing something for those kids who never got a day's worth of IBI, and we are not, despite Mr McGuinty's promise to these parents and many others that the discrimination against the kids over age six would stop under his government. It has not. That wasn't addressed in this report, but it is an important issue that needs to be raised in terms of how we are dealing with all autistic children. In terms of those kids over six, is what the ministry's providing them going to make a bit of difference in their lives or their families' lives? For too many of these parents, I regret to say, it will not.
Let me deal with the oversight. On page 6, the Provincial Auditor said, "The three most critical things the ministry needs to do are as follows: Base funding decisions to the external service providers on relevant, detailed information on specifically what services must be provided to ensure equitable funding of services...."
Because these were the most critical things that the auditor outlined -- there were a number of others that came after -- I'd like to get some sense of what the ministry is doing in response to point 1. Maybe you don't have the auditor's report. Do you need a copy?
Ms Hill: I can assure you we have it.
Ms Martel: Page 6, bullet point 1.
Ms Hill: I was actually going to the recommendations, so I will follow along with you on page 6.
I think this first point regarding base funding decisions is directly related to us having more effective information through our information systems. I did speak to some of the improvements we've made to ISCIS. In order for us to be able to better track our expenditures, as I mentioned, we are striking the working group in December with the service providers. Certainly one of the challenges has been that in the time that the service providers have been working very busily on ramping up of the program, the attention to this level of detail and the ability to compare across programs has not been addressed sufficiently.
In addition, we do want to make clear that the direct funding costs, versus the direct service costs, are really capturing apples and oranges, and we can go through that in greater detail. It is significantly different and it doesn't need to be that different, but it definitely needs to be clarified.
Ms Martel: Can I just ask one point on ISCIS? The auditor pointed out that the service providers told him that when they inputted information, often it was lost, or if a mistake was made it couldn't be changed, in terms of the data, which would really affect your information. What has been done to correct that?
Ms Hill: I'll have Trinela Cane speak to this.
Ms Cane: The deputy mentioned that a number of refinements are currently in process with respect to ISCIS. I should reinforce that they are dealing with many of what I would call the minor irritants for service providers in submitting the data to the system. The member has quite rightly identified, as did the Provincial Auditor, a problem with the existing system, which is that when data is inputted, many of the fields are actually protected, so changes cannot be made by various individuals. We've had a number of discussions with our IT folks in the health and social services IT cluster to talk about what changes need to be made to ISCIS. Those are currently being prioritized. I have to say that a number of the changes to ISCIS are going to require some fairly significant investments over the next period of time.
The training sessions that we held with the regional service providers and their staff who were actually inputting the data were extremely helpful. I should mention that in the course of those discussions, not only have we come up with quite a priority list for action on ISCIS -- and some of that is going to take investment and prioritization -- some of it will also have to be considered in the context of our longer-term plan for ISCIS, because in some cases architectural changes are going to be required and we will have to address those.
Ms Martel: As you said, it's going to require significant investment. Does the ministry have the capital funds in its budget, or are you going to have to make a request to Management Board, and do you have approval for those enhancements to be made?
Ms Hill: In the short term, we are going to be making some changes in December that we can make within our current budget. To make any significant changes in the architecture, we would have to go forward with a request to Management Board.
Ms Martel: Has that been done?
Ms Hill: No, that hasn't been done, because we really will need to assess how much we can accomplish with the changes made in December. It isn't the only information system we work with. The other information system that the auditor referred to is the SMIS system. We want to be able to maximize the use of both systems. It may be that the SMIS system, with the improvements to the current ISCIS system, will be sufficient for the purposes of tracking the information. A great deal of what we need to do is establish the common definitions, make it more user-friendly, make it accessible and continue to refine it through regular monitoring.
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Ms Martel: Is that going to give you correct information with respect to what's happening in the program? The auditor pointed out that, while the ministry had reported that 516 children were receiving services by December 15, 2003, that information was at odds with information in both of your databases, and not only was it at odds, but the information in the two databases was different from each other. So what is being done to rectify that problem?
Ms Hill: That's part of what I'm describing, Ms Martel: the need to have regular reconciliation of the data. In a sense, we have to weave the two together and continually check and recheck why the data are not coming together. It requires a level of monitoring that I think we will be bringing to it that is new.
We are very concerned that, in addition, the consistency of information is not just around the information system -- bad data in, bad data out. You have to continue to work with the providers on this, and they are also very committed to doing that.
Ms Martel: Have you asked the providers to start tracking the number of hours of IBI service that are lost because the therapists aren't providing the services?
Ms Hill: I'll ask Trinela to speak to this, but I think the question of lost hours is a bigger issue. The Provincial Auditor asked us to look at this with the regional providers, which we're going to do. So before just asking the question about whether we're tracking the information, we need to determine whether we're going to make any changes. But I will ask Trinela to speak to this question about information on lost hours specifically.
Ms Cane: In the past number of weeks, specific to a response to discussions with the Provincial Auditor, we have asked the regional service providers to begin to gather data on lost hours. So that is beginning. We mentioned that we will be meeting with service providers for two days in December. One of the focal points for that meeting is around the type of data that we need to have tracked, including lost hours, to identify issues with respect to gathering that data, and the deputy did refer to the broader policy question around lost hours, which we will have to address as well. But we are currently directing and advising our regional service providers that that information will have to be gathered.
Ms Martel: It's the broader policy question that I'm most interested in, because the auditor made it very clear: In the one agency that had some numbers, on average, each child lost 4.4 hours of service that was supposed to be provided every single week.
I just want to read into the record this e-mail that we got from a parent, Tom Barger, who said that he got a commitment of one year at 25 hours a week. The service provider managed to deliver eight and a half months at an average of just over 15 hours a week. When his son was terminated from the program because he turned six, he was still non-verbal. I think that's the situation of a number of parents.
We have another parent in London, Cynthia Boufford, whose son lost 570 hours from their provider, not because the child was sick; that was the provider's fault.
Frankly, I'd like to know what the ministry is going to do on this broader policy issue of ensuring that children are not losing service hours because of therapists leaving, therapists not getting there in time or whatever; that the kids are actually going to get the service hours they have been contracted to get, even if that takes them over the age of six. So I'd like to hear if you're prepared to do that, because you should be. And if not, why are these providers still being paid full freight for services they are not delivering?
