STANDING COMMITTEE ON PUBLIC ACCOUNTS
COMITÉ PERMANENT DES COMPTES PUBLICS
Thursday 8 April 2004 Jeudi 8 avril 2004
INTENSIVE EARLY INTERVENTION PROGRAM FOR CHILDREN WITH AUTISM
The committee met at 1006 in committee room 1.
INTENSIVE EARLY INTERVENTION PROGRAM FOR CHILDREN WITH AUTISM
The Acting Chair (Mr John O'Toole): The public accounts committee is now in order. Our first order on the agenda is a notice of motion filed by Ms Martel.
Ms Shelley Martel (Nickel Belt): Mr Chair, I just need some clarification from the clerk. Do you need me to read this motion into the record again? Yes. Let me start with that, then.
I move that as per section 16 of the Audit Act, the public accounts committee direct the Provincial Auditor to fully examine the government's intensive early intervention program for children with autism including, for example:
(1) why there was no increase in the number of children receiving services (516) between June 2002 and December 2003, despite a $4-million increase in the budget for the program over the same period of time;
(2) why the cost per client has increased so dramatically from August 2, 2001, to December 15, 2003, (example: in the SWR, the cost per client was $33,220 on August 2, 2001; $50,000 on June 1, 2002; and $76,850 on December 15, 2003);
(3) why the average cost per child to deliver the IBI program has been estimated to be $55,000 by economists retained by the Ministry of the Attorney General for the Wynberg-Deskin court cases, while the regional range to deliver IBI per child is $65,746 as of December 2003;
and that the Provincial Auditor report to the public accounts committee with his findings and recommendations as soon as possible.
Members, I'm going to try and go through this as quickly as I can. I've given you a package and I'll give you the appropriate references as we move through this.
The motion has been tabled as section 16 of the Audit Act, which permits our committee, by motion, to direct the auditor to do some particular work. I should point out that since 1999 there have been two such references by this committee, one on a motion by myself to have the auditor review the Bruce nuclear lease and the second on a motion that was moved by Ms McLeod for the auditor to review the for-profit cancer clinic at Sunnybrook. So we have done this in the past.
Second, I want to make it clear that I have spent some time raising issues involving autism, and I can be very political about that. I am not using this committee today to do this. When I tabled the motion last week, right after the meeting I contacted the minister's PA and sent her a copy of the motion. I talked to her in the House last Thursday. I gave her a copy of the package that you have today and some additional documents and talked to her again yesterday. So I am not trying to use this committee to do an end run around anyone, but I do hope that once you see the documents and see the concerns I have, you will agree that it would be good to have a more independent and fuller look at this.
I want to make clear that the documents I'm sharing with you come from the Ministry of Community and Social Services. They have been disclosed, along with many thousands of other documents, as part of the disclosure process related to that case.
The particular information I'm going to reference, with the exception of the very last page in the package, comes from notes that were prepared by Mr Michael Nowlan, who is a staff person in Comsoc's management support branch. It was put together by him and was delivered to other Comsoc staff on January 20, 2004, so it is quite recent. The information that is contained in his briefing notes came from information that was gathered from the nine regional offices of Comsoc and involve information relating to those agencies that provide IBI service to clients. They are the service providers who were selected to do so through a competitive bidding process when the program first started.
The last page actually comes from a Comsoc briefing document that is entitled "MCSS Budget and Expenditure Tables," so that document was not included in Michael Nowlan's package but was included in the bigger disclosure package.
Let me just move to the charts. I've got about nine or so points I'm going to try and work through as quickly as I can.
First of all, the first concern that I raise -- why was there was no increase in the number of children funded: If you look on table 1.0 -- that's the very first page of the charts -- at the very bottom it does give a reference to the number of children who are receiving IBI service. There are three points in time: when the program started, essentially 2001; June 1, 2002; and then December 15, 2003. Those are referenced through the documents. If you look at June 2002 to December 15, 2003, the same number of children were served. There was no increase in the number of children who were receiving IBI services, even though an additional $4 million had been allocated to the program.
