| Ontario's early history of developmental services was focused entirely on segregated care in large institutional settings. The first institution for those with a developmental disability was formally opened in Orillia in 1876. Supports were based on a medical model – individuals with a developmental disability were seen as needing treatment in order to ‘fit’ with society. Individuals were cast in the role of pupils (people in need of education) and patients (people in need of care), but not in the role of citizens.
However, by the late 1960s, the concept of “normalizing” the lives of people who have a developmental disability, and the move to integration into the general community, was gaining worldwide favour.
Many of the agencies that provide supports and services to individuals and families of people who have a developmental disability today can trace their roots to the community living movement originally started by parents in the mid-1950s to integrate their family members more fully in the community. This has resulted in a tremendous sense of family ownership in the system.
By the mid-1970s, Ontario had 19 Schedule 1 (government operated) facilities. While institutions in Ontario have provided care to adults only since the late 1980s, they originally housed both children and adults.
The Emergence of the Social Services Model of Support
The 1971 Williston Report
In 1971, the document Present Arrangements for the Care and Supervision of Mentally Retarded Persons in Ontario: A Report to the Minister of Health by Walter Williston (the "WillistonReport") was commissioned by the then Ontario Minister of Health. The Report undertook a review of the careprovided to individuals with a developmental disability and provided recommendations regarding both Government's and the public's responsibility for their care.
The Report recommended that institutions be phased out as quickly as possible with
residential supports being provided in the community settings equivalent to the size of other dwellings in the neighbourhood. The Report recommended that the supports provided through community agencies be "integrated with and closely associated with educational, recreational, and commercial facilities in that particular area" and "be able to draw on the professional resources of the communities in which they are centered".
The 1973 Welch Paper
In 1973, the Honourable Robert Welch, the Provincial Secretary for Social Development, published Community Living for the Mentally Retarded in Ontario: A New Policy Focus. The Welch Paper was a public consultation paper which introduced a new policy focus for the delivery of services based on the concept of community living.
The Welch Paper recommended that, wherever possible, community based services should be provided as an alternative to institutionalization. Welch noted that the
recommendations contained in the paper were based on studies published in Canada and abroad that indicated the issues facing individuals with a developmental disability are primarily of a social nature rather than medical in nature and that segregation in isolated institutions was neither an adequate nor suitable form of care.
One of the observations in the Welch Paper was that while many individuals with a developmental disability require supportive environments due to their high needs, the level of support does not necessarily imply or demand segregated services (e.g. institutions).
The Welch Paper set forth four recommendations:
- guardianship and protective services should be developed in the community;
- residential care resources should be reallocated from institutions to the community;
- policies should be developed to integrate employment opportunities for individuals with a developmental disability with mainstream society; and
- coordinating mechanisms should be established at both local and provincial levels so that a wide range of services are available.
The 1974 Developmental Services Act
In 1974, the new Development Services Act transferred responsibility for services for people with a developmental disability from the Ministry of Health (MoH) to MCSS.
By 1975, a limited number of residential, day care and workshop programs had developed and were available in community-based settings. They predominantly consisted of group homes, segregated employment related activities and other segregated day activities specifically for individuals with a developmental disability.
1977 - 2004 Deinstitutionalization Era - downsizing and closure
The 1st and 2nd Multi-Year Plans (1977-1986)
In 1977 MCSS implemented the first of now 5 multi-year plans (1977, 1982, 1987, 1996 and 2004) to provide community living opportunities for individuals with a developmental disability residing in government-operated facilities. The second multi-year plan began in 1982. During the course of the first two multi-year plans, between 1977 and 1986, a total of 5 facilities closed and the number of residents in others decreased.
The focus of program development during this time period was to enhance the extent of community living opportunities available for people with a developmental disability. Of particular importance during this period was the introduction of programs aimed at improving supports available to families and at promoting as much individual independence as possible.
New investments in the community-based service system during this period included:
- Residential supports: developmental programming and support services were introduced in 1981 through the Tri-Ministry Program (the Ministries responsible for health, education and social services) for individuals with a developmental disability living in nursing homes funded by the Ministry of Health.
- Supports for families/caregivers: the Special Services at Home program (SSAH) was introduced in 1982 to help children with a developmental disability live at home with their families. The program was expanded to include adults with a developmental disability and children with a physical disability in 1990.
- Community participation supports: increase in day programs focused on enhancing independent living skills (e.g. life skills programs); and client advocacy, case management and counseling supports and services for individuals with a developmental disability needing support to live independently in the community were introduced (Adult Protective Services).
