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Working
Group for Provincial Associations
Representing
Section 20
Care and Treatment Programs
Report on Section 20 Policy Recommendations
Draft
Report – March 17, 2004
Introduction
The Provincial Association Working Group
Representing Section 20 Care and Treatment
Programs was formed in 2003 to act in
consultation with stakeholders and the
various funding ministries of the Government
of Ontario to review issues related to the
delivery of Section 20 services. The
inter-association work is short-term and
focused on developing a population profile
of students, reviewing the current
guidelines, making recommendations in
relation to the comprehensiveness of
service, and identifying key policy
components for an inter-ministerial
guideline for Section 20. Provincial
associations serving children, youth and
families and having an interest in Section
20 Care, Treatment, Custody and Correctional
Programs were approached to determine their
interest in participating in a working
group. The work group members are working on
behalf of and are representatives of the
following provincial organizations:
-
Children's Mental Health Ontario,
-
Ontario Association for Students at Risk,
-
Ontario Association of Children and Youth
Centres (OntChild),
-
Ontario Association of Children's Aid
Societies,
-
Ontario Association of Residences Treating
Youth,
-
Ontario Association of School Board
Administrators for Care, Treatment Custody
and Correctional Programs,
-
Ontario Council for Children with
Behavioural Disorders, and
-
Young Parent Resources Ontario.
The Working Group has developed a population
profile for students served in Section 20.
As part of the inter-association work, the
current Section 20 guidelines have been
reviewed. A “Policy Planning Tool” (Appendix
1) was developed to guide consultation and
the scope of work. On October 9, 2003
representatives from across Ontario met in
Toronto to review and obtain feedback from a
wide range of Section 20 stakeholders
concerning key policy changes needed to
guide the future of Section 20 programs.
It is the recommendation of these
stakeholders that current section 20
guidelines be recognized as anachronistic
and that an inter-ministerial policy review
include describing the populations served
and their unique needs. This information
along with input from key stakeholders can
be utilized to determine an approach to
service that offers a continuum of
educational options that is aligned with the
continuum of care, treatment and
intervention options required to meet each
student’s individual needs (see
“School-based Integrated Service
Model—Schools and Care and Treatment
Services”, Appendix 6).
To this end, the stakeholders developed a
vision for Section 20 programs in Ontario. A
cross jurisdictional review was completed
and areas of excellence were noted in the
various provinces across Canada. Key
barriers and policy changes were identified
as the stakeholders reviewed the key
components of a policy framework summarized
in our Policy Planning Tool.
.
Shared Vision
Our shared vision is an Ontario that
maximizes the educational capacity of its
children and youth who may have care,
treatment, custody and/or correctional
needs. We will achieve this through an
intersectoral continuum of educational
environments that accommodate and
comprehensively meet the individual needs of
students as contributing members of society.
Background
In 2003, there were 506 funded Section 20
Care and Treatment programs in 938
classrooms across Ontario. On average, there
are 8 students per classroom and over 7,000
students at any one time. The majority of
these classrooms are located in community
agencies with only 30% of the classrooms in
community school settings. Students served
range in age from 4 to 21 years and often
have multiple needs requiring care,
treatment, custody or correctional services
for early intervention, autism, pervasive
developmental disorder, intellectual
disability, behaviour,
corrections/detention, medical conditions,
physical disabilities, pregnant/”at risk”
youth, psychiatric/mental health, and
substance abuse. Appendix 2, “Education
Program Types and Data” provides a summary
based upon the Ministry of Education “ISA-4
Monitoring Report (Appendix 10). The various
ministries involved do not have standard
categories that align with range of student
needs served in the programs. As a result
the quality and scope of summary data is
limited, suggesting the need to establish
inter-ministerial monitoring formats.
Many of these students tend to lack parental
advocates and may come from families with
few resources; some are estranged from
family, or are involved with child welfare
agencies. A significant number of these
students have multiple needs and
exceptionalities, surpassing the capacity of
Special Education classrooms. Ironically,
Section 20 funding (ISA 4) is capped,
providing only a teacher and $2500.00
towards classroom supplies, textbooks and
technological resources. The students are
not considered as belonging to the Board of
Education and therefore are not entitled to
access other Special Education formulas
which provide considerably more funding with
more flexibility. As agencies attempt to
meet the complex needs of many of the
hardest to serve students, the children’s
mental health services are stretched to the
point where program viability is becoming an
issue.