If you flip to the next chart on the next page, table 1.1, and also the observations at the bottom -- let me make a couple of points. It's at the bottom in the observations section where it's clear there has been an increase of $4 million since June 2002. The reference by Mr Nowlan is, "Since June 2002, funding has increased by approximately $4 million without a corresponding increase in the number of children receiving services."
If you also look on the same tables, there's a second concern I have, and that is that the program started with funding in August of about $16 million and, in August 2001, 424 children were receiving services. By December 15, 2003, 516 children were receiving services, an increase of only 92 children, but the budget for the program by that point had increased by $24 million. The $24 million is more money than the program started with. When the program started, we were already servicing 424. So there's an increase of $24 million and only 92 additional children were served during that period.
If you wouldn't mind flipping to the next chart, which is table 2.0, cost per client, I have some concerns here that I would just highlight for you. Since the inception of the program, the cost per client has increased in all of the nine regions and, in some, quite significantly. I just took the first as an example. The southwest region in table 2.0 shows a cost per client of $33,000 in August, $50,000 in June 2002 and $76,000-plus in December 2003. If you look at all the regions, there is a similar increase every time, and in some areas it's quite significant. I think what's important to note in the observations section -- and again this response is by the Comsoc person who is doing this. It says in the observations section, "The cost per client has continued to increase for all regional offices. The cause of the increased cost per client is not readily identifiable." I think we'd better identify this because it's quite significant.
The second concern in the same table has to do with some really interesting fluctuations which I don't understand the reason for either. For example, if you take a look -- same table, 2.0 -- under the Toronto region, it's second from the bottom in the top chart, you see that the cost per client in August 2001 was $34,000 and change. In June 2002 it was over $120,000, and then if you move to December 15, 2003, it's back down to $74,000. There is no indication what the fluctuation is caused by. It could be quite legitimate, but it's quite an extreme fluctuation, in terms of cost per client. If you look at the central west region, which is the very bottom one, the same type of fluctuation: a dramatic increase in 2002 and then back to $54,000 in 2003.
The third point that I wanted to raise, again with respect to the same chart, is that the economists who have been retained for the Ministry of the Attorney General, which is the ministry that has the lead for the court cases, have been using the figure of a $55,000 cost per case during the whole trial. That is reinforced in the observation section, where the ministry staff clearly say that is the figure that they are using. But if you look in the tables -- table 2.0 -- in seven out of the nine regions, the cost per client is in excess of what the economists are using at the Wynberg case, and in some circumstances in excess of $25,000.
So I guess I don't understand why there is such a discrepancy between what the folks who have been retained by the AG staff are using in court, which is quite legitimate for them to do -- I'm not making an argument about that -- but then why are the costs in seven of the regions so much different, so much higher than what they believe should be the average cost for IBI for a 40-hour week? I think those are the issues that I wanted to raise on that table.
If you wouldn't mind to move to the next one, entitled "Approved Hours of Intensive Behavioural Intervention Regional Analysis," when we first looked at the table, we wondered whether or not the increase in funding actually meant an increase in the number of hours serviced. Perhaps more children weren't serviced during the time period in question, but maybe the children who were receiving service got more hours. In fact, it doesn't look like that's what's happening either. That's why I included this particular table.
If you look at the table -- just take the southwest region, which is the top one, for example -- you see that in August 2001, 59 children were receiving approximately 19.1 hours a week, on average, of IBI service. If you move over to December 15, 2003, there are actually fewer children -- 54 -- but they are still receiving 19 hours of service a week.
If you go to the second example, the east region: in August 2001, 33 children receiving about 23.6 hours of IBI a week, on average. Look at December 15: 37 children -- four more -- but receiving fewer hours of service, on average; 23.1. That appears to be the same across the regions.