Ms Hill: I think you actually have three questions in that statement, Ms Martel. The first was with respect to what we're going to do about it. We are not going to be making decisions about this unilaterally. We have to work with the service providers. We do have to make a commitment to dealing with it, though, and it is important for us to think through the implications of it. As you say, there are many variables that contribute to the lost hours question. The first is the responsibility of the providers; the second is if families are not able to attend. So we need to address the full policy.
The second question you raised was about reimbursing the service providers. The service providers hire people on salary. I'm not quite sure how we could possibly ensure an effective service model if we were clawing back funding. I mean, these are people who are on salary; they're part of collective agreements. So what I think that --
Ms Martel: If I might, Deputy, if someone is on direct funding and the service is not provided, that money is clawed back from the parents. If you are on direct funding and the hours are not complete, you get that money pulled back.
Ms Hill: If you want to get into a comparison of what's provided under the two models, they're very different.
Ms Martel: I know, and that's part of the problem, because most parents have to cover it out of their own pocket. If you're going to continue with direct funding -- and I think that's a very serious option -- you should also be agreeing that you're going to pay for all the costs that these parents have to assume, especially if there's a difference in wages and salaries between workers.
Ms Hill: There are also costs under the direct service model that are actually of benefit to families under the direct funding model, so I think it is again comparing apples and oranges. Under the direct service model, the assessments are provided by the direct service provider. The relationship with the psychologist is provided under the direct service model. There are other supports provided to families under the direct funding model, through the direct service model.
All I'm saying is that the examination and ensuring that we are capturing comparative information in order to inform our decisions is absolutely key, and we've made a commitment to do that.
Ms Martel: But it's broader than that. It's not just capturing the information.
Let me go back. I mean, you do claw back that money from those parents, and parents know that. All right? There's a second issue: Parents on the direct funding model are usually paying out of their own pocket, whether it be for resource material -- oftentimes it's because they're not getting paid full payment for the actual salary of the therapist or other people consulting in the case of their child. The ministry should be looking at that. I don't know why there's a discrepancy; there shouldn't be.
The policy issue is this: We know, everybody knows -- everybody has had kids who have lost incredible hours of service, not through a fault of their family or their own child but through the fault of the regional provider. Either you're going to address that and make sure those kids get the hours they were promised or you're not going to address it and those kids are going to continue to lose hours. I don't think it's much more complicated than that.
Ms Hill: The other complication is that in a program where you're ramping up and have a shortage of therapists -- we have worked with the providers to try to address the question of how we can ensure the maximum amount of hours. The hours are increasing. We have made progress since this report. The data in this report regarding the number of hours was from a certain point in time. The commitment to increasing those hours is absolutely critical.
The reason we need to make sure we're doing this with the providers is to ensure we make a commitment we can follow through on, and that, in the efforts to continue to recruit and retrain staff, we can continue to flow children through from the eligibility assessment to the various supports families are offered and to the IBI therapy in the most effective manner. I'm not going to make an arbitrary commitment here. What we've agreed to is to look into it.
Ms Martel: Let me make a couple of comments. I've heard the minister say and I've heard you say that the program is ramping up. For goodness' sake, we've had five years of the program. At a certain point, either this program is working or it's not, and if it's not, then we'd better overhaul it and make sure it does. I don't buy the argument any more that we're ramping up.
Second, most parents I talk to who are on the direct funding model have no problem whatsoever finding IBI therapists to work for their kids -- no problem. So I also don't buy that argument any more, that there's a huge shortage. Ask those parents who have direct funding -- Ms Brenda Deskin talked to me this week about her case; she's involved in the court case. There are eight therapists working with her son. There was no problem finding them. There's a problem paying to keep them, but no problem finding them.
So those are some arguments that I don't accept any more, not at this point in time, not five years after this program was in place.
You're not prepared to give us a commitment today about lost hours. That's fine; I understand that. Let me say, though, that there's something seriously wrong when kids who are contracted to receive service lose 570 hours, in the case of Jordan Boufford. Or, in the case of Brendan Barger, he ended up with eight and a half months at just over 15 hours a week. He was only on it for a year anyway, because he waited on the list for three years. He was supposed to get 25, got 15, and now graduates non-verbal. This is not helpful to kids.
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As you look at this, one of the very significant changes that has to be made is recapturing those lost hours, making sure those kids get those lost hours. I don't care if they get them after the age of six -- that's how it could be done -- until they get all they were entitled to. The second is to make very sure that we look long and hard at the direct funding model as an option. Because parents don't have trouble finding therapists; what they do have trouble with is paying for the additional costs not covered under that program that are covered if you're in the direct service model. That's not fair.
Ms Hill: We have said, Ms Martel, in my opening remarks, that we are committed to looking at the direct service and direct funding aspects of the program.
Ms Martel: Chair, I'm going to stop and wait for another rotation.
The Chair: That's fine. Ms Munro?
Mrs Julia Munro (York North): My questions are very closely related to those you have already heard. As a member -- I just realized that I'm supposed to say Julia Munro, York North -- of course I too have had autistic parents come to me over the years and recognize some of the huge limitations they have run into and feel stonewalled and so forth.
I really wanted to ask you what kind of rationale was used in determining that in some places you would provide the direct service model and in some places you would provide the direct funding model. It seems to me there's a huge discrepancy in the outcomes from these two methods of service. When you hear some of the frustrations people have, they very often reflect the fact that, perhaps for reasons they didn't understand or don't understand today, they find themselves in one of those models. I think it's very important both for the families involved in this process, whichever one it is, and for us as legislators to understand how we got into a situation where we have such huge discrepancies and the frustrations that come from those.
Ms Hill: Thank you for the question. To begin with, to clarify, the regional providers all offer both direct service and direct funding options. I can have the ADM for program development, Trinela Cane, speak to more of the details of the way that process works. However, I would like to say that the reason both were offered was in general recognition of starting something in the province where there already were service pressures and demands, recognizing the lack of capacity in the system as a whole, and therefore the need to provide choices. Let me have Trinela speak to the details.
Ms Cane: Thank you very much, Deputy. I would reinforce that part of the early program design did require and still does require service providers to give parents a choice of direct funding or direct service. We recognize, and the Provincial Auditor has noted as well in some detail, that the models are actually quite different: apples and oranges.
I think it is safe to say that the inclusion of the direct funding option not only accommodated parents who perhaps already had service providers in place -- and we wanted to make sure there was continuity of service in that area -- but many parents also have the wherewithal and the desire to coordinate service and had been doing so for a number of years prior to this program on behalf of their children.
