Journey to Belonging: Choice and Inclusion

Minister’s message

In my time as Minister of Children, Community and Social Services, I have had the opportunity to meet with individuals and their families to discuss the challenges they face in navigating the developmental services sector. For many families, they are worried and unsure of how their loved ones will be supported when they are no longer able to care for them.

Over the last 15 years, the demand for services has continued to grow and we know we must act now to plan for the future and look at how to better serve the people who depend on developmental services.

Journey to Belonging: Choice and Inclusion lays out the ministry’s long-term vision for developmental services in Ontario, where people with developmental disabilities are supported to fully participate in their communities and live fulfilling lives.

We have developed a plan for change with the input of people with developmental disabilities, their families, service providers, academics and other sector partners. The ministry heard from hundreds of people and their message is clear – access supports and services that are available, easier to understand, and more flexible to meet individual needs.

Our government has already made improvements to the sector and will continue to make immediate changes that will benefit those who rely on these services. This is a bold vision that will result in significant change for the developmental services sector. While we know this change will take time, we will continue working with individuals, their families and sector partners to take a gradual and careful approach to minimize any potential impacts on people who depend on these services.

Creating change that matters means we are improving how people are connected to supports from other government and community programs. We will continue to work with our many partners throughout Ontario to better support people with developmental disabilities.

I want to take a moment to thank all of those who participated in the consultation process and shared their valuable input which helped develop this plan for developmental services. I look forward to the opportunities to continue hearing feedback as we make progress on our plan.

Our government is committed to planning for the future and looking at how to better serve those who depend on developmental services. This plan will help build a system that is more responsive to people’s needs and supports greater choice and flexibility for people over the course of their lives.

Todd Smith
Minister of Children, Community and Social Services

Introduction

The journey has been a long one; from a place and time when people with developmental disabilities were living in institutions separated from the community, to one where we are in reach of community inclusion and true belonging. Self-advocates, families and service providers have been at the forefront of this important social change through the community living movement. They have worked long and hard to change perceptions about what it means for people with developmental disabilities to live a good life and the kinds of supports that will help them achieve that. People and their families expect to enjoy all the rights and opportunities that other members of society take for granted, like going to school, having a job, receiving healthcare services, and having real choices and control over the decisions that affect them. Significant progress has been made over the years, but we still have work to do.

Despite the progress we are making, we hear regularly from people with developmental disabilities, families and support networks, and sector partners about ways the system can be improved to address key issues. People have expressed that they continue to face stigma and discrimination in their communities. They have shared that life transitions, such as from youth to adulthood, are difficult. People have said that it can be confusing trying to navigate supports from multiple government programs. People are frustrated waiting for developmental services because they don’t know what supports they can expect to receive and when. They want to have more choice and flexibility in how they can use funding to address their needs.

That’s why we will be taking steps over the next eight to 10 years to make meaningful changes to improve services for people with developmental disabilities, and the people and communities who support them. We have developed a plan that focuses on people, and not the systems around them. Our plan is informed by leading practices from jurisdictions across the world. We have learned what they have done to make supports more responsive and effective, such as making services more individualized and providing greater choice and flexibility for people and their families. We also know many innovations have happened right here in Ontario – creative and person-centred approaches to helping people live as independently as they can. This includes creative housing solutions and use of technology to promote independence. We want to identify and share the great efforts developed in this province.

We recognize the changes that need to be made cannot be addressed by the developmental services system alone. Different parts of the government need to work better together, across sectors, and with community partners, to reduce barriers and improve programs so they better meet people’s needs. This includes improving awareness and understanding of the strengths and needs of people with developmental disabilities.

Delivering a bold plan to address the challenges people have outlined will take committed action over time. We will continue to work with people, families, service providers and other key partners to seek feedback and advice on what changes should look like and how they should be implemented. As we work to deliver long-term changes, we will also take swift action during the next year to make meaningful improvements to the experience people have with the developmental services system.

I like the idea that I know what’s best for me.

