Ontario Autism Program: guidelines for core clinical services and supports

Overview

OAP core clinical services and supports will offer interventions and supports designed to respond to the individual needs of children and youth on the autism spectrum, and their families.

OAP core clinical services and supports include:

• applied behaviour analysis
• speech-language pathology
• occupational therapy
• mental health services, including counselling and/or psychotherapy
• technology, program materials and/or therapy equipment at the recommendation of a regulated professional or Board Certified Behaviour Analyst (BCBA)

In the needs-based OAP, eligible children and youth registered in the program, and their families can access other OAP services at no cost, including:

• foundational family services
• caregiver-mediated early years programs
• urgent response services
• entry to school program

Service objectives

OAP core clinical services and supports are intended to provide children and youth on the autism spectrum with access to evidence-informed clinical services at a range of intensities that are responsive to their unique strengths, needs, opportunities and goals.

OAP core clinical services and supports will:

• be planned in partnership with children, youth and their families
• be delivered through a strengths-based approach that empowers families to develop the skills and knowledge to address needs as they arise
• emphasize the development, maintenance and application of skills for children and youth
• support children/youth to meaningfully participate in a variety of settings
• be responsive to cultural, social, geographical and economic diversity and language needs

Children and youth on the autism spectrum vary greatly in terms of their specific needs and the intensity and scope of services required. Different ways of delivering services may be required to best meet the range of needs, including:

• individual and/or group-based service
• collaboration among all professionals working with the child/youth and family
• consultation with the child, youth and family/caregiver
• family/caregiver capacity building that supports individual strengths and needs (for example, by connecting families/caregivers to corresponding services and resources)

All core clinical services and supports should be delivered based on the child or youth’s assessed needs and included as part of their treatment plan. Flexibility is required in terms of the services and supports that are developed, the ways in which they are delivered and the various settings in which they are offered including virtually, at home, and/or in the community, so that access to OAP core clinical services and supports is streamlined for children, youth and their families and tailored to their unique needs and goals.

OAP core clinical services and supports will help children, youth and their families achieve the following objectives, based on their individual needs:

• fostering ongoing learning and development in key domains of need
• engaging children/youth to build the skills they need to make meaningful connections and actively participate at home, at school and in the community
• reducing interfering thinking and behaviour that are impacting wellbeing, learning and adaptive functioning
• enhancing the capacity of the parent/caregiver (defined as the legal guardian of the child who is primarily responsible for care and upbringing of the child) and other relevant professionals working with the child/youth, including their knowledge of and skills in using support strategies
• supporting parents and other caregivers and professionals in different approaches that are tailored to their child’s abilities, family needs and contexts
• improving the quality of life of children/youth and their families by supporting their mental health and wellness, dignity, and ability to thrive

Clinicians delivering OAP core clinical services and supports help children and youth on the autism spectrum to achieve their individual goals and address needs they may have across ten key domains:

• communication — how individuals communicate and understand others to meaningfully participate in activities of daily life
• social interaction — how individuals participate in social situations, shared activities and interactions with others (groups, peers, new settings)
• play and leisure — how individuals engage in play and recreation, independently and with others
• activities of daily living — how individuals complete daily tasks, such as getting dressed and eating
• motor skills — how individuals participate in activities that involve using fine motor skills, gross motor skills, and coordinating their movements such as writing and walking
• cognitive skills — how individuals follow instructions, concentrate and solve problems
• sensory system — how individuals manage reactions to stimuli
• interfering behaviours — how individuals manage behaviours that may impact their ability to participate safely in activities of daily life
• mental health — how individuals manage needs that impact their daily functioning and capacity to meaningfully participate and enjoy daily life
• adaptability and resilience – how individuals manage needs related to being flexible and resilient in daily life

Families will work directly with their chosen clinician(s) to develop treatment options and plans for their child/youth. Throughout a child/youth’s journey in the OAP, families may choose to access one or more OAP core clinical services and supports at any point and can choose to access different services and supports at different times, based on their child or youth’s individual and changing needs.

For children and youth receiving multiple OAP services and/or other services and supports outside of the OAP concurrently, service providers are encouraged to collaborate with a view to align goals, promote a seamless and coordinated service experience for families and avoid duplication of roles.