The 1987 -1994 Challenges and Opportunities (the 3rd multi-year plan)
In 1987, MCSS published Challenges and Opportunities: Community Living for People with Developmental Handicaps, which set out the government's strategic plan for the next sevenyears as part of its long-term plan to:
- establish a comprehensive community service system in which all individuals with a developmental disability would have the opportunity to live with their own families, or live independently in supported living situations or group homes, and receive a full range of supports to maintain them in these settings; and
- phase-out institutional care on a planned basis.
The plan included the closure of five facilities over the following seven years and a
commitment to close all remaining provincially operated facilities within 25 years. The plan to close all facilities was built on the increasing ability of the community-based system to respond to the needs of individuals and the resulting decline in demand for institutional-based living. During the implementation of the plan outlined by Challenges and Opportunities, a zero admission philosophy became practice for the institutions.
Challenges and Opportunities established four service principles to guide future
community-based service development:
- promotion of independence: individuals with a developmental disability should have access to a range of age-appropriate services that provide the opportunity to live with family or in their own community and offer maximum opportunities for self direction;
- protection: individuals with a developmental disability should have access to programs with appropriate supervision and staffing and access to advocates, guardians and appeal processes so that their concerns are voiced and considered;
- individual attention: services should be flexible and individually tailored to the individual's needs; and
- quality programs: programs for individuals with a developmental disability should be operated with effective case management practices, effectively managed at the community level, and should be flexible, with the phase-out of out-dated programs and the introduction of new models as required.
Investments during the 1987-1994 multi-year plan were directed at developing a
comprehensive community-based service system. New investments in the Community Based Service System during this period included:
- Residential supports: the range of community-based accommodation was enhanced through the development of Supported Individual Living arrangements (where individuals typically live on their own or with another person and receive appropriate support with daily living activities from a community based agency), and "Familyhome" opportunities, where individuals reside with a "host family" who receives payment from a community-based agency in return for their support with daily living activities.
- Supports for families/caregivers: development of in- and out- of-home respite programs; increased funding for families caring for children and adult children at home (the Special Services at Home program).
- Community participation supports: opportunities for individuals to participate more fully in the community were developed through employment supports, such as the development of integrated training and employment programs.
- Developmental clinical supports: individuals and families were provided with increased supports to address specific disability-related issues through the development of infant development and behaviour management programs.
Challenges and Opportunities also focused on increasing the community's capacity to
provide residential supports, community participation supports and the necessary developmental clinical supports for individuals with exceptional care requirements. Many of these individuals were residing in nursing homes at the time but these settings were not age appropriate. The plan outlined in Challenges and Opportunities included the development of the necessary community based services for these individuals to be supported by community-based agencies.
1996 - 2000 Community Living Initiative (the 4th multi-year plan)
On July 23, 1996, MCSS announced a four year Community Living Initiative to move
978 people with a developmental disability from facilities into the community. As planned, by 2000, three Schedule 1 facilities were closed and resident numbers were reduced at the three remaining institutions.
New investments in the community-based service system during this period included:
- Residential supports: investment in a range of community living options to support individuals moving from facilities, adults leaving the child welfare system, and those needing immediate care (e.g. adult children living with aging parents).
- Supports for families/caregivers: investment in respite options for adult children living with aging parents and increased funding for families caring for children and adult children at home (Special Services At Home).
- Community participation: investment in day activity and community participation supports for individuals moving from facilities and adults leaving the child welfare system.
- Developmental clinical supports: increased behaviour management and other assessment and treatment services and supports available to meet the needs of individuals living in the community by moving clinical support teams from facilities to the community.
2000 - 2004 Expansion and Enhancement of Community Supports
In fall of 2000, the Ministry met with nine provincial organizations and more than 600
service providers, individuals and their family members and advocates to identify priority areas that were addressed in the 2001 multi-year plan. The 2001 multi-year plan included a commitment to plan for the closure of the remaining facilities.
The 2001 multi-year plan focused on enhancing services and supports in the community
for people with a developmental disability and their families and on recruiting and retaining quality workers in developmental services agencies. The goal of the plan was for people with a developmental disability to participate as fully as possible in community life. The plan focused on: adult children of aging parents; transitional-aged youth, including those leaving the child welfare system; and individuals with
changing, multiple and complex needs.
Investments during the 2001 Multi-Year Plan focused on four of the five key areas of
investment in the community-based service system:
- Residential supports: the addition of 500 new community accommodation spaces across the continuum of residential supports (group home, individual living supports, and associate living arrangements).
- Supports for families/caregivers: increased funding for families caring for children and adult children at home (Special Services at Home); increased access to out-of-home respite for individuals.