Person with a developmental disability
Virtual Engagement Session (November 2020)

Summary of engagements

We released a discussion paper in November 2020 to seek feedback on a draft reform plan. We also held virtual engagement sessions with more than 190 people across the province and received more than 880 online submissions.

Overview of virtual engagements

Eight sessions across Ontario

• Self-advocates (who were also invited to participate in other virtual sessions)
• Francophones
• Toronto
• Central West West
• North
• Central East
• East

We also held two focused meetings with bargaining agents, who represent front-line workers who support people with developmental disabilities, to hear their perspectives and feedback.

The engagement approach and reform plan also benefitted from the advice of the Developmental Services Reform Reference Group. The Developmental Services Reform Reference Group was made up of 18 individuals representing self-advocates, family members, service providers, academics and other sector partners. They met over a period of 10 months, from July 2020 to April 2021, reflecting on their experiences to provide advice and feedback on the reform plan.

We have also met regularly with members of the Minister’s Table, a group of 10 key sector leaders from developmental service providers. The Minister’s Table has met since March 2020 to share feedback on sector capacity and share considerations for the reform plan.

What we heard

Individuals and groups shared many thoughts about how people can be better supported through developmental services. For example, we heard about:

Person-centred supports: Supports should respond to people’s strengths, individuality and changing needs. Positive outcomes can only be achieved if people have meaningful choices available to them and flexibility is built into the system.

Early and proactive supports: People would be better supported in the long term with more proactive planning and supports. A consistent case manager or point of contact could support key life transitions.

Growing demand and wait times: The demand for services is higher than availability and the current system prioritizes those in crisis for services. For others, long wait times prevent them from getting needed services. Existing funding and supports may not meet their needs.

Funding: Funding should be fair, flexible and responsive to people’s needs. People should be able to control more of their funding directly.

Support for families and support networks: Families and support networks play a tremendous role but are often stretched, requiring supports to continue. Many people may not have natural or social supports or families and for those who do, reliance on these can create an imbalance.

Culturally appropriate and regional supports: There is a lack of access to and a shortage of culturally appropriate services to support diverse communities, including for Indigenous and Francophone communities. There is limited availability of supports in Northern and rural communities (for example, housing, travel, broadband internet).

Barriers to accessing services: Discrimination, negative attitudes, stigma, and lack of awareness about people with developmental disabilities prevent people from getting appropriate access to housing, healthcare, education and employment.

Flexibility and responsiveness: People and providers need flexibility to innovate and respond to individual situations.

Quality and experience: People, families and service providers need more information to make decisions about quality services.

Workforce: Staff are dedicated to supporting people throughout their lives and should have training and developmental opportunities to help them meet the changing needs and goals of the people they support.

Vision

People with developmental disabilities are supported by their communities, support networks and government to belong and live inclusive lives. People are empowered to make choices and live as independently as possible through supports that are person-directed, equitable and sustainable.

Guiding principles for reform

Our vision for the future focuses on people and how they can belong in their communities and live meaningful lives. In addition to the vision, the following principles will help guide the work and the plan for reform:

• People receive support based on their needs - Greater equity through individualized funding and budgets tied to people’s assessed needs.
• Services build on the strengths of people and supports provided by families, support networks and communities - Supports complement services available in the community and are culturally appropriate to reflect the needs of Indigenous people, Francophones and diversity within our communities, while also reflecting regional differences across the province.
• Supports are person-directed and flexible - People have more control over directing and managing their funding and supports.
• Supports are proactive and responsive to people’s changing needs across the course of their lives - Greater focus on early intervention and prevention for people, with supports that are better integrated with other sectors.
• Services are driven by evidence, outcomes and continuous improvement - More emphasis on outcomes and quality services that are responsive to feedback from people using them.
• Services and supports promote health, well-being and safety - Services promote positive health and wellness outcomes and a high quality and meaningful life experience. Supports help address systemic barriers (for example, discrimination, racism, ableism) that prevent people from accessing supports and fully participating in their communities.
• System is sustainable - Improving the ability of developmental services to help people now and into the future.