In terms of the direct service option, I should mention -- with the Provincial Auditor's comments as well in this area -- the importance of choice for parents, given that not all parents wish to choose an option that is direct funding. We know, as Ms Martel has highlighted, that the direct funding option has a number of issues associated with it, including the dollar amounts paid and the services that can be covered as part of that. We do know, and the Provincial Auditor also commented, that many of the parents are paying out of their own pockets, and that is a significant issue, which we recognize.
On the direct service side, what we are trying to do is to create a set of services that will also benefit those receiving direct funding, and that has created some complexity, both in the data gathering and the ability to identify, for various program components, the associated costs.
At this point in time, parents do have a choice. The Provincial Auditor noted in his report from comments made by some of the service providers that it puts them in somewhat of a difficult position, because as decisions are made about direct funding, it puts them in a very sticky wicket with respect to the fact that it reduces their ability to create permanent program capacity on the ground. That was noted and is certainly known to the ministry. As Ms Hill indicated, it's an area we're very definitely prepared to look at. Addressing that issue is also quite significant in terms of its policy implications.
Mrs Munro: If I could just follow from what you have said, could you explain the position that parents might find themselves in with regard to having opted for one of these avenues? Since you say that they have the choice and that every provider can provide either, is there an opportunity for them to go to a different method; that is, move from direct service to direct funding or vice versa?
Ms Hill: I think what I'll do is have Trinela speak to this. I think some of the complexity -- and it is exactly one of the issues I think we need to be addressing, as the Provincial Auditor spoke to. When the programs have been working to recruit and retain staff, they have one envelope of funding that is available. They, in a sense, split their envelope for direct funding and for direct service.
One of the challenges we'll have to address is, if we want to make direct funding more available to families, as Ms Martel has raised, it will impact on the program's ability to create capacity. That is one of the fundamental policy questions.
Whether, on a practical level right now, families can choose to switch midway, I'm actually not sure, so I'll ask Trinela to speak to that.
Ms Cane: My understanding is that that is an option open to parents. It does require some accommodation on the part of the regional service provider, but my understanding is that also, in such cases, the regional service provider attempts to deal with that on an expedited basis. My understanding also is that this hasn't, to date, been a significant issue, but we are certainly prepared, through our service provider network, to accommodate that if the case arises.
Mrs Munro: In working out this opportunity for people to make this choice, whether they would go with direct service or direct funding, were considerations given in relation to the kind of ratio that would exist from the perspective of the ministry in terms of funding with regard to administration and front-line service? Clearly, the recipients of the IBI program are naturally looking at -- they're the end user, so to speak, of this service. So for them, the issue is, "Am I getting the service that I understand I should be getting?" I think it is helpful for people to understand what kind of ratio, what kind of funding allocations, break down between what is front-line service and what is the cost of administration.
Ms Hill: The first question you had was whether we set any expectations about what should be the split between the two. That has been left to the service providers. In the inception of the program -- however, it is an ongoing discussion and something we have been discussing with them -- there was no clear understanding of what the take-up would be between direct funding and direct service. Experience will inform, and I think the Provincial Auditor's report actually spoke to the fact, that there are some advantages for families under direct service who may not be able to manage a direct funding arrangement. I think that's still a consideration in terms of ensuring that, for those families who do not want a direct funding arrangement, there's sufficient capacity to support them.
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With respect to administration costs, I'll ask Trinela to speak to that. We have also worked with the service providers around the cost of administration. As I did mention, though, some of what has not been captured clearly enough is the cost of delivering the other supports, such as the eligibility assessments and the parent supports while families are on the waiting list -- those kinds of things. We need to be able to break down those costs, but we wouldn't count that in the cost of administration; that is service.
Perhaps Trinela could speak to what we've done in the way of cost administration.
Ms Cane: If I could just go back, Deputy, to the question of allocation of resources to direct funding versus direct service, our experience currently is that about 25% of parents province-wide have requested direct funding approaches. We know that, in some areas of the province, service providers are telling us that they are actually offering direct service and direct funding at about a 50-50 ratio. So it looks like across the province the take-up is somewhat different, but on average it is a 25%-75% split. I just will mention that, because I think it goes directly to your question.
Whether that will change over time, as the deputy noted, is difficult to anticipate, but I think that's one of the considerations, as we speak with our service providers in December, to look at how we can ensure that there is appropriate money to support the choices by parents that we've just discussed. So I'll just mention that.
We have done some analysis of the cost of administration for this program. Across all service providers, it's in the range of 7% to 9% for the direct administration of the actual program itself. As the deputy mentioned, one of the problems we have is that we're not able to break down discrete costs in areas such as the cost of assessment and the wait-list management that we've currently put in place. We have a coordinator for each one of the service providers, and that coordinator orchestrates a series of supports that I mentioned in my earlier response. We haven't quantified, in a discrete way, the costs associated with that.
In terms of pure administration, in terms of actually administering the programs, it is in the range of 7% to 9% across the board, but there is a range of other services that are part of a cost of doing business and very important supports to parents that we haven't identified in a discrete way.
Mrs Munro: Thank you. I certainly appreciate the difference between what is pure administration and what is the kind of support you're providing.
Can you give me an idea of how many agencies we are talking about across the province and in the regions?
Ms Hill: We have the nine regional service providers, and they have, in the regions, subcontracted with other agencies, so the total number, I believe -- I think actually the Provincial Auditor captured this --
Mrs Munro: I'm sure he did; I just couldn't find it quickly.
Ms Hill: Approximately 64.
Mrs Munro: You've made reference to the two-day meeting and so forth to get people together. What I assume, then, is that that would include both the regional and the subcontracted, or would you just be talking to the regional?
Ms Hill: The network we've been working with over the last period has been the regional service providers, because they are responsible for the clinical and administrative oversight of all the agencies. But we wouldn't hesitate to bring all the providers in if we felt it would be valuable, whether it was a training session or that kind of opportunity.
I think the purpose of the working group is to really work with the nine regional providers as the leaders, to work through some of the issues around the costing, because we really need to sort it through with them first. There could easily be follow-up meetings if we felt we'd agreed on an approach that we wanted to ensure was captured by all the service contracts.