So we can't say, I think, that what happened during the period is, in fact, more kids received more service, and that explains the increase. In fact, in a number of regions, fewer children were receiving service, and the service they were receiving was the same average number of hours as two years before. So I'm looking for an explanation of how $4 million didn't serve any additional children. It doesn't look like it meant that the existing 516 kids got more hours. That didn't happen either. Again, I have no explanation, but I would like to have an explanation of what those increases were attributed to.
If I can move to your final slide, this was a different document. This came from a document that was entitled MCSS Budget and Expenditure Tables. It's "Table A: Budgets, Expenditures and Percentage Increases for Autism Strategy."
A couple of concerns here -- and I'm only going to deal with the very first item under the column "Program/Year." You will see a column that's entitled "Intensive early intervention program." Then you see the budget for a number of fiscal years and the actual expenditures for those fiscal years.
In the first year of the program, $16 million was budgeted for this program. The actual expenditure was $15,400,000; so $600,000 was not spent.
In 2001-02, a budgeted program of $36 million, and $30.9 million was actually spent. So about $6 million was left unspent.
Then in fiscal 2002-03, an estimated $40.3-million program; $36.7 million was actually spent. So about $3.6 million was left unspent.
We don't have the actuals for the most recent fiscal year, which just ended. The program was budgeted to spend $46.5 million. As I said, TBD; we don't know what the final figure is for that.
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I raise my concern on this issue. I don't understand why the regional offices were sending money back to the centre. This program has a waiting list of 1,100 kids right now who are waiting for service, but in every fiscal year so far, it appears that money came back to the centre and those kids sat on a waiting list. With this government announcing an additional $10 million for IBI, I don't want to see that happen again, I really don't. I don't think anybody in the room does.
There are a couple of other concerns that I have. I don't have slides for them, so let me just go through this quickly.
The Chair (Mr Norman Sterling): The problem here, Shelley, is you're presenting the evidence and you're drawing conclusions. Some of them I can't add up. In your August 2 to December 15, you're saying that there wasn't any increase in services, and I see on your chart that there was an increase in services. You went from 9,510 hours to 11,872 hours. There were more kids receiving --
Mr Jeff Leal (Peterborough): Mr Chairman, what chart are you looking at?
The Chair: I'm on the second-last chart. I don't mind your pointing out this stuff, but the average hours per kid went up from 22.43 to 23.01. So your allegations don't match what the charts are saying.
Ms Martel: Mr Chair, if I go back to the chart and look at the average number of approved hours -- just use the first two regions -- essentially there was no difference in the average number of hours that were approved per child. If you look at --
The Chair: No, but you take the average across the province and it went up. You take the total number of approved hours and it went up significantly. It went up by about 15% between August 2, 2001, and December 15, 2003. I don't know.
Ms Martel: Let me point out that there were an additional --
The Chair: I'm as anxious as you to get to the bottom of any kind of discrepancies that might be, but I don't think we should go off on a -- if we're going to ask the auditor to look at this, let's give him what we have and let him draw the conclusions.
Ms Martel: Mr Chair, I don't think I said that there was no increase in service hours; I said there wasn't a significant increase in service hours. I think if you look at the averages through the regions, even the first two that I referenced, in the second case the average went down. So in some regions it did go up, even if you look overall at the whole program.
From the period August 2, 2001, to December 15, 2003, an investment of $24 million appears to have resulted in an increase of only about 2,000 approved hours per week, which is even less than what we started with when the program started. We're doing better in the first year that the program started than we appear to have done in the period from August 2, 2001, to 2003.
The Chair: I think the numbers require the auditor to look into it, but they are confusing. As you know, there was a dearth of people that we could get to do this program. There were a lot of people who were switching from public to private, because they could make more money doing that. I had people in my constituency office who did that. So there's a whole number of factors associated with it. That's why I think some of the regional areas couldn't spend the money: they couldn't find the therapists to do the program.
