8 thoughts on Minister Smith’s December 17 Ontario Autism announcement

Promises made, promises broken. That was not the message Todd Smith wanted to deliver at his December 17 press conference update on the Ontario governments plans for its Ontario Autism Program.

In fact, Smith attempted to spin the announcement as a good news story stating that the purpose of the announcement was to “share some positive news about the future of the Ontario Autism Program.” But it became very clear based on the audience reaction and the questions coming from the press that this announcement was yet another train wreck for the beleaguered Ford Government.

For a rundown of what was announced, read my article The December 17, 2019 Ontario Autism Program press conference by the Minister of Children, Community and Social Services Todd Smith

Here are my top 8 thoughts on Minister Smith’s December 17 Ontario Autism announcement:

1. While I share the community’s frustration that the government failed to meet their April 2020 deadline to implement the needs-based program, I’m not surprised in the least. Upon the release of the Ontario Autism Advisory Panel Report, my thought #5 in my November 2 article was “The stars will have to align to implement these recommendations by April 2020.” Well, as it turns out the stars did not align.
   
   Keep in mind that no plan was ever presented that would justify an April 2020 implementation. April 2020 was a made-up date that simply aligned to the beginning of a new fiscal year. There simply was no meat behind April 2020 when the government didn’t have a clue what the Advisory Panel would recommend. All April 2020 did was buy the government time to figure out how they were going to clean up MacLeod’s mess.
   
   The only viable path to a needs-based program for April 2020 was to reinstate the legacy program with a few tweaks. The other core services could have been phased in once the government was ready to implement them. That’s not that hard to figure out. Smith simply chose not to go this way.
2. Todd Smith, you had an option, sir. On the topic of providing a one-time childhood budget to everyone on the waitlist, Todd Smith framed his option between making families wait with nothing for months and months versus providing families these one-time payments. This of course is poppycock, a false choice if I ever heard one.
   
   There were other choices that could have been made that would provide meaningful help to families right now. If there’s one core service that Ontario knows how to deliver, and can deliver right now it’s Applied Behavioural Analysis (ABA). While the implementation committee may need time to figure out how to provide speech language pathology, occupational therapy, and mental health as part of the Core Services, there is no good reason to dismiss enrolling more children into ABA.
   
   Heck, Smith could have leveraged the recommendation from his colleague Roman Baber and reinstated ABA with an interim 30 hour per week cap. This would have overwhelmingly been positively received from the community where 80% want ABA as per the governments online survey.
3. Not coming to the press conference with a clear answer on how the government will treat those in-service is bonkers. For god sake, even Lisa MacLeod came armed with information of 6-month extensions. Here’s the reality, there are in-service children whose 6-month extensions end April 2020! That’s just a little over 3 months from now.
   
   It’s nice to say the intention is for a seamless transition, but when you’re already admitting that Core Services won’t be available by April 2020, and you know in-service kids extensions start expiring by April 2020, you have to provide a guarantee that there will be no interruption in service. To do otherwise is particularly cruel.
   
   Cruel in that while Todd Smith and company are sipping on their spiked eggnog this Christmas, in-service families will be kept up at night wondering what the hell will happen to their child’s therapy in a few months. That’s the same stress and anxiety felt when Lisa MacLeod first announced her program changes all over again.
   
   Todd, do the decent thing and go get your damn Cabinet approval and guarantee continuity of service before you cause a nervous breakdown for these families.
4. Prepare yourselves to fight against a system of benchmarks. Omitted from the press announcement were the mandate details of the Implementation working group. Of concern are the details on determining the level of support:

It’s very interesting that bureaucrats have slipped in “no fewer than 5 levels of need”. This cannot be found in the Ontario Autism Program Advisory Panel Report. Couple that with core services being capped based upon service and/or duration and we’re prime for a system of benchmarks.

The pre-Coteau OAP did this. If the child was way off from hitting the benchmarks, they would be moved out of services. If they stayed close to those benchmarks, then they would stay in the system for 2–3 years and then typically discharged into the school system.

Let’s be clear here, the discharges were not based on the child’s needs. The other crazy thing was your child’s clinician in charge did not make the discharge determination, instead it came from a psychologist from one of the regional public providers who barely knew the child except for an annual assessment and reports provided the child’s clinician.

This often led to a highly unethical situations and significant discrepancies between the publicly provided direct service option and receiving services privately through direct funding.

5. The implementation committee has their work cut out for them to prevent the Care Coordinator from becoming the Churn Coordinator. I warned about the Care Coordinator in my November 2 article, and let me tell you I really don’t have the warm and fuzzies after hearing Todd Smith go on about the importance of the Care Coordinator in this new OAP.

Louis Busch said it well in this article: “there is very high risk of conflict and control from government through an MCCSS funded Care Coordinator. It must be clear, that service navigation, support to access urgent response, and forecasting support needs are separate from clinical decision making.” He then goes on to state, “Taking clinical decision making out of the hands of clinicians and putting it in the hands of a bureaucrat is dangerous, and would not be acceptable in any other practice.”

In the Pre-Coteau OAP parents were better equipped to fight the system and get more services when leveraging the Direct Funding Option (DFO) over Direct Services. But hey, don’t take my word for it, it’s right in the Auditor General’s report:

Of the children discharged from IBI services in 2012/13 on a province-wide basis, those under the direct funding option received on average almost one year more of services than those under the direct service option (35 months versus 25 months). In fact, almost 25% of children under the direct funding option received more than four years of services compared to only 5% of children under the direct service option.

A big reason why this happened is that DFO clinicians effectively challenged the public service’s psychologists trying to discharge their patients, whereas the publicly provided Direct Service clients were in a losing fight as the psychologists worked for the same organization they were getting their ABA from.

When you’ve got the pressure of bureaucrats trying to enforce waitlist movement, it’s easy to see how these so called Care Coordinators will feel compelled to act as Churn Coordinators.

6. There’s a lack of ABA representation on the Implementation working group. Again, the number one response on core services was ABA at 80%. This is the working group that will coming up with all these service caps. Why did Smith choose to underrepresent ABA in the working group?

7. The mandate of the Implementation working group is not inclusive of all the advisory panel’s recommendations. Will the government address this? If the intent is to implement all recommendations, say it and explain how you’ll address the gaps (i.e. future phase, etc.)

8. Todd Smith and I are on the same page on this statement: At the beginning of the press conference Todd Smith said that “No government has ever gotten this right, including our own.” I agree completely, your government has not got this right, including the decisions you announced on December 17th.

If you truly believe that your government didn’t get this right, then surely you must be open to the concept that you didn’t get this announcement and interim direction right either. Hold yourself accountable and course correct. The stakes are simply too high not to.