Immediate actions

We heard during the engagements that people and families want to see changes now, while we build supports for the future. Our plan includes making immediate changes over the next year to improve access and reduce barriers for people and families.

1. Make it easier for people to access services

To enhance people’s experience during the application process we will:

• Provide people with clear information about what to expect during the application, intake and assessment process, how and when they might receive service, and who to connect with if they don’t receive immediate support. This information will be available to people and families early in their lives so they know what to expect when they are transitioning to adulthood.
• Reduce assessment wait times by providing more training and supports for Developmental Services Ontario (DSO) offices
• Continue to provide options for people to have assessments virtually or in person and pilot tools to book assessments online

To improve to the Passport program, we will:

• Enable people to purchase technology-related supports by reviewing the funding flexibility introduced during COVID‑19 and evaluating which elements to make permanent
• Support people to make it easier to submit expense claims online for quicker reimbursement
• Provide clear guidelines to help people better plan how they spend their funding

To cut red tape and free up service provider capacity, we will:

• Streamline administrative processes such as reporting and contracting so providers can focus on supporting people, not completing paperwork

2. Reduce service barriers for people through strategic partnerships

To support people through key life transitions we will:

• Help people access affordable housing and community-based housing solutions by working with sector partners, including Consolidated Municipal Service Managers and the federal government
• Increase employment for youth with developmental disabilities by helping them prepare for and find opportunities through targeted initiatives
• Develop early interventions to improve outcomes and transitions for youth moving from the child welfare and children with special needs systems to adult developmental services

To improve availability of skilled staff who can provide evidence-based and responsive services for people we will:

• Improve staffing capacity in the sector through recruitment and retention efforts
• Shift to a more person-centred way of delivering services by supporting the sector through the ministry’s Knowledge Translation and Transfer Hub
• The KTT Hub and Network provides knowledge exchange, collaboration and mentoring opportunities to all developmental services agencies, as well as to individuals with developmental disabilities, their families and caregivers. Resources are posted on RealXchange website – a site where products, tools and services are available to assist organizations to improve services, spark new ideas and where opportunities for partnerships and collaboration are formed.

To increase Ontarian's awareness and address negative attitudes we will:

• Carry out an education and awareness campaign across sectors to reduce stigma and discrimination faced by people with developmental disabilities

Reform plan: key commitments

While we make the immediate changes to improve people’s current experience with the system, we will also be focusing our attention on fundamental changes that are needed to better support people across their life, including through the developmental services system.

Our plan for developmental services includes actions across three key commitments:

1. Putting people first
2. Improving service experience
3. Improving quality and accountability

1. Putting people first

Have services at different levels in the community to help meet the diverse needs of an individual with intellectual disabilities

Person with a developmental disability
Virtual Engagement Session (November 26, 2020)

People’s needs change over the course of their lives and how they are supported should reflect that. As part of the reform plan, we’re focusing directly on the needs of people.

Planning for people to live good lives

Families and caregivers told us how overwhelming it can be to figure out how and when they can get supports for their loved one. At the same time, not everyone has a support network they can rely on to help them connect to services. People should be supported to plan for their future and know what supports they could get throughout the course of their lives.

Supporting people through key life stages and transitions means helping them know what to expect and prepare for the support they will need. That’s why we are focusing on interventions and prevention to address some of the challenges people face at key points such as transitioning from youth to adulthood, moving to a different living situation, aging, or finding employment. We will also help people get the services and supports they need across the many systems and sectors, in government and in community.

We will also develop more options for people to direct their own supports. People will be empowered through more choice, control and flexibility on the supports they receive based on their unique needs and circumstances.

Families and support networks are often the first to identify person-centred solutions that build on government-funded supports for people with a developmental disability. We will provide supportive environments for people and families to exchange experiences, ideas and knowledge and help people better plan for their lives.

Our plan will:

• Support people to pursue their goals through better planning and coordination across key sectors and programs
• Support individuals, families and support networks to make connections, get peer support and find information
• Address people’s emerging needs and help prevent crises through early interventions and service coordination approaches

A new funding model focused on people

A person-centred system is one where funding for supports is based on people’s individual needs. We want to shift to a system where funding and supports for people are provided in a more equitable, fair and transparent way. To do this, we need to develop a funding model that is evidence-based and directly linked to people’s assessed needs.