The current funding and policies related to
Section 20 Care and Treatment programming
are anachronistic and in need of revision.
These guidelines were developed in the mid
1960’s when the Ontario Government directly
operated care and treatment institutions. In
order to run a Section 20 program,
institutions only required a teacher and
some supplies from the Ministry of
Education. As service delivery methods
changed, agencies attempted to meet the
demands of a range of populations by
adapting their programs to meet the needs of
the student. As a result, practice no longer
matches policy. Although the need for
inter-ministerial collaboration and
cooperative funding has been recognized by
service providers, the MOE is the only
funding Ministry that is able to identify
the extent of the resources invested in
Section 20 programming. The current
guidelines place children and youth in a
situation where inadequate resources are
available to meet their specialized needs.
This results in systemic barriers that
impact the accessibility and equality of
educational opportunities.
The Ontario Child Health Study
and subsequent work from the Offord Centre
for Children and other research and
published best practices has given us a
20-year body of evidence to support
effective approaches to the needs of
children and youth. At the present time,
Ontario lacks a provincial approach to meet
the diverse needs of children over the age
of 6 years yet there is compelling evidence
of a period of accelerated brain development
in early adolescence -- an investment in the
development of early teens will also result
in more productive youth.[insert
reference]. The creation of the new
Ontario Ministry for Children and Youth
Services provides an opportunity to overcome
many of the barriers that have slowed
inter-ministerial efforts in the past.
Key Issues
Today, more children with severe needs are
being referred for Section 20 services at a
younger age. According to the Canadian
Journal of Psychiatry, 18% of children and
youth in Ontario have a diagnosable mental
health disorder.
The Ontario Child Health Study has
identified children’s mental health as a
major issue influencing the quality of life.
Increasing population along with the current
approach to behaviour management in schools
are key factors that have contributed to a
steadily increasing demand for Section 20
services. These trends influence the need
for educational programs that address the
child/youth’s needs for care, treatment,
custody and/or corrections – yet significant
systemic and policy barriers exist to
prevent them from obtaining service.
The current policy is exclusionary in nature
and programs are based on serving children
who cannot be served in regular classrooms.
These students are the hardest to serve,
highest-risk students with intensive care,
treatment, custody or corrections needs.
There are greater numbers of students with
complex needs being identified as needing
Section 20 services at younger ages. At the
present time, there is a lack of common
definitions on needs and monitoring data.
These students are excluded from the
benefits and procedures of Special Education
Services in Ontario.
In the past, the Ontario Ministries of
Education, Health, Community and Social
Services and Community Safety and
Correctional Services have lacked an
integrated approach to acknowledge and be
accountable for their funding and policy
responsibilities to these children and
youth. The recent development of the
Ministry of Children and Youth Services (MCYS)
and the willingness of the MOE to undertake
an inter-ministerial policy review are two
key factors to indicate the time is right to
address these long-standing needs.
Schools have experienced a limited capacity
to meet the mental health needs of students
at risk. Community service providers also
have a limited capacity to provide service
and current guidelines regarding access and
transitions to and from Section 20 further
impede the ability to meet student needs.
Section 20 Care, Treatment, Custody and
Corrections Programs require
inter-ministerial cooperation to address
priority issues that threaten the continued
existence of these services and create
significant risk to children and youth.
Programs governed by the current policy fail
to meet the needs of these students and
creates further inequities in their ability
to optimize their educational attainment
while meeting their needs for care and
treatment. These students have been excluded
from the benefits of Special Education and
form optimum achievement of their
educational experience and eventual
diminished societal participation. The
current practice and pressing needs of these
children and youth demand an update of
policy at this time in order to align the
range of care and treatment options and
education options. The Boards of Education,
community service providers, and the various
Ministries of the Ontario Government must
work to determine creative, collaborative
approaches to appropriately accommodate
these students. The field is united to work
together to address these needs.
