By: Emerson Iudiciani
In February 2019, the Ontario government announced its revised approach to the Ontario Autism Program (OAP) and launched it in March 2021. Part of this amended commitment was the result of significant backlash from parents and community organizations against the program previously announced the year prior, by former Minister of Children, Community and Social Services, Lisa Macleod. The recent changes included a commitment of 600 million dollars annually, double the original amount allocated by the Ontario provincial government in February 2019. The new program took effect in March 2021, and 600 children were then phased into the program. This figure is expected to expand to include 8,000 children by the end of 2021 and into 2022. According to provincial data, there are over 50,000 children currently registered to receive services under the OAP. The phased rollout approach of the OAP is leaving many autistic children and their families without support for vital services, hindering the child’s development at key stages of their life. OAP would benefit from refocusing the procedure of allocating resources and adopting a need-based approach to better account for the varying requirements of autistic people.
Broadly defined, Autism Spectrum Disorder (ASD) is a complex developmental disability most commonly diagnosedbefore the age of six. It is associated with a wide-ranging set of conditions that include challenges with social skills, repetitive behaviours, speech, and communication. Currently, there is no identifiable cause of autism, however, early diagnosis and intervention can dramatically increase the potential development and quality of life for the child. Depending on the severity of needs, lifetime costs for an individual with autism can range from $1.2 million to $4.7 million. In Canada, among individuals between the ages of five to 17 years old, it is estimated that one in 66 have an ASD diagnosis, with males being four times more likely to be diagnosed.
The OAP offers services and supports to improve outcomes for children and youth on the autism spectrum, promote quality care from autism providers, and help as many families as possible. It supports children and their families by providing funding for eligible services until the child reaches the age of 18. After administrative applications are submitted, service coordinators conduct family interviews to determine the respective funding for the child. Transfers are then provided directly to families to purchase core clinical services, such as applied behavioural analysis therapy, occupational therapy, speech-language pathology, and physiotherapy.
The allocation of funding under the OAP is based on age and the intensity of the child’s support needs. The degree to which a child receives support falls under categories that range from limited to extensive need, depending on the child’s age. The maximum amount of funding a child with extensive needs could receive under the new OAP is $65,000 per year.This only covers a portion of the costs shouldered by families that have a child with autism. Annual fees for extensive behavioural therapy in Ontario can amount to over $90,000, leaving many families in financially precarious situations and in some cases, having to decide between selling their home or paying for their child’s therapy.
There is a need to refocus support based on individuals’ specific situation as opposed to allocating funds based on generalized categories. The implementation of a needs-based funding model, considering both the individual needs of the child, as well as the overall financial situation of the family, is long overdue. The universal approach of having allocative categories leaves many children and families with a lack of support in accessing essential programs and services. In some cases, the generalized categories also provide more support than is necessary for some children, taking resources away from those who require an increased level of support.
As there is currently no cure for autism, evidence-based services such as applied-behavioural analysis therapy and speech-language pathology are vital to promoting the physical and mental health and future development of individuals with autism. It is evident that the Ministry of Children, Community and Social Services does not have sufficient capacity and resources to effectively manage such a program.
The Canada Health Act (CHA) aims to protect, promote, and restore the physical and mental well-being of residents of Canada and to enable access to health services without barriers, while also requiring that medically necessary services be insured by provincial or territorial plans. A shift to regulate autism services under the Ontario Health Insurance Plan (OHIP), in collaboration with the Ministry of Health, could assist in ensuring that children with ASD are able to receive necessary evidence-based services and resources that support their growth and development in both the short and long term. Current and past efforts have lacked a holistic approach to managing this program, and the current phased approach in Ontario will leave many children in critical stages of life without proper support for future development.
Emerson Iudiciani is a first year Master of Public Policy candidate at the University of Toronto’s Munk School of Global Affairs and Public Policy. He previously graduated from York University with an honours Bachelor of Arts in Political Science and Government. Some of his policy interests include labour, environmental and social policy.