We want to give people greater choice and flexibility to better meet their needs. This means introducing different ways people can get supports. People could continue receiving supports from service providers or choose to manage their funding directly. It could also mean a combination of both.

We want to give people more control over their supports and make the system more responsive to their needs. We want to encourage providers to innovate and provide high quality services that deliver the best possible outcomes for people.

We will take a collaborative approach to this work as we aim to develop a funding model over the next three years. Developing a new funding model will take time and several steps will be needed before it can be put in place. A key first step is working with sector partners to gain a full understanding of the cost of service delivery across the province, including where and why these costs vary.

It is critical that we work to make the system sustainable for the long run so it is there for people when they need it. Implementing an evidence-based funding model will allow us to make funding decisions based on the current needs of people, instead of historic arrangements. As part of this shift, we will also be able to set prices and determine how much government will pay for services. In addition to driving greater sustainability, setting prices for services will help us introduce greater consistency and equity across the province for people and providers. We will continue to engage with people, families and sector partners as we undertake this important work.

Our plan will:

• Promote greater fairness and equity by providing funding based on people’s assessed needs
• Give people more flexibility, choice and control by introducing options to direct their own supports
• Increase transparency for people and providers by allocating funding using an evidence-based funding model
• Provide people clear guidelines on the services and supports to be funded by the ministry
• Support people and agencies to adopt a new funding model

Supporting service for people with developmental disabilities across sectors

Our vision for people with a developmental disability cannot be achieved by one ministry alone. The developmental services system should not be the only way people are able to get support. We know that people with developmental disabilities have difficulty finding and accessing services from other sectors. When they do find support, often it doesn’t fit their needs or circumstances.

The quality of life for people with developmental disabilities will be improved by reducing barriers and connecting people to services such as health, housing, education, employment and transportation services accessed by all Ontarians. For people to truly belong in their communities, they must be able to access the wide range of activities and programs in those communities. We will continue to work across government, with other levels of government, in communities and with sector partners, to better address the needs of people with developmental disabilities.

Our plan will:

• Address barriers for people to access the various services in their communities (for example, housing, education, employment, health) and the opportunities available to all Ontarians.

Culturally relevant supports

Putting people at the centre of how services are delivered requires a holistic approach that recognizes the importance of culture for living a good life. The shift to more person-centred developmental services means people will have access to culturally relevant supports and resources.

We will develop opportunities to expand availability and connect people to culturally relevant and inclusive supports, including those for Indigenous and Francophone communities. We will continue to engage with stakeholders and Indigenous partners as we explore these opportunities for their advice and feedback.

Building more diverse and inclusive systems of supports for people means addressing barriers that prevent them from accessing various services. Our plan includes working with partners to address barriers faced by marginalized groups, including Indigenous, Black and racialized people. We will also work with the sector to attract staff with the right skills to deliver person-centred supports and reflect the diversity of their communities.

Our plan will:

• Support the development of responsive and culturally relevant supports for Indigenous peoples, Francophone, racialized and marginalized communities.

2. Improve service experience

Don't put a life into boxes. See the whole person […] Look at what I need to live the same life as any other person. Make it easy - ask a few questions to see what I can do without any help. That should make it clear for most people. For others then do more detailed questions. Remember most people need more help as they get older not less.

Person with a developmental disability

Think more of investment-supports, rather than crisis-supports

Virtual Engagement Session (November 18, 2020)

Our plan will focus on modernizing services, making them more user-friendly and improving the service experience for people and their families.

Building a people-centred service experience

We want to improve how people apply for developmental services and their experience during the intake and application process. We want to make the process simpler and easier for people. People and their families have highlighted challenges in getting information they need early on or knowing what to expect during the various parts of the application process. Our plan will help improve communication between Developmental Services Ontario (DSO) offices and people applying for services. We will focus on ways to provide people with clear and early information so they know what supports they can expect to receive and when. This will help reduce uncertainty and allow them to plan for their future. In addition, we will work with DSOs to reduce the amount of time people need to wait to have their needs assessed.