Mrs Munro: Moving to include those subcontracted agencies would be a most admirable step to take, simply because those are the front-line people, the people our constituents deal with. The level of frustration, obviously, and perhaps misunderstandings that develop come at that point. To me, it seems that's an extremely important area to look at, to see what kind of issues come from that particular group of people.
Mr Chair, I'll wait until my next time around.
Ms Hill: In response to your suggestion, I think you're absolutely right. Driving consistency through all the provision is a very important aspect of what we will be focusing on. If we are engaging with those subcontractors through our various training or discussions or clarifications or changes, we definitely need to make sure that's part of our plan.
Mrs Munro: Mr Chair, after having said that, could I just ask one follow-up question that relates to that? I think all of us would be comforted by the notion that during that process you would agree to an undertaking in terms of best practices. Certainly from the position of the committee, we are well aware of there being many discrepancies in terms of service provision and things like that. To have your undertaking that any work you do with the agencies and the contracted agencies would address the issue of best practices would be something I think all of us would like to hear a commitment on.
Ms Hill: Absolutely. We are very committed to continuous improvement and using best practices, whether it's from this jurisdiction or other jurisdictions, to deliver the most effective program.
The Chair: The approximate times I have left are: the Liberal caucus, slightly under 20 minutes; the Conservative caucus, slightly under 20; and the NDP with about 15 minutes left. So we'll work in those time frames.
I have three on my list from the Liberal caucus. I have Ms Sandals, Mr Mauro and Ms Di Cocco. You can judge your time between you.
Mrs Liz Sandals (Guelph-Wellington): First of all, I'd like to get some clarification from the auditor, if I may. We understand that you did the work over the summer and into September. When I look at the actual data provided, it is all labelled as if it's data collected relevant to the previous budget year, the 2003-04 budget year.
Mr McCarter: That's correct. The data we got basically ended at the fiscal year March 31, 2004. We got the data; then, going out to analyze it, we basically asked our questions based on that data. But we did the work in July, August and September.
Mrs Sandals: So in fact when we look at the data in this special audit, it is reflective of what was happening in the 2003-04 budget year.
Mr McCarter: Yes. If you're looking at data like lost hours, like dollars, that data would be up to March 31, 2004.
Mrs Sandals: Thank you. It's important to note for the record that the new programs that the Liberal government has brought in were largely beginning in the 2004-05 budget year, so in fact the data we have available in the special audit does not measure a reflection of the new programs introduced in this budget year. I think it's important that we clarify that for the record and for the public so we're all clear at least on what we're measuring or attempting to measure.
That sort of takes me into the next comment. As a committee, when we looked at the data, we were all very uncomfortable with the data available in the original audit, which is why we all agreed that we needed to do a more thorough examination of the existing data to try and get a firm handle, if possible, on what was really going on. With my background, I'm a firm believer that, while we all understand that there are a number of very serious challenges in this program, if you're going to do an intelligent job of attempting to address those challenges, first of all you have to collect the data and find out what is really going on before you can figure out how to fix it.
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When I speak to people in my constituency office, I hear a variety of concerns, and one of the concerns is around the waiting list for IBI. I also hear other concerns, though, about waiting lists for other services and availability of other services. In fact, I've had parents in my office who say to me, "I've got more than one autistic child. For this child, I'm really frustrated because I can't get them IBI. For the other child, I'm really frustrated because I can't get them" some other service that would be appropriate for that child. That really leads me into a question which I think fits quite well with Julia's question.
Actually, I didn't introduce myself either. We're all not doing very well at this, Mr Chair. I'm Liz Sandals, Guelph-Wellington.
If we look at recommendation 7 on page 24 -- I'll just read it while you're looking. "To help assess the effectiveness of the intensive early intervention program for children with autism, the Ministry of Children and Youth Services should develop specific performance measures to determine if the program is meeting its objectives of providing both short- and long-term improvements in children who have received services."
A concern I would have, with my background in education, is that we need to measure whether the program is delivering what we expect it to deliver. We certainly need to measure whether it's reaching the children it's designed to reach. I wonder if you could elaborate on the answer you gave the auditor in terms of what you are planning to do to address that recommendation around program effectiveness.
Ms Hill: Thank you for the question. I think I will have Trinela Cane speak to our plans on performance measurement and evaluation. This is an area that we think is long overdue. We are also concerned, though, that it does include a number of different elements. Program effectiveness includes, as you said, determining whether children are benefiting from the program on a short- and long-term basis. Some of that actually will end up being a research initiative because we would need to follow the children. However, in the short term, we are concerned about looking at the program design and making sure we are making improvements, as well as looking at the information we have to date to determine how children are benefiting from the program. So we have multiple parts to what we need to evaluate.
With respect to performance measures, I'll have Trinela speak to that.
Ms Cane: With respect to performance measures, the commitment we have made in response to the audit itself is something we had underway already, which is the development of what we hope to be a small course set of performance measures for the program that will be incorporated into our business planning process of the ministry during this fall period.
What we have currently by way of program measures deals much more with service outputs and with transactional types of data. With the creation of the new ministry, our minister and deputy are very focused on looking at outcomes-based approaches, which represent a fairly significant shift to the approaches taken in the past. With regard to that, our performance measures are going to be much more outcome-based this year.
I think the deputy has highlighted, in terms of the actual program effectiveness elements, that this is a difficult area, in part because what we do know from parents is that those who are receiving IBI services, for example -- and the Provincial Auditor noted this as well -- are very satisfied with the service for their children, and as we know, parents not able to access those services would very much like to do so on behalf of their children. So from an anecdotal perspective, we do have a lot of information on day-to-day progress on the part of children.
I think that as we start to look at outcomes, we do need to look at -- even our own data systems are much more focused, as I mentioned, on transactional data. We need to move to much more of a case management approach. Our service providers, in fact, have their own case management systems, but as the deputy mentioned, we need to be looking at longer-term results on behalf of our children in the program, both to look at how they're doing in the short term and, I think, from a research point of view. As you know, evidence in this area is somewhat difficult to come by. There's a variety of evidence in a variety of areas, but I think part of what we want to do in the new ministry is to create a research chair for the study of autism, which is something that was announced last spring and we're pursuing it now. We are also looking at providing scholarships through the Ministry of Colleges and Universities to support that, so that people who are undertaking studies at the masters level and the PhD level will have some funds available to them to pursue studies in autism. So it's actually both a program effectiveness issue -- and we are prepared to address the program design issues the auditor has identified -- and also a longer-term research process that we need to make sure is in place.
