Background / The Request
Skip to the data or skip to the charts if you'd rather.
For the sake of getting to the point, I'm not going to share the emails between myself and the Ministry of Community, Children, and Social Services (MCCSS) as I usually do.
I asked for breakdowns based on categories including:
- Applied Behavioural Analysis (ABA)
- Speech-Language Pathology (SLP)
- Occupational Therapy (OT)
- Physiotherapy (PT)
- Non-therapeutic interventions (e.g. respite, sensory devices) with a further breakdown if possible
I also asked for a breakdown by age or at least age range (0-6, 7-12, 13-18).
Given the length of time and cost required to file the request, I elected not to include mental health/psychology services as said services primarily would apply to older children/youth. I left physiotherapy in as it would potentially apply to all ages.
Why Did it Cost $65.00?
Those of you who have filed FOI requests in the past in Ontario will be aware that there is a mandatory $5.00 fee. However, the linked page indicates that additional costs may be required:
Additional fees may apply to process a request. The processing fee is determined by the:
- type of information you requested (for example, general records or personal information)
- format you wish to receive the information (for example, paper, electronic or multimedia records)
- total costs incurred by the institution to produce or prepare the information
In this particular case, an extra $60.00 was required to research my FOI request, payable only by cheque made out to the Ministry of Finance and mailed to the MCCSS Access and Privacy Office. There is no online payment or equally convenient option, which in turn created a further delay in terms of receiving a response.
The Data
On May 11, I finally received data from MCCSS, and I've linked to it below. I have left it exactly as it was sent to me:
MCCSS Unedited Responsive Record (aka the data)
For those of you who may need an Excel reader to open this file, here are some alternatives. I haven't tried any of them and have no recommendations, though.
In order to answer any questions that may come up immediately:
- Yes, this is the actual spreadsheet that MCCSS sent me.
- No, it's not for a calendar year as I requested.
- The 6-17 age range was not broken down into 7-12 and 13-18, as requested.
- Yes, the math is incorrect.
Data Issues
Totals are Incorrectly Added
First of all, the math is incorrect as I indicated above. The researcher hastily used the SUM function in Excel to add all of the column numbers. As a result, the subcategory figures contained within the Therapies and Specialized Services categories were added twice to generate the totals.
I emailed MCCSS the revised spreadsheet below indicating the error and the potential revised totals to verify their accuracy.
Revised Spreadsheet Containing Corrected Data
To the credit of the MCCSS representative that I spoke with, he did acknowledge the mistake, apologized for it, and indicated that my interpretation was correct. He also promised to send me a corrected spreadsheet. To date, I have not received said spreadsheet.
Data Limitations
The data itself has multiple limitations that impact its fidelity and usefulness. It is evidentiary, but by no means conclusive:
- Not all spending is covered. As I mentioned, I elected not to include mental health for the sake of expediency. In addition to this, the first spreadsheet footnote reads as follows:
The information provided in this report includes all expenses, electronically submitted, received and processed by the ministry up to and including February 22, 2022. It does not include any expenses that have been submitted via paper-expense forms, as the expense details are not yet available in a format that can be provided electronically. It also does not provide details on expenses that have been received but due to system limitations currently remain unmatched to the respective child/youth allocated budget
In other words, any paper expenses and expenses that are "received but unmatched to the respective child/youth allocated budget" aren't included in the totals.
Unreconciled expenses are also not included. - The lack of a standard time period. January 1, 2020 - February 22, 2022 is a non-standard time period and thus is not an ideally useful time period in terms of analysis and comparison with other time periods. A calendar year is the most useful period.
- Potential fidelity issues in other areas. Since there is no further breakdown of the various categories, it is possible and arguably likely that there are errors pertaining to the calculation of the various figures contained within the spreadsheet.
Summary Charts and Interpretations
Notwithstanding the aforementioned issues, there is still potentially useful information to be gleaned from the data itself. However, it is highly subject to interpretation.
Data Enhances the IMN Argument; It Does Not Change the Argument
As the first set of charts will attest, the IMN argument that ABA should be considered a medically necessary intervention does not materially change; it is the predominant therapeutic intervention choice, particularly among families with small children.
Statistical Variance
Some statistical variance is to be expected between the data gathered from this period of time and future years, due in part to COVID-19 and associated lack of availability of in-person therapeutic services and supports. This is reflected in the proportionate increase in therapeutic services as a portion of the overall spending between Childhood Budgets and Interim One-Time Funding, as Childhood Budgets were only issued until approx. April 2020 with the exception of any "legacy kids" who were transitioned to Childhood Budgets, and as such the majority of spending of said budgets would largely take place in the 2020 and the early part of 2021.