That's what I think we should have the auditor do rather than reach the conclusions. The evidence you present supports your case for having the auditor look into it. I just hesitated drawing conclusions on the documentation that we have. Anyway, go ahead.
Liz, did you have a --
Mrs Liz Sandals (Guelph-Wellington): No, I was just going to ask that you put me on the speaking list.
The Chair: Okay, fine.
Ms Martel: A couple more points. One of the arguments that I make is that the auditor should look at the difference between the direct service delivery, which has been done through service providers, and the direct funding model, whereby the ministry does provide funds to parents so they can go and hire their own therapists. I just want to make it clear that these numbers do include both categories. We're not just talking here about service providers directly delivering the program. This included the funding for both categories of parents. There is a very legitimate concern about which one of those two options works better, works well and might be more effective. I'm hoping the auditor can take a look at both of those delivery agents and make some recommendations back to us about that.
Secondly, one of the concerns I had was that in some of the regions, there appears to be a single service provider that the ministry flows money to, and that single service provider provides IBI directly. In other areas, it appears that there seems to be a middle organization that deals with the administration and then contracts out the service delivery to four or five other agencies. I'm not sure how cost-effective that second strategy is and whether or not we may be paying money for a duplication of services that otherwise would not be there if we just contracted directly to the service providers.
I'm not saying I know what that model should be. I'm just saying that I hope the auditor will look at the situation where you seem to have a middle-man organization that's not doing the direct service delivery and whether or not savings could be achieved by working directly with those service providers who are actually delivering IBI treatment.
The other concern that I had, and there's not a slide with respect to this, but we do have cases of children who, when they started the program, were guaranteed to have a certain number of approved hours of IBI service per week. For example, Jordan Boufford, who was here with his parents on Monday, began IBI treatment in November, 2001. The contract that his parents signed with the service provider said he would receive 25 hours of IBI service a week. By July 2003, he had been shortchanged over 500 hours of treatment. This was treatment that was cancelled by the service provider, not because he was sick, but because the service provider, for whatever reason, could not provide the service. That's one case.
We have another case in Hamilton, where over 800 hours were lost, which should have been provided as part of the contract. The parents have been trying to get those hours given past the age of six and have not had any luck in that.
My question is, if those kinds of hours were not being provided, where did the money go? There continued to be quite an increase in costs per client, but for those two examples at least, very significant service actually wasn't delivered. So I'd like to have a bit of a look at that.
I just want to see if I have any other points. I didn't include it in the package, but we do have a copy of an audit that was already undertaken of one service provider at the instigation of the ministry, but done by a firm outside of the ministry. It was done in the fall of 2003. I think the auditor should take a look at that particular audit and the conclusions that were drawn, to see if the recommendations are being followed up and if there were any other things that should change with that particular service provider.
In conclusion, I've tried to give you what I have in terms of documentation and give you some reasons why I hope we can have a fuller investigation. What I'd really like to see -- there's a lot of money going into this program and I think we all want to see the maximum number of children being served and the program developed in a way that's going to provide the best, most cost-effective delivery as well.
I'll stop there. If there are questions, I'll try to deal with them.
The Chair: I have Ms Sandals, Ms Matthews and Ms Broten.
Mrs Sandals: We would actually share Ms Martel's concern with these numbers. I thank her for bringing these forward. We would want to see the auditor have a look at them because I think the numbers are quite alarming.
I've personally always had a concern because I've been involved with this from the school board's point of view. We're talking about a service here that requires basically two weeks of training for the therapist. How does two weeks of training translate into costs that are $50,000 per year or $70,000 per year to provide a service? It just doesn't really make any sort of sense.
