Principles and requirements

Guiding principles

The following describes guiding principles for the delivery of all PSL program and Children’s Rehabilitation program elements. These principles underly the foundational system-level opportunities that will support effective implementation of tiered intervention services and the service continuum.

Child- and Family-Centred: Services are founded on values, attitudes, and approaches that recognize that each family is unique; the family is the constant in children’s lives; and the family is the expert on their children’s abilities and needs^{footnote 11[11]}. Services are provided in a manner that is respectful, empathic, and responsive to the specific needs of the child and family.

Equitable and Culturally Safer: Service providers support the diverse needs of families in a culturally safer way, and promote equity, anti-oppression, anti-ableism, and anti-racism, including dismantling anti-Black and anti-Indigenoeus racism. They engage thoughtfully with families in ways that recognize and address intersectionality and the inherent power imbalances between service providers and families.^{footnote 12[12]}

Effective and Evidence-Informed: Service providers offer a broad range of evidence-informed services within a tiered intervention model to provide a continuum of service delivery, based on the diverse needs of children and their families. The evidence used to inform practice goes beyond data, research, and Western ways of knowing; it includes the voices of individuals with lived experience, experiences of service providers and recipients, Indigenous and traditional knowledge, and more.

Seamless and Streamlined: Service providers are leaders and drivers of change within their agencies and they apply a systems lens when planning and delivering services within their catchment wherever possible, so that families experience equitable access to services, and a more seamless, streamlined, and integrated service journey.

Coordinated and Collaborative: Service providers take a collaborative leadership role to build awareness and capacity in support of early identification and early intervention. Through coordination with education and health partners as well as other MCCSS-funded child development providers they facilitate access to information and services to optimize children’s participation and developmental outcomes.

Accountable and Efficient: Service providers demonstrate responsible stewardship and management of government-funded services. They foster a culture of continuous quality improvement including monitoring program, organizational, and system performance using a range of qualitative and quantitative measures and demonstrating effective and efficient use of resources for services.

Summary of required program elements

The ministry has set nine requirements for service providers to improve access, family experience, and functional outcomes. These requirements are grouped under two categories: foundational and delivery-specific.

The foundational program elements are system-level requirements. For example, applying a child- and family-centred and strengths-based approach improves the delivery of all key clinical functions from intake to transitions. Similarly, establishing key partnerships improves the delivery of all aspects of service by taking an integrated approach to rehabilitation services.

The second set of elements are related to specific steps in the delivery process. However, since they operate on a continuum, providers must consider the impact of changes in one aspect of delivery on the continuum. For example, changes in access and intake as well as early intervention opportunities will impact how assessment and later interventions occur.

The foundational elements and continuum work together to sustain a holistic approach to service delivery that provides quality services to children and their families.

Figure 1: The foundational and continuous elements of program services

Each of these nine requirements is described in the following section. More details on best practices and how to meet these requirements are provided in the latter parts of this document.

Foundational program elements

The foundational elements of the program are system-level changes. Taken together, the foundational program elements are:

• System-level considerations and actions that will improve the quality of services across the continuum of service delivery
• Impactful to each of the elements of the service delivery continuum to varying degrees
• Interrelated and will likely be combined during the operationalization of the service elements

Implementing these foundational program elements will support tiered intervention services and improve service delivery across the continuum.

1. Child and family-centred, strengths-based and culturally safer

Requirement: Service providers will take a child- and family-centred, strengths-based approach founded on the F-words for Child Development,^{footnote 13[13]} and will support families in a way that is culturally safer, responsive, and promotes equity, anti-oppression, anti-ableism, and anti-racism, including dismantling anti-Black and anti-Indigenous racism.

To achieve this, service providers must:

• Be leaders and drivers of change, both within the organization and with service partners, towards a service culture that is strengths-based and solution-focused; child- and family-centred; trauma-informed; and that promotes equity, anti-oppression, anti-ableism, and anti-racism, including dismantling anti-Black and anti-Indigenous racism.
• Establish relationships with equity-deserving communities and any local community-based agencies that represent them, and work with these communities/agencies to build or strengthen all aspects of service delivery, and help families access other programs and services in their communities.
• Embed processes for orientation and ongoing training and development of staff and foster a culture of continuous professional development and clinical best practice.
• Meet all professional college practice standards and guidelines from their respective Ontario regulatory colleges and self-monitor their competencies to provide high quality, child- and family-centred services within their scope of practice.
• Provide specific staff training to support cultural change leadership, including anti-racism, bias awareness, Indigenous cultural competency, F-words for Child Development training, solution-focused coaching, and trauma-informed service delivery approaches.

2. Seamless service delivery pathway

Requirement: PSL Lead Agencies and CTCs in each respective catchment will collaborate to implement a seamless, streamlined, and integrated service pathway and equitable approaches to wait management centred on family experience.

To achieve this, service providers must:

• Align local clinical service pathways for specific needs/populations within catchments to support quality and consistency, while being flexible and responsible to unique child and family needs, throughout the entire service journey from intake to transition/discharge, as applicable
• Provide families with clear information about how to connect with their provider(s) and encourage families to follow-up at any time if they have questions, immediate needs, or no longer require supports once families have entered services and are waiting for assessment or intervention

3. Collaboration and partnerships

Requirement: Service providers must engage as leaders and collaborators with broader service system partners in the planning and delivery of child-centred services and supports in their communities.