Related Issues
The Ministry Of Education (MOE) Framework
for Section 20 identifies “a child/youth in
a care, treatment, custodial or correctional
facility receiving an educational program in
the facility must not be recorded as a pupil
of a board and is not eligible for funding,
on either a full-time or part-time basis, as
a pupil of the board.”
As a result, students are ineligible for the
range of Special Education supports and
accommodations that may be offered through
the traditional school system. This has
resulted in pronounced funding inequalities
that impact on the availability of resources
to support the unique needs of the student
i.e., the student is no longer eligible to
be identified to receive ISA grants that
accommodate additional staffing or adaptive
technology needs.
The Ontario Provincial Auditor has
identified a series of systemic barriers and
policy issues.
Timely access to children’s mental health
services is often critical for ensuring the
best possible outcomes for children in
need/at-risk. Children’s mental health
services are experiencing capacity issues
which results in lengthy wait lists for
service. Each year transfer payment agencies
receive the same amount of base funding,
largely without review. The costs incurred
by these agencies for accommodation are
threatening the viability of programs. Care
and treatment staff in the community
experience a significant salary differential
with the hospital and other government
sectors. As agencies face increased service
demands and cost increases, decisions need
to be made in relation to the elimination or
reduction of services in order to operate
within the base funding allocation.
The Ontario Human Rights Commission has
documented various failures to accommodate
the rights of children and youth with care
and treatment needs.
Section 10(1) of the Human Rights Code
provides a broad definition of “disability”
that encompasses most of the students with
care and treatment needs. These students do
not have equal access to educational
opportunities in Ontario. The Education
Act requires the MOE to ensure that all
exceptional children in Ontario have
available to them appropriate special
education programs and services without
payment of fees. The MOE also has numerous
policy statements related to the delivery of
special education services and yet
stakeholders continue to express concern
about the accessibility and equality of
educational services for students requiring
care and treatment as they fall outside of
the Special Education continuum. Students
and their families encounter numerous
barriers such as a lack of timely
assessments, inaccurate understanding of
student strengths, wait lists for service,
an uncoordinated system of services that is
difficult to navigate, ineligibility for
Special Education supports, and a lack of
support during the transition process from a
specialized setting into a mainstream
school.
Ontario has what are commonly known as
service “silos” in government. This results
in barriers among and within sectors like
social services, health care, corrections,
and education. Each of these sectors comes
under their own set of
legislation/regulations. The presence of
silos makes inter-ministerial partnering for
resources difficult as each sector maintains
its allegiance to its funder. This also
makes the delivery of ancillary services
difficult when the same service is offered
in a variety of different structures.
Students at risk often have multidimensional
problems that require multidisciplinary
solutions. Historically, services to
families of at-risk students have not been
offered in a coordinated way. Community and
social services, health professional
agencies, recreational services, community
police, and correctional and custodial
services must have close links with
education and collaborate in providing and
funding these services to enhance capacity
and to meet the individual needs of the
student.
Some communities are working towards this
and need to be supported by
inter-ministerial policy development.
Mental health services located in or
governed by hospitals that support children
and youth are under the jurisdiction of the
Ministry of Health and Long Term Care (MOHLTC).
The MOHLTC business plan describes their
vision for the services offered as:
“A health system that promotes wellness and
improves health through accessible
integrated and quality services at every
stage of life and as close to home as
possible… Our goal is a system that ensures
everyone in the province has access to
quality health care services to which they
are entitled – at every stage of their
lives.”
Community-based children and youth mental
health services are under the jurisdiction
of the Ministry of Community and Social
Services/Ministry of Children’s Services (MCSS/MCS).
The MCSS/MCS vision for services is
identified as:
“… a service system in which children are
safe and people most in need receive
support… Designated groups of children will
have access to a system of supports and
services to promote healthy growth and
development.”
These vision statements reflect the conflict
between universal health care legislation
that recognizes the right to service by
those requiring it versus the Child and
Family Services Act that offers services
to children who have social, emotional,
behavioural, and/or psychiatric problems.
Service is no longer viewed as a right but
instead is discretionary under the Act and
is provided only to the level of available
resources.