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I have heard concerns about duplication from parents in my own office, parents who talk about having been assessed by a local person who is qualified to do the assessment. They are assessed as being autistic and having a type of autism where the child would benefit from IBI therapy -- not all autistic children do benefit from IBI, but these children have been assessed as having a category of autism where the child would benefit from IBI -- and then they have to go off to the centralized service for the region and get in a waiting line to be reassessed before they can actually get in the waiting line to access the service. So what one is doing is duplicating the assessment, which is part of the problem, I think, in some of these overhead costs that we may be seeing.
In terms of the discrepancy that appears to be there in item number 3, I have no idea what that is, and certainly the auditor can look at that. One thing you might want to look at, though -- I've had this argument a whole lot of times with the Ministry of Education about whether when one is doing provincial averages one does a weighted average of the actual service or whether one takes the regional average and then averages the averages, which often gives you a very different result. You've obviously run into it too, Auditor, given the head-nodding that's going on. Depending on whether you do a true weighted average or an average of averages, you get quite a different result, so that may be partly where that discrepancy lies, but I leave it in your hands to figure it out.
Certainly when you look at the number of hours that are being provided, at a very high cost per child -- I mean, I'm just blown away by that Toronto result of $120,000 per year. Whether there's something weird with the bookkeeping there, that just doesn't seem to make any sense at all. Clearly whatever was going on there in a couple of regions, people have reined it in, because it's gone down again the next year.
There are clearly some problems here, and we would want to get to the bottom of them too. I think some of the problems that appear to be highlighted in these data are precisely the reason we've been looking at a redesign of the whole program, because there are clearly some problems in the way the program has been delivered currently. Given the amount of money that's being spent, there are clearly some problems in terms of the number of children who are actually being serviced. I think we all want to find a way that we can get more service to more kids in a more cost-effective way.
Quite frankly, that's why I think the minister has said, "Forget what's going on there. Let's start looking at how we can redesign the whole service delivery model," because clearly there are things we need to look at in the current service delivery model to figure out how we can do this more cost-effectively than what is happening right now so that we actually get the service to the kids. We would certainly support having the auditor try to get to the root of this, because there are obviously some problems with the way the money has been spent.
Ms Deborah Matthews (London North Centre): I have a question and then I have a comment.
My question is this: I notice that the three months we're comparing are August, June and December. I just wonder, are there seasonal fluctuations that would explain some of this? Why would those three different months be chosen for comparison?
Ms Martel: I have no idea. The ministry documentation didn't give much of an example either. It just says, "In December 2003, the management support branch completed a regional analysis of information pertaining to the ... program." It doesn't say why those particular months were chosen.
Ms Matthews: Thank you. My comment -- I'm not going to spend a lot of time, but I am going to say that, I think like every member, we have had visits from parents. I've had several parents come see me. This clearly is an issue where the waiting lists are simply too long and there are too many kids who aren't getting what they need. If the auditor could bring to light some savings, that would be a big step forward, so I certainly will support this.
Mr John O'Toole (Durham): I'm also very supportive and very interested, having served on special ed committees, both locally and provincially, when I was a trustee. I am very familiar, like each of us, with many constituents who draw real cases to our attention. In many cases, there are very capable parents involved, both from the point of view of advocacy, as well as intervention in their own right. I'm wondering if we could present to the auditor, not just auditing the status quo delivery model, but looking at whether there are other jurisdictional areas with successful outcomes in other delivery models. The train-the-trainer model, I think, is extremely important. In an ongoing sense, the parents need to have skills anyway. If they get 20 or 24 hours, they still need to know how to supplement that. I think it's very important that the resources are put in the home somehow.
It really gets down to my second part, really an observation more than a question. When we looked at individuals with special needs, often many parents in an organization with assisted living kind of questions don't want to fight their organization, but they want direct funding themselves. They want some role in making sure that the appropriate service is being delivered. The service provider is usually some agency, or through some organization, and they seem to get in the middle of what the appropriate treatment or course of support is.
