ICYMI we posted a Myth vs Fact series on our social media platforms to try to dispel some misconceptions about the OAP (Ontario Autism Program). We've compiled all those posts here.
Please note there are hyperlinks in this article
1) "The OAP waitlist has doubled"
For parents/caregivers, it's difficult enough learning that their child has exceptional needs. Having to then wait for government supports is beyond stressful
As of March 2023, 58513 children are REGISTERED in the OAP. That does not mean over 58K are completely without support. That number includes those still in the legacy program (the OAP that was implemented by the Liberals by 2018), those who have received Childhood Budgets/Interim Funding and those who have received Core Clinical Services funding.
Furthermore, anyone registered in the OAP can access Foundational Family Services and Urgent Response Services. Depending on the child's age, they may also be invited to Caregiver Mediated Early Years Programs and/or the Entry to School Program.
How the government posted numbers on their website was changed. In July 2019, it was indicated that there were 24924 children waiting for service and 10365 in service.
That meant 35289 were actually registered.
35289 to 58513 is not a doubling.
Before the Ministry took over intake and registration, it was the regional providers (which includes centres like Erinoak Kids and Surrey Place) who managed their own waitlists. What was considered “in service” varied from regional provider to regional provider. It could have meant the child was receiving 1:1 ABA via DSO (direct service option) or a time limited block of parent-mediated sessions or merely phone consultations. Being "in service" meant different things. So, the Ministry website was changed to indicate how many were "registered" in the OAP instead
However, we must stress that ANY waitlist is terrible. This government (and previous ones too) have made several missteps when it came to addressing the wait.
There have been many changes over the years which have made things confusing and inconsistent. Now that there's a program providing direct funding for more than just ABA and more robust funded (free) programs, we hope that more families will be able to get support they need
2) "The majority of children being invited into service are those who are already in service or received service under prior government programs"
While it's true that some children who registered earlier may still be in service (under the legacy program) or have already received some sort of support under previous programs, to say that these children should not transition to Core Clinical Services would be unfair.
Having children in the legacy program (the OAP that the Liberals implemented in 2018) transition to Core means there would no gap in service - which is important for consistency. But, being in the legacy program does not automatically mean the child is actually receiving the services they need (ABA is the only intervention provided) at the intensity required (many DSO or Direct Service Option clients have had hours drastically cut without clinical rationale).
There are kids who registered as early as 2015 or 2016 that received a block of ABA-based supports, were discharged, put back onto the waitlist, and haven't received anything since. Or they were discharged from the old AIP (Autism Intervention Program - this was before the legacy program) and have since been waiting for support.
Some contend that these children shouldn't transition to Core Clinical Services because "they received services already".
We would argue that these children need to transition to Core Clinical Services even more so as they would be aging out soon and should not be penalized for already having received some type of support under a previous government program years ago.
3) “The OAP is not needs-based because there are age caps"
The funding allocations are not arbitrary but clinically informed.
Both the OAP Advisory Panel and Implementation Working Group (IWG) looked at many studies and lots of pedagogical data to determine an average and maximum number of hours that autistic children at various age levels should have. The funding allotments can be traced back to how many hours a child should be in therapy. That number goes down as kids age. Once they are in school, the number of available hours for therapy also goes down. As they get older, the types of supports change, and the hours that those supports require goes down.
The IWG also found that research shows more ABA hours doesn't necessarily equal better outcomes.
(See this JAMA Pediatrics article)
There is no evidence showing a teenager benefits from getting 30-40 hours/week of ABA. There may be cases where a teenager is getting that intensity but it doesn't mean that they should.
The funding allocations and age appropriate ranges are informed by evidence and clinical experience. Furthermore, to move 58K kids through a system with limited funds, you have to define ranges for them to be funded by.
4) "The government should be prioritizing children who haven't received services"
It's been known for some time that they would be moving kids into Core Clinical Services according to registration date. This was a recommendation from both the OAP Advisory Panel and Implementation Working Group (IWG).
The children who have earlier registration dates should be moved into Core Clinical Services (regardless of status) since:
1. They will be aging out of the program sooner
2. Being older, they may need other supports such as mental health services which they may not be able to access otherwise
3. Younger children and parents/caregivers can access other programs in the OAP such as Caregiver Mediated Early Years Programs and the Entry to School Program which are provided free. They also can access supports outside of the OAP such as preschool speech and language services and EarlyON centres
(NOTE: This isn't to say that these programs are a replacement for direct service. However, they are informed by evidence. They can empower parents/caregivers with tools they can use to support their children; as well as provide children opportunities to learn new skills)
5) “Clinicians must have the final say in the needs determination process, not a care coordinator who lacks the qualifications and has been trained on a needs-determination tool for one day.”
Care Coordinators are NOT determining clinical needs. They are gathering information from parents/caregivers (and, if available, any professionals involved with the child) to determine funding allocation. The DON (Determination of Needs) interview is extensive; going over 10 domains and taking up to 4 hours. Any reports / assessments that parents/caregivers may have from therapists and clinicians are also taken in account.
The process for Core Clinical Services is similar to Alberta's Family Support for Children with Disabilities (FSCD) program (which is purported to be the best in Canada). Over there, families also meet with a worker to go over their child's needs and strengths to determine funding.
Even in the legacy program, clinicians did not make funding decisions. They came up with a service plan (OAP Behaviour Plan) for a child and costed out everything in an OAP Budget Plan (hours, travel expenses, assessments, meetings, training, consultations, supervision, etc.). Those budget plans were still subject to approval by the regional providers (however, have not heard any feedback from parents who had their OAP Budget Plans rejected because they were deemed too costly).
(NOTE: Should be noted that there isn't a fee card that private providers have to follow. While the legacy program funded up to a maximum of $55/hour for ABA, providers have free rein to charge whatever they want for services. Furthermore, at the time of writing, ABA is still unregulated. There have been a few (albeit unverified) reports that some providers submitted OAP Budget Plans that were well above the cost of what would be considered typical for an ABA program.)
Job postings for Care Coordinators call for qualified, university-educated individuals who have experience in a human service, social service or clinically related discipline providing support to families. Getting one day of training on how to administer a standardized tool is not unheard of and occurs in other sectors such as healthcare.
It would also be expected that there will be additional training opportunities in the future as the process and program is refined over time.
To find out more about the different parts of the OAP, please see our article and infographic here
Other blog posts about the OAP can be found here