- Community participation supports: increased funding and access to programs that provide support to individuals to participate in meaningful daytime activities.
- Health and safety issues: all community-based agencies' base budgets were increased to enhance the stability and capacity of the community-based agencies by addressing wage discrepancies in the sector, and providing access to training to help attract and maintain quality staff.
2005 - 2009 Citizenship and Full Inclusion (5th multi-year plan to close remaining three institutions)
September 2004 - Minister announcement to Transform Developmental Services
On September 9, 2004 the Minister of Community and Social Services announced that the Ministry would work with stakeholders to transform the community-based developmental services system to better meet the needs of individuals and families.
Part of the transformation includes phasing out operations at the three remaining institutions for adults with a developmental disability by March 31, 2009 (the Facilities Initiative). These closures complete the move from an institutional-based service system to a community-based system that promotes inclusion, independence and choice.
Strengthening the Foundation of the Community-Based Service System
Identification of Supports required
To support the transformation, MCSS consulted with individuals, families, and community organizations. The Ministry sought input from stakeholders on strengthening the foundation of the community-based service system. In particular:
- The Ministry created a Joint Developmental Services Sector Partnership Table, with representation from associations of self-advocates and families, service provider associations, the Ministry of Community and Social Services, and the Ministry of Children and Youth Services.
- The Ministry held six policy forums on key topics related to the strengthening of community-based services: Specialized Resources, Residential Options, Citizenship and Advocacy, Quality Assurance, Funding Approaches, and Strengthening and Supporting Families. The forums were attended by approximately 1000 people, including individuals, families of individuals currently living in the community and in the remaining facilities, service providers and experts.
- The Ministry held ten meetings between the Parliamentary Assistant (Disabilities) to the Minister of Community and Social Services and individuals and families across the Province to hear thoughts, ideas, and concerns about developmental services.
- In May 2006, the Ministry released the document Opportunities and Action: Transforming Supports in Ontario for People Who Have a Developmental Disability. The document drew on 18 months of consultation with individuals, families and agencies and outlined the directions the Ministry intends to move in transforming developmental services. The document had two purposes:
- to introduce the new direction for the delivery of funding and supports based on the advice from stakeholders; and
- to give anyone with an interest in the deliver and funding of supports to people with a developmental disability an opportunity to share comments, and ideas about the best ways to implement the strategy
Investments to Strengthen the Foundation of the Community-Based System
Since January 2004, the Ministry has initiated or announced new programs and new funding to support the transformation of the community-based developmental services system.
New investments in the community-based service system include:
- Residential supports: funding to provide supports for individuals who need immediate care including those leaving the child welfare system or who are living with aging parents. Expanding the continuum of community living options by building 390 new spaces for individuals who are currently residing in the community, including 90 specialized spaces. These spaces are over and above the residential spaces that will be created for people leaving the facilities.
- Supports for families/caregivers: additional funding for families caring for children and adult children at home (Special Services at Home).
- Community participation supports: additional funding for the new Passport Program that provides programs for individuals who have recently left the educational system. Funding for day activities and community participation supports and services for individuals moving to the community from the remaining facilities.
- Developmental specialized supports: two video-conferencing pilot projects that serve adults living in southwestern Ontario and 46 remote northwestern communities who have a developmental disability and co-existing mental health issue(s) and/or challenging behaviour. The pilots provide both specialized supports and training to family members/caregivers, agency staff, local professionals and students to enhance their ability to support individuals with specialized needs.
- Health and safety: additional base funding for agencies to strengthen staffing, to cover costs related to agency operations or make their residences more secure and one-time funding for agencies for health and safety, security renovations and/or minor repairs.
- Wage funding: In 2007/08 and 2008/09, the Ministry provided funding specifically to increase wages of workers in developmental services sector and help agencies to continue to attract and retain staff.
- Base increases: In 2007/08 and 2008/09, the Ministry provided funding to increases agency base budgets to help with operational costs.
In 2008/09, the total budget for Developmental Services is over $1.5B.
By March 2009, all individuals with a developmental disability in Ontario are to reside
in community-based settings and will have access to appropriate services and supports to enable them to live and participate in the community.
In September 2008, new legislation was passed to replace Ontario’s 35-year-old Developmental Services Act. It received Royal Assent in October 2008, making it a new Act. The Services and Supports to Promote the Social Inclusion of Persons with Developmental Disabilities Act, 2008 will help people with a developmental disability to receive the appropriate mix of services and supports to participate more fully in their communities. The Act is designed to help build a modern developmental services system that reflects the fact that people live in and are an integral part of communities. |