Early childhood initiatives have increased
the resources available to offer parental
support and a number of screening tools have
been put in place to allow for early
identification of children with issues that
make functioning in the regular school
system difficult. These initiatives have
been successful in identifying children at
risk however; minimal resources have been
invested to address the demand for service.
The former Ontario Government focused on
Child Welfare Reform Legislation and
this has resulted in more children and youth
coming into care and being identified as
having significant mental health risks. A
crisis has resulted, and rather than
addressing some of the key care, treatment,
and intervention needs of children and
youth, they have been placed at risk by not
being able to access the services and
support required.
The Ontario Liberal Government policy goals
emphasize education that supports success
for all students. The Liberal government is
committed to ensuring the investments made
in preschool children through their “Best
Start” initiatives are based on a vision of
high quality early years education and
supports that subsequently become integrated
extensions of the public education system.
Through development of the MCS, efforts are
being made to ensure that children’s issues
are a top priority for this government. The
plan also addresses students with special
needs and the foundation of the platform
focuses on quality education that meets the
needs of all students. There is recognition
that an integrated approach is necessary and
that substantial improvement will require
cooperation between the government,
educators, school boards, and parents, as
well as real increases in funding support to
schools and innovative programs. The Ontario
Liberal government is looking at long term
funding in an attempt to lend stability to
the approach established to meet the needs
of all students.
What will be the outcome if we act now?
An integrated policy framework addressing
Section 20 care, treatment, custody, and
corrections that is supported by the various
ministries of the Government of Ontario
providing service to children, youth and
their families will provide a forum for the
long-standing needs of children and youth to
be met. This represents a significant
investment in the future of Ontario’s
children. McCain and Mustard
advocate for a comprehensive model of
seamless supports with more effective
interaction and collaboration between early
child development and education providing
access to early intervention for families in
need. Through this comprehensive model,
children will receive the resources required
for brain development from conception
through age six and this has been found to
have the most important influence of any
time in the life cycle on brain development
and subsequent learning, behaviour and
health.
A policy is needed to clarify roles and
responsibilities in the education and
treatment of children and youth with care
and treatment needs. This cross sectoral
approach to policy and resources will permit
alignment between Ministries, resulting in
more efficiency and a better use of
resources which support the continued
optimal development of these children as
they reach age six and mature into
adulthood.
Status quo of current government structures
maintains systemic barriers that prevent the
true strengths and needs of Section 20
students from being realized. The historic
territoriality of Ministries resulting from
the chronic under-funding of services has
resulted in the various Ministries avoiding
responsibility to address resources for care
and treatment. This has created a
significant threat to the viability and
sustainability of Section 20 services.
Systemic changes are required to develop
flexibility to respond to the individual
needs of a student. Service delivery must be
seamless for children, youth, and their
families.
Some regional government office staff
members have a clear vision of a
multi-sector, collaborative, integrated
service model and are already promoting the
need for this framework for Section 20.
Their vision, experience and skills can
provide guidance to work with
representatives of the range of types of
community service provider organizations to
address the policy guidelines required to
ensure the equal access to equitable
educational opportunities through continued
existence of Section 20 Care and Treatment
programs for Ontario’s students requiring
those services. Models of service from other
jurisdictions such as Manitoba can be used
as a basis for excellence in service.
A multi sector, collaborative, integrated
service model may impact Human Resources.
There is the potential that increased
efficiency should provide more service with
existing staffing levels. Involvement of
other organizations in the development of
the integrated policy to provide support
both from a prevention perspective in
schools and also in specialized settings
will provide a forum for articulation of a
policy around the use of multisectoral
teams. It must be recognized that various
groups of unionized employees may resist
staff involvement from other organizations
and be reluctant to utilize the expertise of
other groups.
There is evidence to confirm more integrated
approaches to service will be better able to
address basic literacy needs that prevent
many of these students from progressing and
will promote increased levels of educational
achievement. Increased educational
achievement has been directly related as a
contributing factor to a reduction of
criminal involvement that is born from
failure and the effects of poverty. (?
