Four months ago, TVO.org published a three-part series looking at the funding of autism therapy for children in Ontario. It’s a hugely complicated issue — and, at the time, it was a real problem for the Progressive Conservative government, just as it had been for the Liberal government before it. Though the issue faded somewhat from the headlines (having been replaced by other major problems), there was a significant update this week.
More of a surrender than an update, really. The government will, once again, try to reboot this program. Todd Smith, the new minister for children, community and social services, admitted at a Monday press conference that the government’s handling of the autism file has been a failure. “It is clear that we didn’t get the redesign right the first time, and I am here to tell you that we will now,” he said. He also apologized to families for the anxiety this has caused them.
But what are the Tories actually going to do? The plan has, to put it mildly, been in flux for months — it’s already on its second minister, and the government is barely 13 months old. It’s been such a mess, in fact, that the Toronto Sun’s Brian Lilley quipped in a recent column that he’s not sure whether this is the second or third reboot. Come to think of it, I’m not sure it was a quip.
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The autism file is complex and important enough to warrant a proper, in-depth re-examination at a later date. In the interim, consider this an update to the first series of articles and a bridge to the next — a summary of where we are in August 2019 and a best guess as to where we’re heading next.
To help contextualize the recent developments, I spoke with Nancy Marchese, a psychologist who’s been working with childhood autism-therapy programs in Ontario for years. Marchese had originally spoken with me in April, for the above-mentioned series, and I asked her for an update on what had happened since.
There were two answers: Politically, she said, a lot had happened. Lisa MacLeod, who had responsibility for the file in April (and who spoke with TVO.org for the series) was demoted and replaced in June, and the government pledged to do better. That’s obviously important.
But Marchese noted that there had been another key development. As mentioned in the series, the government had come under intense pressure from parents and activists. That was problematic enough. But in June, the government also had to contend with dissension in the ranks — Roman Baber, a Tory MPP, wrote a scathing report on the autism file that was quickly leaked to the media. Baber was quoted as warning that the government had misled the public about the size of wait-lists for treatment, rushed a poorly designed plan out the door, and then dug in and defended it with undue hostility.
“In my respectful opinion,” Baber reportedly wrote, “a full reset is required, including a retreat from the February/March Plan to a needs based plan, predicated on accurate and non-confrontational messaging.”
That may seem benign enough in isolation, but it’s a very strong rebuke of a government from one of its members. And Marchese thinks it mattered: this wasn’t just an angry parent telling Premier Doug Ford that the party had screwed up — it was one of the party’s own.
So that was the political answer to my question: the Baber report, the earlier reversal by the PCs, the eventual removal of MacLeod. But there was also my other question. What had changed on the ground for parents and their children?
Not much, she said.
In April, when I interviewed Marchese for the initial series, it was hard to keep on top of new developments. The government was in the process of retreating from its initial plan; what would happen next wasn’t fully clear. What the Tories had committed to was a six-month freezing of the status quo. Children already receiving government-funded care would continue to receive it; families who were on the wait-list could apply to receive government cheques intended to reimburse families for money spent on private therapy. That six-month extension of the interim program has now been extended again — an interim extension of the interim extension, Marchese noted wryly.
This is good news for families already in needs-based therapy programs. It’s so-so news for the families getting cheques for private care — that program has been slow and scattershot; not every family is receiving enough to cover their actual costs, and, in some communities, there’s no private help available. But some children are getting therapy who were not before. That may be a low bar, but the file has been such a problem that clearing it is, sadly, noteworthy.
What happens next?
It’s obviously too soon to say — the government has said that it will have its new program in place by April 2020. That’s a long way off. But Marchese is provisionally optimistic: “We’ve now heard for the first time the minister say that the program will be fully needs-based. Not a component — fully needs-based. I think that’s good news.” In the meantime, though, she said that children who remain on the waitlist, or those who’ve been denied care or have no local private-care options, will remain in limbo. Early intervention matters with autism. Every month lost is a big deal, and those families could end up waiting eight more months, at least.
Let’s assume, I said to Marchese, that the new program arrives in April and is fantastic. The government knocks it out of the park. Are there things the government can and should be doing now, in the meantime, to do a better job of this and to begin preparing families and children for the April launch?
The easy answer, she said, was better processing of the applications for wait-listed families. But there was something else that could make a big difference. As noted above, children who were already in provincially funded needs-based programs have been able to remain in them. But some of those children have, with the benefit of therapy, improved. They can now move on from those programs. But because the funding for those spots was grandfathered in on an interim basis, when a child exits the therapy, their funding disappears.
Why not immediately use that funding to move a new child into the current programs? Marchese asked. She acknowledged that a dramatic expansion of existing service offerings would be logistically complicated and would be unlikely to be completed by April. But there’s capacity in the system right now that isn’t being fully used. That, she said, is a good place to start helping families, and in a way that wouldn’t require new money or additional resources.
Makes sense to me. If nothing else, it would help some families and children. With an overhauled system still eight months away, it’s probably the best we can hope for in the here and now.
TVO's The Agenda discussed Ontario's new autism strategy on July 31.