To achieve this, service providers must:

• Actively promote the importance of early identification with families and the broader children’s services systems (including community, early years, health, and education) and work collaboratively with partners to support children and families.
• Build and continue to strengthen relationships with local Indigenous and other equity-deserving communities to support early identification and access to services.
• Engage with families’ Service Planning Coordinators, in accordance with locally developed formal agreements with the Coordinating Agency in the catchment, for families accessing Coordinated Service Planning.

4. Performance measurement and reporting

Requirement: Service providers will use quantitative and qualitative data to inform program planning, clinical decision-making, and outcome measurement. To achieve these objectives, data are to be accurate and timely when collected and reported. A culture of continuous quality improvement will be fostered in alignment with the ministry’s performance measurement framework that focuses on service access, experiential, and functional outcomes.

To achieve this, service providers must:

• Collect and report “access” and wait time data to quantify demand and capacity in the system and identify trends and mitigation strategies
• Solicit information from families to help understand their service experience and use this information to support planning and continuous quality improvement
• Collect and report on functional and child participation outcomes as a result of services delivered

Continuum of service delivery program elements:

The continuum of service delivery program elements supports a coordinated system of early identification and intervention services that:

• Puts children, youth and families at the centre of planning and delivery
• Supports optimal development of children and youth
• Addresses needs from birth through to school start and the transition to adulthood
• Supports seamless connections and transitions throughout the service experience

Consideration of the continuum of service delivery program elements will assist in effective tiered service delivery.

5. Access and intake

Requirement: Service providers will make information and services accessible to all Ontario children and their families, no diagnosis or referral required. The PSL program will be accessible to families with children until school start.

Families will experience a holistic approach at intake, in which service providers support identification of family concerns and needs and connect them to early supports^{footnote 14[14]} and services as warranted, including connections with SmartStart Hubs as appropriate.^{footnote 15[15]}

To achieve this, service providers must:

• Support families to access services through a well-publicized toll-free telephone number and through electronic access (e.g., email, website, social media), working with partners in the local catchment to provide key information to families
• Enable families to initiate services through self-referral
• Be aware of, and foster connections, with child- and family-serving partners enabling timely referrals to additional supports or specialized services
• Not require a diagnosis to access services
• Make resources used to support families available in English and French at a minimum and in other languages as needed

6. Early intervention

Requirement: Service provider organizations will work collaboratively across sectors to raise awareness, build capacity and develop alignment among related sectors and services towards optimal child development.

To achieve this, service providers must:

• Support access to early Tier 1 services/Universal Supports for families prior to the child/youth receiving an initial assessment
• Connect families to a range of early supports from general family-based supports to discipline-specific resources at or shortly after intake

7. Assessment

Requirement: Service providers will work collaboratively with families and others (with consent) to assess children’s skills, abilities, and functioning, identify needs, provide further supports, and determine next steps.

To achieve this, service providers must:

• Ensure assessments meet all professional college practice standards and guidelines, including scope of practice, resource requirements, risk management, competencies, and procedures
• Ensure families in PSL will only receive one initial assessment (IA) though more than one visit may be required to complete the assessment process. Those who transfer between service providers or re-enter PSL do not need to undergo another IA
• Communicate the results of assessments to the family (and child/youth, when appropriate) and document as per college standards. Service providers will communicate using accessible language with a focus on children’s strengths and in a way that is culturally appropriate
• Recommend an intervention when needs and goals are identified through the assessment process consultation with the family (and child/youth, when appropriate)

8. Intervention

Requirement: Service providers will employ a response to intervention (RTI) approach that supports decision-making based on continuous assessment of children’s responses to a continuum of tiered interventions.

To achieve this, service providers must:

• Work together with families to develop functional, strengths-based goals that are meaningful to children and their families
• Use evidence-informed clinical reasoning throughout an intervention to adapt and refine goals and approaches based on outcomes, and support movement between tiers to provide the right service at the right time
• Include a broad range of Tier 2 and Tier 3 interventions such as parent/caregiver consultation, parent training, one-on-one and group intervention, both in-person and/or virtually as appropriate
• Obtain consent from families, and youth where applicable, to receive Tier 2 and 3 services. Create a health record for the child/youth
• Support families and other team members, such as educators, through coaching, training, and check-ins to implement intervention strategies at home and in the community and/or education settings

Requirement: When more than one service provider is involved in delivering intervention (either within the same discipline or across disciplines), providers will collaborate in a coordinated, team approach to support the needs of the child and family.

To achieve this, service providers must:

• Work with families to make collaborative, evidence-informed decisions to determine the intensity of services provided within the context of their local service system
• Base decisions on evidence and clinical best practices when prioritization is necessary as part of clinical service pathways

9. Supportive transitions

Requirement: Service providers in the catchment will collaborate to support families at key transitions and minimize service gaps.

To achieve this, service providers must:

• Put transition plans in place at key transition points for all children who have an identified need that will continue to require intervention supports (e.g., at school start)
• Include the family, child/youth, other service providers, as well as school staff and/or adult developmental service agency in transition planning as appropriate
• Support service transitions in alignment with the family’s choice for school start (kindergarten or Grade 1) and/or any other programs that also provide transition support
• Collaborate to develop and implement transition protocols to support the warm transfer between service providers (including with Ontario Autism Program Entry to School service providers) using an equitable approach
• Collaborate in the catchment to support equitable prioritization for families based on factors including needs, available resources, and original referral date within the locally integrated service system
• Coordinate services to prevent duplication and support goal alignment and service continuity