Hertzman information)
Other Approaches Considered
Maintenance of the status quo where children
are in limbo while the supporting Ministries
decide who has the responsibility to provide
resources for service is not viable as the
need for services continues to grow in the
face of diminishing resources. The current
policy framework that supports Section 20
programming does not offer these students
access to equitable educational
opportunities. Section 20 students lack the
attention of the various Ministries of the
Government of Ontario and their needs are at
risk to be ignored.
The MOE alone does not have the capacity to
address the serious inter-ministerial under
funding of existing programs. The MOHLTC and
the MCSS/MCS continue to respond to funding
needs by indicating they “do not fund
Section 20”. Funds that are dedicated to
Section 20 in MOHLTC and MCSS/MCS
organizations are not specifically allocated
to Section 20 but organizational decisions
determine the allocation to support service
as a priority.
Small changes to the current policy
framework will not result in a workable
approach to providing the services
required. The current policy framework is
inadequate on many fronts. In order to
develop an approach that meets the needs of
the children and youth served, bold steps
will be required such as an integrated
collaborative policy and the development of
a policy requiring a common service plan.
Currently, the policy guidelines are a
detriment to the development of best
practice. If the policy guidelines were to
be strictly enforced this would impact on
the viability of programs.
Financial Implications
The sources of funding for Section 20 in
Ontario are mixed. At the individual
classroom level the MOE contributes funding
to provide a teacher and limited classroom
supports ($2500.00) annually. The funding
spent provincially for Section 20 services
by the MOE is $73.9 million. The MCSS/MCS
and the MOHLTC fund services that support
Section 20 although the services are not
defined as such. These would include MCSS
Child and Family Intervention
Non-Residential Funding and the MOHLTC
outpatient hospital-based programs across
Ontario. The actual portion of funds used by
these services to support Section 20 is
unknown. There is no clarity of where staff
salaries and benefits are being paid from
and there has been no audit to determine
what resources are currently being used by
MCSS/MCS and the appropriateness of those
resources.
There are significant financial implications
when children cannot benefit from education.
The Early Years Study
cites evidence that children who do not
receive the necessary components of care for
early childhood development may have greater
difficulties to overcoming deficits later.
These children will be more likely to
develop learning, behavioural, or emotional
problems later in life including an
increased incidence of juvenile delinquency
and crime for males.
Community care and treatment services
continue to be stretched to provide services
to increasing numbers of children and youth
with complex needs. These services are
defined as discretionary and only provided
to the level of availability according to
the MCSS business plan. This is detrimental
to prevention, early identification, and the
ongoing support needed to reduce the effects
of mental health, emotional and behavioural
problems. The viability of services
provided in the community is threatened by
the lack of adequate funding provided by the
various funding Ministries. Efforts must
focus on building and sustaining capacity
and this requires stable multi-year funding
that allows organizations to have a solid
base on which to establish partnerships,
increase effectiveness and efficiency and to
develop and retain adequately compensated
staff. Without stable funding organizations
cannot develop their capacity to meet
growing and new needs and opportunities.
Legislation
Existing legislation addressing care and
treatment needs and education was developed
when the government directly operated
service in institutions.
·
The Child and Family Services Act
makes provisions for Child Welfare. The
Ministry may choose to support Section 20
Care and Treatment however there is no
legislation to support standards of service
or service guidelines.
·
The Education Act states that every
student with special needs is guaranteed an
educational program to meet those needs. In
reality, Student Focused Funding:
Legislative Grants (ISA Level 4) for service
to students in Section 20 is limited to the
salary and employee benefits of a teacher
and $2500.00 dollars for supplies ($3300.00
for start up supplies) per classroom.
·
The Ontario Safe Schools Act (2000)
sets out standards for behaviour and
specifies the mandatory consequences for
student actions that do not comply with
these standards. The standards represent a
zero tolerance policy for violence in
schools and this has contributed to the
number of students being suspended, expelled
or excluded from the regular classroom
setting due to their behaviour. A result of
the Safe Schools Policy there has been an
increased in the demand for 20 programming.
·
There is no child and youth specific
legislation in the MOHLTC with regard to
mental health treatment services
The current government’s commitment to
education and the new MCS would signal an
opportune time for the development of this
legislation as currently, there is no
provision for community services of this
nature.