To that end, I will also mention that the deputy made reference to an evaluation framework. We have made a commitment to evaluate the IBI program and in fact to develop evaluation frameworks for the school support program and other programs that we're offering. We need to do it in a much more comprehensive way, and we will be undertaking that. We will have to pursue proposals through RFP processes through the spring, but we hope to have contracts in place -- in fact, it is our plan to have an appropriate contract in place -- by the end of the fiscal year to begin the program evaluation and the longer-term research agenda.
Mrs Sandals: Good. I am glad that we're taking a look at the program and actually measuring what we're doing so that we can get a handle on what works and what doesn't work in terms of program delivery.
Mr Chair, I'm going to defer to some of my colleagues.
The Chair: Mr Mauro?
Mr Bill Mauro (Thunder Bay-Atikokan): We'd be happy to allow the rotation to go and then come back.
The Chair: Is there any objection?
Ms Martel: You don't want to finish?
Mr Mauro: No, we want to use our time, but we're just allowing the --
Ms Martel: You mean that you're going to wait to see what I say and see how to respond.
Mr Mauro: We're just trying to be fair.
Ms Martel: Come on. I've been here longer than that.
OK, let's go to it. I have some general questions. Are these guidelines that you left on our table -- preschool intervention program for children with autism program guidelines -- the guidelines that were referenced in your October 8 press release as being the guidelines you're giving service providers with respect to their waiting lists?
Ms Hill: I don't have the October 8 press release in front of me.
Ms Martel: There's a reference to new guidelines that service providers were supposed to use for doing evaluations for the wait-lists. I'm wondering if these --
Ms Hill: I think I'll ask Cynthia Lees to speak to this.
Ms Cynthia Lees: Ms Martel, we have since reissued these guidelines to the service providers to provide the clarification on children who are five and under. I think there was some confusion; I think people had the impression that we were changing our eligibility for the program and that we were cutting children off the program. There was no intent to cut any children off. We have since reissued the guidelines to our service providers, along with a letter of clarification to the service providers.
Ms Martel: I have the letter of clarification. I'm assuming that what's attached to it are the new guidelines, then, because that's what I wanted to get a copy of. I only have a copy of the letter. So I can assume these are the new guidelines which are now being used that have been approved by the ministry?
Ms Lees: Yes.
Ms Martel: OK. Thank you.
My second question is on eligibility assessments. I understand that Kinark now, in an effort to deal with their wait-list and get their assessments done, are doing new assessments for kids who are on the wait-list and refusing to accept assessments that would have been done either by Sick Children's or North York General, for example. I'm wondering why we're spending money on assessments when people have up-to-date assessments from, I think, reliable organizations. Do you have an answer?
Ms Lees: I'm not aware of that. I would certainly follow up. Our expectation is that if there are assessments that are done, then the service providers should accept those. We don't want service providers to do assessment for the sake of doing assessment. I would be happy to follow through with Kinark.
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Ms Martel: OK. I think Mr McIntosh, who is probably in the overflow room, has had that experience, so I'll make sure that Bruce talks to you before we finish that today.
I want to know how much additional money went to the agencies this year. Was it the $10 million that was promised?
Ms Hill: I'll ask Cynthia to speak to the cash flow. Our expectation from the last contact we had with the regional service providers is they are on track to spend the full allotment for the new investment for the preschool program. But we don't flow funding at the beginning of the year at 100% before people report back to us on how their spending is going.
Ms Martel: So you can provide us with the anticipated allocation to each of the providers? They must have been given some idea of how much money they were going to receive.
Ms Hill: Yes, absolutely.
Ms Martel: And we can have that list? Would I assume that list is going to add up to $10 million?
Ms Hill: Yes, it will.
Ms Martel: I'll be looking forward to receiving that.
I want some clarification, because you talked -- and somebody's going to correct me if I'm wrong -- that there are benefits and services that families who are on direct funding get from the direct service model. Can you just repeat what those are for me again, please?
Ms Hill: I think Trinela can speak to the different components.
Ms Cane: My understanding is that the actual specific services that may be offered and the supports to parents may vary somewhat region to region and the intention is for regional service providers to respond to the needs as identified by parents. Certainly in discussions with the service providers themselves, they've given us an indication of the types of supports that are provided. They include things like documents and information for parents, referral to autism society chapters in the various locales. It includes the availability of individual workshops for groups of parents dealing with specific issues or more general issues. It deals with some specific supports to parents who have just learned of the diagnosis for their child, specifically focused on addressing some of the questions and concerns parents may have at the outset. In addition, my understanding is that there are groups that may be provided in some regions for the children themselves, particularly in preparation for transition to school. So those are at least a short list of the types of services that are being provided.
I should also mention, separate from what I guess I would call the supports to parents, the service providers are also providing the eligibility assessment and the clinical assessment of the children. I hope that responds to the question.
Ms Martel: And the workshops for parents, do they pay for those themselves or is that covered by the direct service provider?
Ms Cane: The service providers will cover that.
Ms Martel: Let me ask about waiting lists. How many children would be on a waiting list right now?
Ms Hill: I will ask Cynthia Lees to speak to our most recent information.
Ms Lees: The recent information I have, Ms Martel, is that as of September 30, there were 950 children waiting to be assessed in the program.
Ms Martel: How confident are we that that number is accurate?
Ms Lees: We're as confident as we can be, Ms Martel. This comes directly from the service providers and we've validated this with the service providers.
Ms Martel: You'll understand my concern about your information, when the auditor has said that not only information from the ministry but information from the service providers was not accurate; it was incomplete, and not correct either. So when I look at that figure, you'll forgive me if I say I don't have much confidence that that's actually the situation.
Has that been arrived at as a function of saying we've hired 40 new therapists? Is that how the calculation has worked, or do you feel confident there are actually 250 more children, regardless of what happened on the therapists, who have actually come off the waiting list?
Ms Lees: This is the information we've collected from the service providers. They have assured us this is an accurate number, so we stand by the number with the service providers.
Ms Martel: Can I ask, of that 250, does that mean 250 are getting service, or is that 250 kids who have been assessed and some are receiving service and some will not receive service?
Ms Lees: This would be a combination.
Ms Martel: Ah.
Ms Lees: Some of the children would probably be deemed not eligible for the program; other children would certainly be assessed and move on to IBI services.