The following section provides an overview of the different OAP core clinical services and supports available in the OAP and who can provide these services.

Types of services and qualified providers

Applied behaviour analysis

Applied behaviour analysis (ABA) is a scientific discipline that is rooted in learning theory, basic research, and applied research. The overall objective is for a person to experience meaningful changes, such as increasing independence, developing new skills and/or experiencing fewer challenges to learning and functioning.

ABA can help children and youth on the autism spectrum by systematically teaching skills and reducing interfering behaviour that may be harmful or unsafe. ABA can help people with varying strengths and needs by:

• focusing on building skills, such as learning readiness, social initiation, toileting and play
• reducing interfering behaviours, like aggression or self-injury

For more information about applied behaviour analysis, visit the Ontario Association for Behaviour Analysis (ONTABA) website.

Qualified providers

ABA services must be delivered or supervised by a Board Certified Behaviour Analyst (BCBA), Psychologist or Psychological Associate registered with the College of Psychologists of Ontario, who either:

• meets the OAP’s qualification requirements for Clinical Supervisors
• is working towards the qualification requirements and has completed and signed an Attestation Form to this effect

Speech-language pathology

The field of speech-language pathology (SLP) involves the prevention, assessment and treatment of communication delays and disorders. SLP services help children/youth on the autism spectrum in all areas of communication and social interaction, including the development of verbal and non-verbal communication, play and social learning.

SLP services may also include helping clients to choose and learn to use augmentative and alternative communication systems, produce clearer speech, use their voices in healthy ways and speak without stuttering.

For more information about speech-language pathology, visit the Ontario Association for Speech-Language Pathologists and Audiologists website.

Qualified providers

Speech-language pathology services must be delivered or supervised by a speech-language pathologist (SLP) who is registered and in good standing with the College of Audiologists and Speech-Language Pathologists of Ontario.

Note: the delivery of audiology services is not considered eligible for OAP core clinical services funding.

Occupational therapy

Occupational therapy (OT) helps people to learn and develop new skills that are important to them by partnering with them as they engage in meaningful activities, such as self-care, play and leisure activities, and home and community participation.

Occupational therapy enables children and youth on the autism spectrum and their families to better understand:

• how their sensory processing systems work
• how their brains think, feel and learn
• how to develop and learn new motor-based skills

For more information about occupational therapy, visit the Ontario Society of Occupational Therapists website.

Qualified providers

Occupational therapy must be delivered or supervised by an occupational therapist (OT) who is registered and in good standing with the College of Occupational Therapists of Ontario.

Mental health services

Mental health services, including counselling and psychotherapy, help people improve their mental health and well-being. These services also promote positive personal growth and change through a therapeutic relationship or interactions with a trained mental health professional.

Counselling is primarily a talk-based service and can help children, youth and their families to find solutions and make choices through:

• exploration of options
• identification of strengths and needs
• locating information and providing resources
• promoting a variety of coping strategies

Psychotherapy involves the assessment and treatment of a variety of psycho-social or emotional challenges using techniques delivered through a therapeutic relationship to promote positive change in thoughts, feelings, behaviour and interpersonal functioning.

Child and youth mental health services can help to support a range of mental health problems or disorders, such as anxiety, depression or emotional dysregulation.

For more information about mental health services, visit the Ontario Association of Mental Health Professionals website.

Qualified providers

Mental health services, including both counselling and psychotherapy, must be delivered or supervised by regulated professionals who have psychotherapy in their scope of practice.

This may include qualified physicians, psychologists, psychotherapists, social workers, occupational therapists and nurses, registered and in good standing with their respective college:

• College of Psychologists of Ontario
• College of Registered Psychotherapists of Ontario
• Ontario College of Social Workers and Social Service Workers
• College of Nurses of Ontario
• College of Occupational Therapists of Ontario

Eligible expenses

Families may use their OAP funding allocation to purchase eligible OAP core clinical services and supports.

It is important to note that some of the eligible expenses for OAP core clinical services and supports are different than previous funding criteria for evidence-based behaviour plans, Childhood Budgets and Interim One-Time Funding.