Spending Total Summaries
INSTRUCTION: To view a section and its associated data, hover over it.
Therapeutic Interventions
This will come as little to no surprise to most people; the majority of money spent on therapeutic interventions went toward ABA therapies.
- All Ages
- 0-6 Years
- 6-17 Years
Direct Therapeutic Interventions vs. Other Products and Services
I've provided pie charts below to show the differences between direct therapeutic services and other. This is likely to be the most surprising aspect for many of you. As the data indicates, the majority of spending that can be tracked was not directly therapeutic, particularly as it pertains to the children aged 6-17 years.
- All Ages
- 0-6 Years
- 6-17 Years
Even if we factor in the lack of availability of services during the initial COVID shutdown period of 2020 and early 2021, the missing mental health piece, and the probability that many of the other products and services would be used to support therapeutic interventions, this does not fully explain the high proportional levels of spending on items other than direct therapies, as the next set of graphs will attest.
Category Total
NOTE: The "Additional Autism Services" and "Family Service Planning" categories are consolidated in the charts below because the Family Service Planning spending amounts are proportionately miniscule.
View enlarged pie charts with Family Service Planning spending amounts separated.
- All Ages
- 0-6 Years
- 6-17 Years
As one can see, the chart looks distinctly different for children aged 6-17. This reflects an increase in complexity of needs as children age and corresponds with an increase in services such as employment and transitional supports.
Respite (indicated in green) is prevalent among non-therapeutic interventions, particularly among older children and youth; this indicates a need of some urgency for expanded Special Services at Home (SSAH) funding in order to allow for greater community participation, self-determination, and dignity. This is a concern shared by families with disabled adults and Community Agencies as a letter sent by People For Personalized Funding attests.
Key Takeaways / Actionable Items
Data Must be Prioritized
- OAP raw data must be readily available at no charge. No one should have to file a Freedom of Information Request to access the data shared above. It is expensive, time-consuming, and lends itself far too easily to human error. The Province of Ontario has an open data catalogue for this specific reason.
- Data must be gathered with fidelity. Even though there are several potential actions that can be drawn from the data, the lack of fidelity associated with the data means that any decisions made based on said data are not truly evidence-based decisions.
- The Independent Intake Organization (IIO) must be given any financial and other resources within reason to generate proper data. The IIO is utilizing more advanced tools within the AccessOAP family portal such as Telerik; for those not in web development, Telerik is a high-end set of user interface components used by highly sophisticated programmers. This means that said programmers are using tools that can generate data with the required fidelity, and potentially present said data in an easy-to-understand fashion to the public.
- Establish a clear set of metrics. The number of children in the OAP, Childhood Budget invitations, and Interim One-Time Funding invitations are inadequate in terms of determining the most efficacious course of action to help as many kids as possible. An updated set of metrics needs to be established with families, IIO members, providers, and other key stakeholders who have shown the capability to adopt a holistic viewpoint working in conjunction with one another.
- Independent forensic auditing on a regular basis should be considered. Auditing from an independent third party (e.g. KPMG, Deloitte) would go a long way toward ensuring accurate data from which future improvements to the OAP can be determined.
Establish Which Children are on the Waitlist for Core Services and What Their Needs are as Soon as Possible
As the data above indicates, a significant proportion of spending was allocated to non-therapeutic products and services; this is particularly true among children aged 6-17. This indicates that a large percentage of older children in particular are not in fact waiting for core services. Who are the children who need core services, though? Where are they? What are their needs? We need to establish this as soon as possible in order to shorten waitlist times for those children and prioritize regions that may require greater therapist capacity.
Expand Special Services at Home (SSAH) Funding for Children who Require SSAH Supports
In order to ensure that those children in the OAP who do not require Core Services do not slip through the cracks, SSAH will need to be expanded and overhauled to provide families with upfront funding. These are changes that families have required for years.
Focus on Underserved Populations
The small portion of funding associated with Family Service Planning (individualized family service and interpretation services) indicates that racialized populations are being potentially underserved. Families typically have to be made aware of services such as interpretation services, and the usage of funding indicates that this may not be the case.
Similar thinking will need to be applied to other populations that are historically underserved, such as First Nations and rural populations.