Ms Martel: It would be very helpful if you could give the committee the breakdown, because I would say the impression that has been left in the media recently that there are 250 children less on the waiting list is an impression that those 250 kids got service. I would like to know how many of the 250 actually qualified for service.
Ms Lees: We'll be happy to provide you with that information.
Ms Martel: That would be great.
Let me go back to the direct funding model -- a couple of things in response to what I heard. My experience is that parents in most jurisdictions were never offered the choice. I don't know if she wants me to use her name. Is it OK, Deb? Deb Campbell was not given a choice, was on direct funding and was told she could wait on the wait-list for direct service for at least another year. The auditor also told us that, in two regions, the option of direct funding was not offered at all by the providers. That was in his report. Maybe you want to give me some clarification.
Mr McCarter: Maybe I could just clarify that. I think what we said was that, in two of the regions, there was no take-up of the direct funding option. As to the reason for that, we're not sure. I'd have to go back and check the wording, but I think we said there was no take-up of direct funding.
Ms Martel: My apologies, then. My concern is that in fact the offer is not being made. Why I lead to that is my concern that what's happening is a number of the lead agencies are perhaps more interested in ensuring that they maintain control of the service and they get the money than they are in ensuring that parents are able to get some money and get some service.
I've got to tell you that I was particularly offended by the comments made to the auditor about why some folks might not take up a direct funding model. This is a quote from the auditor's report. He can speak to it more if he wants, but he said, "Staff indicated to us that the direct funding option is most suitable for parents who are financially stable, speak fluent English and are capable of finding private sector therapists and administering the funding agreement." I found that pretty offensive, actually. I know a number of these parents, and no matter their level of education, they are tremendous advocates for their kids. They know where the services are. They're lobbying to try to get them. It's not a problem that they don't go out and try to get whatever they can for their children, whatever is being offered.
This leads me to my question around your review as you look at what you're going to do about direct service and direct funding. Give me some guarantee that these kinds of criteria -- whether they speak English, whether they are financially stable and whether somebody thinks they're capable of making the arrangements to get the receipts in -- are not going to be the basis for any decision you make about what to do next.
Ms Hill: Ms Martel, I think we've committed to looking at how to actually strengthen the program, and we are particularly concerned that the question of balancing building capacity in the direct service provider option and creating choices for families is addressed. We are very committed to doing that. What we tried to indicate was that the initial concept for the program was to actually advance choice, and if that's not working effectively, we are committed to addressing it.
Just to clarify, the challenges for some families have been brought to our attention. We're not saying by any stretch of the imagination that all families aren't capable. We know that many families would prefer that option and we need to make sure that the options are delivered to both sets of families or any individual family -- how we can meet both sets of families' needs -- and we are committed to doing better in that.
Ms Martel: You'd understand, Deputy, though, if that's the attitude of some of your providers whom you contract with to provide service, that's not a very positive or helpful attitude, and it would explain why the option may not be provided to parents in the first place.
Ms Hill: I didn't interview the lead service provider who might have made those comments. I can't really attribute a judgment to the comment. We are aware, though, that some families have much more limited resources -- I think you may acknowledge that -- and certainly we want to make sure we meet the needs of those families as well.
Ms Martel: I think if it were a choice, though, between getting some service or no service at all, those families would find some of the financial resources they need. It's better than trying to pay for all of the IBI out of their own pockets.
Ms Hill: Absolutely. And I think the other aspect of it is that what we are most committed to doing is ensuring that some service is provided to all families.
Ms Martel: One of my concerns about the wait-list -- I raised the case about the criteria and the ministry responded to that. I have a second concern about whether or not some of your regional providers may be in fact cutting the current number of hours that some of the current clients are receiving in an attempt to deal with the wait-list problem as well. Do you have any sense of that, or have you been making inquiries or trying to track whether or not that is also happening out there right now?
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Ms Hill: Actually, we have checked with the regional service providers about how they are progressing on hours of delivery. I think Cynthia can speak to that.
Ms Lees: It is not my impression that they are cutting back hours. Actually, the hours are increasing. It is something we certainly try to monitor. I can tell you, Ms Martel, that we are in weekly contact with those service providers. Part of bringing them together again in December is to look at all these issues and make sure that as many services as possible are being delivered to the families.
Ms Martel: If I might, Cynthia, I don't think some of these service providers would tell you that the way they're dealing with their wait-list problem is to cut down some services to clients. What I'd like to do, if you don't mind -- I suspect there are a number of parents who would be quite happy to come forward and give you a sense of what's happening. When I get that, I'm going to share that with you. I don't expect that your providers are going to tell you they're doing that as a way to deal with their wait-lists. They're just not.
Ms Lees: I'd be happy to speak to the parents.
Ms Martel: I appreciate that.
The Chair: Thank you, Ms Martel. Your time has expired. Mr Mauro.
Mr Mauro: Thank you, Chair. Initially, I'd like to thank the committee and the ministry for being here, but the entire committee as well for unanimously endorsing the request for this special report as we all work toward a more open and enhanced service system for the children who are receiving these programs. Thank you to everybody involved in that decision.
Ms Hill, it was implied earlier that the school program that's been developed has little, if any, effectiveness in terms of service provision for children with autism. I didn't hear you have an opportunity to respond to that implication. I'm wondering if you can take a minute to try to address that for us.
Ms Hill: I guess how I would begin to comment on that is that we do believe we worked with a number of advisers in designing this program. We did not initiate this program behind closed doors. We worked with a number of people who are familiar both with educating children and with autism spectrum disorder. It was designed based on the principles of behavioural intervention. We feel it can add significant benefits to the school environment.
Cynthia was actually involved in working with those through a working group. I think she can speak specifically to the guidelines that were developed and, in a sense, to the evidence we brought forward to the program in order that we could design the most effective support.
Ms Lees: We worked very closely with a committee that had been put in place. The committee reflected people who had expertise and knowledge of autism. The committee made several recommendations to the ministry on how to establish this program and implement it. It was probably the best model we have had in a long time of the excellent collaboration and partnership between our ministry and the Ministry of Education.
The program is designed to support the educators who have those children in their classrooms, to provide them with enhanced knowledge and skills around how to manage and deal with those children so that they can be most helpful when they have those students, day in and day out, in their classroom.