Communications
The Provincial Association Working Group
arose out of the work of the Toronto Region
Section 20 Working Group. The work done at
the regional level and in other regions
resulted in parallel issues being
identified. Service providers recognized
that no resolution of these issues could
occur without provincial commitment.
The forum held by the Provincial Working
Group provided an opportunity for
consultation with groups from across
Ontario. The infrastructure has been
developed for further communication with the
field and the Working Group is prepared to
assist with any further consultative
efforts.
Recommendations
Key stakeholders in the provision of Section
20 Care, Treatment, Custody and Correctional
Services recommend the following.
1. The development of new inter-ministerial
Section 20 policy framework that reflects an
integrated continuum of supports and
identifies well defined policies to address
the needs of all children and youth
receiving service. An integrated policy
framework will clarify roles and
responsibilities in the treatment and
support of children and youth.
Rationale: The needs of children and youth
served by Section 20 are multidimensional
and require a multidisciplinary team to
provide a comprehensive continuum of
services and range of supports that are
integrated and accessible in order to offer
students an opportunity to continue their
education. The current guidelines are based
on exclusion of students that cannot be
served in regular classrooms. The new
guidelines should reflect systemic changes
to develop flexibility to meet the needs of
children and youth regardless of their
challenges and should be strength based and
inclusive. By acknowledging the continuum of
supports required by the students,
coordinated services can be established
through interagency collaboration with
policy support to cross silos. Documentation
of shared common service goals that address
the holistic needs of the student may be
done through a plan of care that reflects
the services provided to students on a
continuous service operation basis (24 hours
a day/7 days a week).
2. The new Section 20 policy will align the
work and the funding mechanisms of the
ministries that serve children, youth, and
families and will reflect inter-ministerial
partnering for resources.
Rationale: The solution to funding does not
rest with any one funding mechanism. At
present Ontario offers a patchwork of
programs with no coherent system that can
meet the diverse needs of the students
requiring Section 20 support. Current levels
of funding for supplies and technological
resources are inadequate. Agencies
contribute a variety of resources and
preparation of a new policy will require
identification of these supports and
resources. Efforts must include clarifying
inter-ministerial funding mechanisms and
relationships to ensure initiatives are
aligned to meet needs.
3. The integration of funding, policy, and
legislation to meet student needs should
occur through a policy development table.
Implementation planning at both the
provincial and local levels will specify
targets, milestones, outcomes and funding
accountability.
Rationale: A policy development table should
be used as the mechanism to ensure
appropriate policy, guidelines and planning
support at the local and provincial levels.
This table will identify the range of
resources needed to meet the student needs.
It will promote inter-ministerial policy
development with shared language that
considers planning, funding, evaluation,
epidemiology, economic outcomes and
research. Roles and requirements for
partnerships, funding, and service delivery
can be examined and models of excellence
reviewed to build on what already exists in
Ontario and across other jurisdictions.
4. The Ministry of Education in
collaboration with MOHLTC, MCSS/MCS and
MCSCS will establish a process for setting
provincial standards for Section 20 Care,
Treatment, Custodial and Corrections
Services and for determining the
administration, monitoring, and delivery of
those services ensuring appropriate outcomes
measures are in place.
Rationale: Currently, Section 20 programming
is outside of the Special Education
continuum of services and yet serves those
students with the highest level of need. If
province-wide criteria were established that
were flexible to meet the needs of all
students regardless of their challenges, a
seamless system of service would be
necessary to respond effectively and
efficiently. By integrating students into
the Special Education Continuum and as such
making Section 20 students residents of the
Boards of Education those children and youth
will have access to a broader range of
services and supports and become eligible
for more flexible funding approaches.
Current issues identified in the practice of
offering Section 20 services such as
transitions and transportation could be
dealt with from a more holistic student
focused perspective.
Conclusion
Recent development of Ministry of Children’s
Services provides an opportunity to realize
the needs of students currently served in
Section 20 programming and to ensure the
services required and funding mechanisms are
aligned to provide a responsive, accessible,
high quality service for those students at
risk. Through cooperative implementation of
service at the local level, capacities can
be enhanced through an integrated continuum
of service to serve all Ontario students
including those with the most complex and
challenging needs.
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