What we’re doing:

• Improve the application process for people by making it simpler and easier to access
• Providing timely and clear information to reduce uncertainty for people and allow them to plan for their future

Improving how people’s support needs are assessed

A key part of the application process for developmental services is identifying people’s support needs through an assessment. We want to make this process more flexible and responsive to people’s individual circumstances at different points in their life.

We know that not everybody wants or needs the same level of support. We want people to have more choices and be able to better share how they are best supported.

We will review the type of information currently collected, how it is collected and how it is used to support people. We want to introduce greater transparency into the process so that people know how information about their support needs links to their funding and supports. We will also provide timely and clear information for people so that they know what kind of services they could receive right away or in the future.

We also know people’s needs don’t stay the same over time. They change as people age, learn new skills and deal with unexpected life events, such as illness or the loss of a family member. We will identify ways to re-assess people’s support needs to better respond to life changes and proactively support them to prevent crises.

Our plan will:

• Review different approaches to the application and intake process that are more responsive to people’s circumstances, support needs and the service they are looking for
• Make it easier for people to understand the link between their assessed needs and funding and supports
• Improve how people’s needs are re-assessed as things change in their lives and how supports may be adjusted based on those changes

Adopting best practices and supporting innovation

We want services for people with developmental disabilities to be truly person-centred and based on evidence-based practices. Shifting to a more person-centred system means thinking differently about how and where people are supported, and who has a role to play. We want to support providers and enable them to adopt best practices to make supports more responsive and effective for people.

Service providers and family networks across the province are finding new and innovative ways to support people to live more independently, participate in education and employment, and be active members of their communities. There is a growing evidence-base of leading practices in Ontario and other parts of the world that we can build on to promote true belonging for people. For example, we know there is an immense potential for technology solutions to improve independence for people and support them with daily living activities. A number of promising practices and examples have emerged right here in Ontario as a result of ministry-funded pilot projects to support the use of new technologies to better support people and give them greater control over their lives.

We are developing a platform to allow service providers to share their knowledge and experience from pilot projects and promising practices. Beginning this year, we will provide tools and resources to promote this sharing of information amongst service providers. As we continue to expand this platform, we will be able to showcase success stories and develop promising practices and pilots across the province.

Our plan will:

• Provide a platform that allows the sector to share best practices so ideas can be scaled-up and adopted across the province, including innovative technologies to support people to live more independently

Supporting technology and digital delivery

Technology and digital tools have the potential to support independence for people, relieve pressure for service providers and help staff focus on supports that provide the greatest value.

Technology can support people to live more independently and participate in their communities in new and meaningful ways. Virtual services and supports also allow for people to have more choice and flexibility over when and where they access them. As part of our plan, we will improve how we use technology and expand virtual service delivery to better support people in a way that complements in-person supports.

Adopting digital practices and eliminating time-consuming paper processes will also support the shift to a more person-centred system. We want to promote the use of digital platforms and online resources and support people to find information and access services in a way that is convenient for them. We are looking to deliver an inclusive online experience that is accessible and reflects the needs of people and their families.

It is important to remember that digital first does not mean digital only. Adopting digital practices and technology is challenging where people may not have access to reliable internet or resources. Meeting people’s expectations about service delivery means providing a range of options that work for them, including in-person and over the phone.

Our plan will:

• Implement more convenient service options for people such as online forms, virtual delivery and self-serve options
• Use digital platforms to provide information and resources to people and families

3. Improve quality and accountability

I don’t want the person caring for my child having to worry about paying for daycare or feeding their children.

Parent of a person with a developmental disability
Virtual engagement session (November 25, 2020)

We want people to receive high quality services and promote a stronger focus on improving outcomes. Here’s how.