What we have also tried to do is that it's not only a support to the actual teacher but a support to all the educators in the school. The consultants will also work with the teacher, with the teams -- some schools have specialized teams that deal with autism. They will deal with those teams. They will work with the principals, they will provide workshops and training for teachers, and they will provide resource material to the school personnel. They will also help in the planning for those children. So they are certainly there as a strong resource to the school educators.
Mr Mauro: Thank you. Ms Hill, in your opening remarks you also made reference to the fact that there were unexpended funds left over in the program, which I think is alarming to all of us. It sounds like the explanation for the unexpended funds was a lack of capacity to deliver the services. Is that accurate? I guess my question is, then, in terms of the nine lead agencies that are out there, does the under-capacity exist equally in all of the agencies, or are there some agencies that have more of a capacity to deliver services than others?
Ms Hill: I'm actually not sure I can be specific about which lead agency might be in a better position to ramp up and increase capacity historically. I think what I would say is that the first few years of this initiative were very challenging for service providers, and we have reached a completely different level today with the ability of programs to expend their allocations than we were historically. This is not uncommon. There are many government programs where, if you are particularly expanding in the human service sector, there are challenges in terms of meeting the objectives of budget over time.
Mr Mauro: I guess what I'm trying to get at is that you would expect that the lead agencies would have some sense of the human resources available to them to deliver the programs. If they have more money than they believe they can expend, what's the mechanism in place for those agencies to get back to the ministry to advise them -- the funds are flowing quarterly, as I understand it, so in the second quarter or in the third quarter, to advise the ministry that we have this much money and we don't believe we're going to be able to spend it? If the funds could then flow back to the ministry to be redistributed to an agency that perhaps has an overcapacity in terms of its service provision capabilities so that some of the kids who are waiting for the service would then be able to get that service -- are we doing that, and will we be doing that?
Ms Hill: Currently, I don't think we have concerns about the lead agencies' ability to expend the funds. However, we do have a very rigorous process of monitoring the expenditures that will help us reallocate if that was necessary in the program. I can certainly have staff speak to what that process is.
Mr Mauro: OK. So you're saying the problem was more historical. Currently, you don't believe we have that same challenge?
Ms Hill: That's right.
Mr Mauro: OK. Then I'm not sure what has changed, because our programs, the $10 million that's aimed at the training programs and the collaboration with MTCU, from what I understand, that one-year program does not take effect till 2005-06. So those people will not be coming on stream until then to address an under-capacity, but you're suggesting that we've already addressed it now.
Ms Hill: No. What I'm saying is that the current allocations that we've given to the regional service providers will be monitored closely to ensure that they can continue to recruit and retain. So we have both short-term strategies and long-term strategies to ensure that there are sufficient numbers of therapists in the field generally. Those therapists may be hired by the regional service provider or they may be hired through the direct funding model.
We recognize that many of the graduates who might come from that program may end up in school settings, as well as educational assistants. It's a generic set of schools that can support a wide range of services. So we're actually strengthening a number of services by that initiative.
The funding that has been flowed to the community colleges through the RFP process is a distinct amount of money through training, colleges and universities. The amount of money for the chair is a distinct amount of money. The amount of funding for the school support program is another envelope of funding. So we're monitoring the expenditures in each of the envelopes.
Mr Mauro: We've addressed the capacity issue, then, in terms of the service provision to the kids.
Ms Hill: We will have to continue to address that. That won't be something that is solved overnight. It will be continually a question of ensuring that we are --
Mr Mauro: I'm sorry, I'm running out of time, and I don't mean to interrupt you. I thought you had answered my question, and now I'm not sure you have. So if there are going to be lead agencies that don't have the capacity to meet the mandate and the funding that they have available to them, is there something in place for those people to flow funds back to you or at least advise you?
Ms Hill: Yes, there is.
Mr Mauro: So next year, if we're back dealing with this issue again, we're not going to hear that money was not expended because certain service agencies didn't have the capacity to deliver a program.
1140
Ms Hill: We will be doing our utmost to ensure that we can spend the entire budget in this program. We think that's extremely important, whether it's through direct funding or direct service. However, we can't carry the funding over into the next year. That does not meet the rules of strong financial accountability. I think the Provincial Auditor outlined that, in fact, the way we had been ensuring that the funding we were flowing could be spent was done within a reasonable approach.
Mr Mauro: OK. Thank you. Mr Chairman, I'm just going to share my last few minutes with another member.
Ms Di Cocco: Do I have a minute?
The Chair: You have a couple of minutes.
Ms Di Cocco: Thank you so much. I just want to state again that transformation of how the government is doing its business is about some of the issues that you discuss. It's about an ability to measure results for the investments that we make.
For people who may or may not know this, it's kind of a new paradigm, believe it or not, in government. It's something that we are working on right across ministries in trying to make sure that this is the new modus operandi as we move forward. I'm glad to hear that the Ministry of Children and Youth Services is undertaking exactly this.
The government has a responsibility in all of this. No one -- and I believe it was stated before that there's an intent or something, that the government isn't taking responsibility. The government is taking responsibility for this, and that's indicative of the actions that have been taken to date. Part of that action is to applaud a review of the programs, so that we can better analyze what is missing.
That work is ongoing. There is no magic wand, that we suddenly say, "Everything is going to be fixed now." As much as we want to state, "It should have been done yesterday," there is an ongoing process to improve how we deliver the services. In that context, I guess, and with the whole process of measuring results and being able to address this system-wide, the work is ongoing, and there is an intent to get it right, as best we can. It has to be a reasonable expectation that we will be trying to get this right long-term.
When it comes to making the decisions of how we're getting it right, the ministry is not doing it in isolation; they're doing it with various stakeholders. Maybe the deputy can speak to that, about the process of coming to decisions as we change and shift the system, which is not done overnight, how we're going to improve that and who we talk to when we are making the decisions to bring about changes, and that it's not done in isolation.
Ms Hill: Thank you for the question. As you may be aware, the minister held a series of round tables across the province, where she was listening to both service providers and families and young people. That was very informative for the ministry.
In addition, in a number of our initiatives, whether it's in this area or in the area of child welfare or children's mental health, we are clearly working very closely with service providers, but we also do listen to what our communities are saying about how things need to be improved.
As you've said, Ms Di Cocco, it is a long-term transformation. There are many aspects to our work where we need to be removing barriers, improving services, addressing program changes. We are very committed to doing this. It's very difficult to do it overnight, but we are very committed to those approaches and see this as a process of collaboration. There is always the challenge of making sure that we're making the best use of our resources to meet as many of the needs as we can.
