On March 21, 2019 the Ontario Government promised to consult with parents and clinicians over the next several months to “develop a needs test for those children who have the greatest severity”. Since then, there has been much conversation on what the autism community should advocate for during consultations. One of the most common things I keep hearing is for autism services to be moved under healthcare, or as many Ontarians say, put it under OHIP, the Ontario Health Insurance Plan.
Conceptually I’ve always agreed with this. Although I appreciate there are some who don’t like ABA for their own personal reasons, for myself I have seen amazing results with ABA and my son generally likes doing his ABA work with his therapists. There are also decades of evidence showing the efficacy of ABA, so there’s actual science behind it. The notion that ABA should be medically recognized, with regulated practitioners, and be a part of our healthcare system resonates with me.
But would moving the OAP from a social services ministry to healthcare change anything?
First let’s look at what the Canada Health Act says.
Under the Canada Health Act, provincial and territorial plans must insure all medically necessary services provided by hospitals, physicians, and dentists (when the service must be performed in a hospital). Medically necessary services are not defined in the Canada Health Act. The provincial and territorial health care insurance plans consult with their respective physician colleges or groups. Together, they decide which services are medically necessary for health care insurance purposes.
The provinces and territories also provide supplemental coverage to certain groups of people, such as seniors, children, and social assistance recipients.
In the Supreme Court in Auton v British Columbia ruled that:
the benefit of “funding for all medically required treatment” is not guaranteed by law, as it is neither promised in the Canada Health Act nor any provincial health legislation. Rather, the Health Act only guarantees funding for core services of which ABA/IBI for autism is not one.
Without a change to the Canada Health Act to mandate the definition of what are medically necessary services to include ABA, being apart of healthcare means ABA would fall under supplemental healthcare coverage. Here’s the thing about supplemental coverage, it’s open to the jurisdiction to determine how to implement and is typically not universal.
Both Nova Scotia and Newfoundland & Labrador have implemented their ABA programs under health, and guess what? Their programs are not needs-based and suffer from similar issues to those programs under social services ministries.
The Nova Scotia Department of Health and Wellness has an Early Intensive Behavioural Intervention program that offers Pivotal Response Therapy, a form of ABA which is more naturalistic and occurs in the child’s environment, using the child’s interests to achieve goals and work on skill development. This is for preschool children only. Due to capacity issues there are waitlists. Priority is given first to age 5, then to age 4. Over the first six months a child gets 15 hours per week. This is gradually reduced over the following six months (10 hours per week for the first 3 months and then 5–6 hours per week for the remaining 3 months). Training is provided to parents during that year. After the first year, children who do not enter school are provided an additional graduated six months treatment. All costs are covered by the Nova Scotia Department of Health and Wellness.
Newfoundland & Labrador’s Health and Community Services provides ABA to children from 18 months to age 8 who have significant behavioural delays. The Early Intensive Intervention Services provides 30 hours per week until end of kindergarten, then 15 hours per week through grade 3. Services are typically delivered in home where a senior therapist provides direct home-based training to families and home therapists. Parents need to find their own home therapists. Wait times vary depending on where you live based on your ability to find a home therapist. All costs are covered by Health and Community Services.
So, there you have it. Two examples of Autism services as a part of a province’s supplemental healthcare, two very different programs. There are limits on the amount of services you can receive, reductions of services based on age, age cut-offs, and wait lists.
Legislation mandating ABA as a medically necessary autism therapy is likely the only thing to ensure everyone with autism has the right to needs-based therapy. In America, ABA is considered an evidence-based best practice treatment by the US Surgeon General and by the American Psychological Association. Many states have legislated autism therapies. In Canada, this could happen at the provincial level or federal level. Either way, that’s not happening within the short timeframe available for consultation with the Ontario Government.
For now, pushing to move autism services under OHIP is not where energies should be spent. The move is unlikely to have a substantial impact to how autism therapies are supported in Ontario. The only thing it may achieve is a new minister!