Effectively delivering on quality and outcomes

The government spends approximately $2.7 billion to fund services for people with developmental disabilities including:

• More than $1.8 billion in residential supports to serve roughly 19,300 people
• Over $900 million in agency-based supportive services (serving over 25,000 people) and direct funding through Passport (serving over 52,000 people)

We have a responsibility to ensure these significant investments are meeting the needs of people and helping them achieve their desired goals. We want to promote greater quality and accountability at all levels to support better outcomes for people.

Moving towards a funding approach that gives people greater choice and control over their supports will play an important role in promoting service quality. Individualized funding can encourage service providers to innovate and provide high quality services that deliver the best possible outcomes for people. As providers adapt to offer services that better meet people’s needs, we also want people to be able to judge the quality of services they are getting whether it’s from an agency or from someone they have directly hired. We will develop ways to provide information to people to help them make informed decisions about their support arrangements through our work on building a quality framework.

We also want to be able to measure how well different parts of the system are performing in order to improve the quality of services for people. To help achieve this, we will introduce a performance measurement approach to measure outcomes for people and get feedback on their service experience. We will begin testing this approach starting next year and expect to put it in place across the province by the end of 2023.

Our plan will:

• Support continuous improvement in services for people by introducing a performance measurement approach across the province over the next two years
• Help people better understand and choose quality services through a transparent quality framework
• Promote healthy competition among providers and reward innovators

Planning for a skilled workforce

The passionate and dedicated staff working in the developmental service sector make a real difference in the lives of the people they support every day. Their passion and commitment to their work has never been more evident than over the past year as we have battled COVID‑19.

We want the people working in the sector to be valued and recognized as skilled professionals who provide critical services to Ontarians. We heard through our engagements that it can be difficult for people to attract and keep the staff they need. We are looking to build on joint efforts with the sector to develop a workforce strategy to address these issues. This strategy will focus on making the sector an attractive place to work and build a career, by exploring ways to make compensation more consistent, and provide more opportunities for enhanced training and skills development.

Over the next year, we will partner with the sector to move forward with three initial workforce initiatives:

• marketing and recruitment
• updating core competencies
• leadership and management training

We will also support the sector to attract staff with the right skills to deliver person-centred supports that reflect the diversity of our communities. This will include promoting diversity at all levels, including senior positions and at the board-level. We will also work with the sector to improve training opportunities that support person-centred delivery, such as cultural competency and trauma-informed approaches.

We recognize that well-trained staff who are valued and compensated fairly can help deliver high quality, person-centred services and improve outcomes for people. We will work with the sector to continue making improvements to address the needs of sector staff so that they can support people in the best possible way.

Our plan will:

• Support a skilled, diverse and professional workforce to help people participate meaningfully in their communities and live good lives
• Collaborate with the sector to develop a long-term workforce strategy so that people and their families have access to high-quality support staff

The path forward

Achieving an ambitious plan takes time. Our plan will be implemented gradually over eight to 10 years to make sure we get these changes right and that these changes have a meaningful impact for people and their families. While we are taking some immediate actions over the next year to improve existing supports for people, we will take a phased approach to put the longer-term changes in place. Here is what that will look like:

Conclusion

We have made important strides in improving the lives of people with developmental disabilities across Ontario. These include:

• Providing Passport funding to more than 28,000 additional people over the last three years
• Investing $40 million through the COVID‑19 Residential Relief Fund (CRRF) to support residential service providers respond to the COVID‑19 pandemic
• Investing $700 million on temporary wage enhancements for personal support workers and direct support workers, including those in developmental services sector
• $13 million over three years, beginning in 2021–22, to assist more people with developmental disabilities in accessing community housing and expanding the Adult Protective Service Worker program to support them to live independently

We know there is more work to be done by communities, sector partners, support networks and the government to help people with developmental disabilities live meaningful and inclusive lives. We have an ambitious agenda and we are committed to delivering on our plan.

One thing COVID‑19 has clearly shown is that the people of Ontario are dedicated and resilient. As we take steps to achieve the vision of true belonging for people with developmental disabilities, we will listen, learn and work together, with people, families and our sector partners. Together, we can realize our vision where people with developmental disabilities are supported to truly belong as citizens in their communities.