Mrs Munro: Much of our discussion, obviously, has centred around the auditor's report, but I think part of our interest in this was not only to ask the auditor specific questions and get some responses from him, and obviously giving you the opportunity to be here today, but also to look in terms of where we are going from here.
In the last opportunity that I had to provide questions, one of the things I referenced was needing your commitment in terms of best practices, and certainly understanding your comment, then, that it's the service providers that determine the ratio and things like that. Obviously, we have real concerns about those types of decision-making and where they happen.
My questions now reflect more of a sense of where you are going in the future and what kind of commitments you can give us that we're not going to be revisiting this kind of issue in the near future. One of the things I'd like to begin with is asking you, what would be the difference between the training of those therapists who are qualified to do IBI now and those people you've identified would be in the 2005-06 program?
Ms Hill: There's a wide range of training backgrounds in those who might be IBI therapists. I think what I can do is have Trinela Cane speak to the intent of the one-year certificate program.
Not all IBI therapists, I don't believe at this point, would have a one-year certificate program. They might have a range of training from a community college setting, a university degree and also what I would call intensive training programs. Perhaps Trinela can speak to the intent of the certificate program.
Ms Cane: The deputy is right in terms of the current IBI therapists who are on staff as part of our current host of service providers. Many of them have degrees in different, related fields. It could be psychology, it could be early childhood education, it could be any number of either certificate programs or degree programs. We actually have quite a wide variety across the board. Each of those therapists has received at least two weeks of additional training specific to the role they're playing in the service provider's agency, as well as ongoing in-service training.
With respect to the certificate program itself, it is focused on intervention and providing the skills to do effective intervention to those students who are taking those programs. Our expectation is that they will come from a wide range of backgrounds but will all be focused on an interest in and a passion for providing direct intervention services.
The intention is that when they have graduated from the certificate program, they will not require additional training as they enter the workforce through the service providers or are available either through the private service provider network or available to school boards and others.
Mrs Munro: Could you just give us your sense of the future? Is the number of autistic children going up or going down?
Interruption.
Ms Hill: I am not a scientist --
The Chair: Pardon me. I'm not going to throw that person out.
Ms Hill: Certainly it seems that there is an increased incidence, and it's not understood what the causes are. Even as recently as the last two weeks, there have been articles in the media that have considered what might be some of the biological or chemical factors that might be contributing. It is a question I think all of us would like to understand better: Why? Therefore, there's the need to continue to have the research that is being done in medical settings to look at what is contributing to this.
Mrs Munro: My question is a really serious one in the sense that obviously what we are looking at here today provides a foundation in terms of future planning. You've mentioned system and functional kinds of assessment, but clearly the value of intervention, which was the question raised earlier this morning, is an extremely important one.
So I think what we would like to hear from you is a commitment in terms of the ongoing sensitivity to the research, and as well a commitment in terms of timeline. Those two things, I think, go hand in hand.
As representatives within our communities, we need to go away today comfortable that you are making significant steps in the area of understanding the value of the kind of intervention we're looking at, as well as looking at what's happening in other jurisdictions, and that you're prepared to make some kind of commitment with regard to timelines.
For the people who are facing this issue today, the value of international studies and things like that don't have quite the same importance. They want to know about an analysis and, frankly, a conclusion to the issues around lost hours, the cost of direct services and the issue that I raised earlier around direct funding and home-based service.
I think we need to come away comfortable that you are prepared to provide us with some kind of timeline on the here-and-now issues, but you're also giving a commitment on the long-term, go-forward issue with regard to training, research and best practices. Those are the things that, ultimately, are going to mean that we can take pride in the service we're providing. Today, we obviously have grave concerns about the kind of service that's being provided.
Ms Hill: Thank you for that question. We are committed to both a long-term perspective and resolving the short-term policy questions -- they're not really policy questions; they're program design questions -- that the auditor has asked us to consider. I can't be specific on when they will all be resolved. I wouldn't want to make a commitment I can't make. But we do feel very strongly that these are the central questions, and we do need to address them.
Mrs Munro: People would like, of course, more specificity.
The Chair: Are you finished, Mrs Munro?
Mrs Munro: Yes.
The Chair: It's about five minutes to 12. You've been asked many questions. I believe you've undertaken to provide information to us, to members of the committee. I hope you will share that with all members of the committee and the Chair of the committee. I suspect we will be writing a report, as a result of the auditor's report and this meeting.
I want to thank each and every one of you for attending today. We will look forward to improvement. I think it's obvious, from the questions today, from the past conduct of all members of this committee, that we want to get to the bottom of this, and we want to get to the bottom of this as soon as possible.
Thank you very much. This meeting is adjourned.
The committee adjourned at 1154.
CONTENTS
Thursday 18 November 2004
Special Audit Report,
Provincial Auditor: Intensive early intervention program
for children with autism P-247
Ministry of Children and Youth
Services
Ms Jessica Hill, deputy minister
Ms Trinela Cane, assistant deputy minister, policy development and program
design
Ms Cynthia Lees, assistant deputy minister, program management
STANDING COMMITTEE ON PUBLIC ACCOUNTS
Chair / Président
Mr Norman W. Sterling (Lanark-Carleton PC)
Vice-Chair / Vice-Présidente
Mrs Julia Munro (York North / York-Nord PC)
Ms Laurel C. Broten (Etobicoke-Lakeshore L)
Mr Jim Flaherty (Whitby-Ajax PC)
Ms Shelley Martel (Nickel Belt ND)
Mr Bill Mauro (Thunder Bay-Atikokan L)
Mrs Julia Munro (York North / York-Nord PC)
Mr Richard Patten (Ottawa Centre / Ottawa-Centre L)
Mrs Liz Sandals (Guelph-Wellington L)
Mr Norman W. Sterling (Lanark-Carleton PC)
Mr David Zimmer (Willowdale L)
Substitutions / Membres remplaçants
Ms Caroline Di Cocco (Sarnia-Lambton L)
Mr John Wilkinson (Perth-Middlesex L)
Mr Tony C. Wong (Markham L)
Also taking part / Autres participants et participantes
Mr Jim McCarter, acting Provincial Auditor
Clerk / Greffière
Ms Susan Sourial
Staff / Personnel
Mr Ray McLellan, research
officer,
Research and Information Services