Eligible expenses for OAP core clinical services and supports may include the following:

• Hours spent with a child/youth, family member and/or relevant professionals working with the child/youth and family. This would include time spent assessing the strengths and needs of the child/youth and delivering treatment, where the child/youth and/or family is present. This also includes consultation with the child/youth and family, as well as multidisciplinary collaboration with other qualified OAP providers who are working with the child/youth and/or that is directly associated with service delivery.
• Supports related to service delivery such as documentation and report writing, treatment session preparation, interpretation and translation services and staff orientation and training to support service delivery.
• Travel expenses, including transportation costs for families to travel to a service provider to access eligible OAP core clinical services and supports, or for a service provider to travel to a child and family to deliver service. Families and service providers should choose the most practical and economical way to travel in order to receive core clinical services and supports from providers of their choice.
  • Travel expenses may include bus or train fare, parking charges, and mileage driven in private vehicles. For travel that is less than 100 kilometres, $0.40 for every kilometre driven will be considered an eligible expense. For travel that is more than 100 kilometres, $0.41 for every kilometre driven will be considered an eligible expense.

All fees associated with the delivery of OAP core clinical services and supports should be established, well-communicated and agreed upon by both families and service providers prior to service delivery.

Service providers are encouraged to manage and collect payments in a way that is consistent with the corresponding profession’s ethical principles and values, and with its standards of practice:

• College of Psychologists of Ontario
• College of Audiologists and Speech Language Pathologists of Ontario
• College of Occupational Therapists of Ontario
• College of Registered Psychotherapists of Ontario
• Ontario College of Social Workers and Social Service Workers
• College of Nurses of Ontario

Technology purchase

Families may use their OAP funding allocation to purchase technology within the following parameters:

• Technology is required based on the child’s assessed needs and is included as part of the child/youth’s treatment plan.
• Technology is recommended by an OAP core service provider, who is a regulated professional or Board Certified Behaviour Analyst (BCBA) knowledgeable in the use and application of the technology as it relates specifically to the child’s needs assessed by that provider.
• Programming and any required training for the use of the technology across different settings and contexts can be directly supported or supervised by the recommending professional.
• The most economical option is considered when purchasing technology to support a child/youth’s goals.

Invoices for technology must be accompanied by a letter of recommendation from a regulated professional or Board Certified Behaviour Analyst (BCBA) delivering or overseeing services to the child.

Program materials and/or therapy equipment

Families may use their OAP funding allocation to purchase program materials and/or other therapy equipment within the following parameters:

• Materials and/or equipment are required based on the child’s assessed needs, are recommended by a regulated professional or Board Certified Behaviour Analyst (BCBA) and are included as part of the child’s treatment plan.
• The implementation and any required training for the use of program materials and/or therapy equipment is supported by the recommending professional.
• The most economical option is considered when purchasing program materials and/or therapy equipment to support a child/youth’s goals.

Invoices for program materials and/or other supporting equipment must be accompanied by a letter of recommendation from a regulated professional or Board Certified Behaviour Analyst (BCBA) delivering or overseeing services to the child.

Ineligible expenses

The following expenses are not eligible under the OAP core clinical services and supports guidelines:

• Fees for other therapies or specialized services not identified as an eligible core clinical services and supports expense (for example, physiotherapy, psychiatry, nursing, dieticians, personal training, massage therapy, neurology)
• Housing and home maintenance costs (for example, rent, furniture, home renovations or modifications, housekeeping, swimming pools, pool lifts, washlets or bidets, hot tubs and playground equipment)
• Household items and electronics (for example, furniture, musical instruments, appliances and televisions)
• Respite services and supports (for example, cleaning, meal preparation, snow removal and care of other family members) to provide temporary relief to families during the day, evening or weekend within or outside the family home.
• Holiday travel (for example, personal or family vacations)
• Telephone/telecommunications (for example, home phone service, internet service and mobile phone services)
• Groceries, food and restaurant meals
• Clothing and personal goods and services (for example, toiletries, spa treatments, aesthetic and cosmetic services)
• Dental care and services
• Vitamins, medical supplies, orthotics, supplements, incontinence supplies, and special diets
• Services already received through the Ontario Disability Support Program (for example, drug benefits and medical aids)
• Private school tuition fees, tutoring, tuition fees for college or university programs
• Day care fees
• Vehicle purchases, leases and rentals
• Website advertising costs associated with finding qualified professionals
• Investments, including contributions to Registered Retirement Savings Plan (RRSP), Registered Disability Savings Plan (RDSP), and Registered Education Savings Plan (RESP)
• Fees associated with registering or purchasing a certified service or guide dog, including any costs associated with the care of the service or guide dog
• Any core clinical service and/or support supervised and/or delivered by a primary caregiver regardless of professional qualifications or residence, or a child under the age of 18 years
• Cancellation fees for autism services and supports due to missed or cancelled sessions
• Diagnostic assessments, psychoeducational assessments
• Travel costs not associated with directly accessing eligible core clinical services, travel to purchase supports, such as technology, program materials and/or therapy equipment
• Service fees for providers or third-party organizations to manage the budgeting and payments of OAP funding allocation

If families are not sure if a service or support is eligible for purchase using their OAP funding allocation or have questions, they are encouraged to discuss it with a care coordinator.

Funding provided to families through OAP core clinical services and supports must only be used to purchase eligible expenses to support children and youth on the autism spectrum, which may be amended at any time in the Ministry of Children, Community and Social Services’ sole discretion, and as may otherwise be communicated by the ministry.

Before you make a purchase

Before purchasing technology, program materials or equipment to support a child or youth’s goals, it is recommended that families:

• Consult all relevant professionals involved with their child to help choose the right technology, program materials or supporting equipment.
• Work with a qualified professional(s) to develop a plan to support the implementation, ongoing monitoring and evaluation of their child’s progress.
• Determine if the technology, program materials or equipment can be accessed through other available funding programs or on loan.
• Carefully review the list of eligible and ineligible expenses for OAP core clinical services and supports.

If you have questions about eligible purchases or using your OAP funding allocation, you can contact a care coordinator. If you have other questions, please use the latest contacts for the OAP.

Role of care coordinators

AccessOAP care coordinators are responsible for guiding families through the process to determine a child or youth’s support needs and associated funding for core clinical services and supports. Care coordinators will complete the determination of needs process with a family at least once annually to reflect a child’s changing support needs.

Care coordinators work with families to understand each child and youth’s strengths, support needs and priority goals across ten key domains: communication, social interaction, play and leisure, activities of daily living, motor skills, cognitive skills, sensory system, interfering behaviours, mental health, and adaptability and resilience.

In addition to the ten domains, care coordinators consider factors such as developmental and life stages, as well as co-existing health and environmental factors.

This process includes:

• meeting with families to identify their child's goals, strengths and support needs across key domains;
• allocating funding to families so they can purchase core clinical services and supports from providers of their choice; and
• supporting families with next steps to access core clinical services and supports of their choice.

This process is separate and distinct from the clinical assessment that would be completed by a clinician as a first step of treatment planning for core clinical services. Once families receive their OAP funding allocation, they will work directly with their chosen clinician(s) to develop a treatment plan, which may include a clinical assessment to determine a child or youth’s current needs and priority goals in order to inform the delivery of eligible OAP core clinical services and supports.

After the determination of needs process

After completing the determination of needs process with families, care coordinators offer to support families to make informed choices about next steps and help to navigate other supports within and outside of the OAP. This includes:

• providing families with resources or additional information about how to select providers
• talking to them about their child’s priority goals and considerations for treatment
• addressing a families’ questions

Core clinical services funding

Based on the results of the determination of needs process, the intensity of a child or youth’s support needs will be determined as being extensive, moderate or limited across different age ranges.

This information will result in a corresponding OAP funding allocation that families can use to purchase OAP core clinical services and supports. The process will be completed with each family, at least annually, to help ensure a child’s changing support needs are reflected over time.

A child or youth’s age range is determined by their age on January 1 of the calendar year that the determination of needs interview appointment with their care coordinator takes place.

Families who are eligible to receive an OAP funding allocation for core clinical services and supports that is less than $25,000 in one year will receive their funding in a single payment after they complete the determination of needs process. Families will be required to submit an expense form and any required documentation (such as an attestation form or a letter of recommendation) to account for the funding they spend.

Families who are eligible to receive an OAP funding allocation for core clinical services and supports that is more than $25,000 in one year will receive their funding in installments, up to a maximum of $25,000 per installment. Families will receive their first installment after they complete the determination of needs process. Families will be required to submit an expense form and any required documentation before they can receive future installments.