I would wonder what Ms Martel's position is on a direct funding model, where there are assessments done and the criteria have been met, and these are the supports that should be provided, whether it's speech and language, whatever kind of thing it is, including IBI. There may be a whole raft there. They're not all the same. Some of it is speech, some are non-verbal, some are verbal, some are physically active and some aren't. To think that one therapy is going to solve all this is absolutely wrong, I think. I'm just wondering about the parent's role following up on the assessment. Now, they would not get the money directly, obviously. It would have to flow through somebody.
But they would have to sign. I get the same questions, Shelley, about the therapist that didn't show up. I get a lot of that. They are fighting to get the extra 10 hours, and they're spending all that unnecessary energy. The service recipient should have to sign something -- that they got it -- and then the money is released.
Those are just some observations. I think there are other methods for each individual case of providing appropriate services, with the parent having a very significant role where that seems to be a signed-off agreement. There could be other situations where there isn't the full support of the family.
Ms Laurel C. Broten (Etobicoke-Lakeshore): Obviously, this file is an important issue to the minister herself. She spent a lot of time on it. With a commitment to invest even more funds, I think the role of the auditor is an important one and the role of this committee is to make sure that we get the best value we can for the funds that we put in place and, as my colleagues have said, get the most help to the most kids out there.
We're in a bit of a difficult situation. Unlike some of my colleagues, I wouldn't consider myself an expert, not having ever seen these documents before today and knowing that they come out of the context of litigation. Obviously, it's not appropriate for us to comment in one way or another that might guide the context of the litigation or look like we're trying to influence it. But at its heart, the basic concept of finding out how the money is being spent, asking the auditor to do that, making sure that we get the best value we can, is something that I support, certainly, and I know a lot of my colleagues do.
Moving forward on some more innovative strategies to get even better value for the dollar to help the most kids is, I think, also important. I know, like all of us, I've spent a lot of time with the families in my community, many of whom I know Ms Martel knows well, working with them and helping them get what they need for their kids. It's a priority for all of us. We want to make sure the new funding that we're going to put in place is well spent. We don't want it to be wasted. We don't want it to go to therapists who aren't trained, and we don't want it to go to therapists who don't show up. So we support the work you've done in this area to bring this to light and want to ask the auditor to help us make sure we get the best value. That's what those families need from us.
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Mr Leal: Just a quick question to Shelley. In the case you mentioned, the parents were provided funding and then the therapist -- could you go over that again? I didn't make my notes quickly enough, and I think it's an interesting example.
Ms Martel: It turns on Mr O'Toole's point about the two options that are in the program, one a direct funding option and the second a direct service option. Under the direct service option, a service provider, with their staff, provides the IBI to the child. The parents sign a contract at the point that they are approved for the program, and the contract outlines how many hours of service per week will be provided, the parental obligations etc.
This was a direct service issue. I believe he started in November 2001, and the parents were told that Jordan would get 25 hours per week. By July 2003, he had lost over 500 hours of service that contractually should have been delivered. Now, if you lose an hour because your child is sick and you have to cancel, that's your problem. I'm not making an argument in that case. That happens. However, if you are losing your hours because your service provider is having trouble getting your therapist there for whatever reason, then I don't think that's the parents' problem any more. In this case, within about an 18-month period -- closer to two years -- 500 hours that should have been provided were not. The parents assure me, because they documented those hours, that it had nothing to do, from their side, with their son not being able to participate in therapy; it was a problem through the service provider.
The case we have in Hamilton is 800 hours, and that is not uncommon. But those hours are lost. I don't know the reason behind that, why you could have so many hours lost in an organization.
Those are the two examples that I'm hoping the auditor can look at, how that works and how well it is or isn't working.
It speaks to Mr O'Toole's question about what method I prefer. It's hard to tell, because both have some pros and cons. For example, the direct service option is attractive to many parents. They sit on a waiting list hoping to get that option because 100% of their costs are covered. The therapist's costs are covered; the psychological assessments are covered. If you're getting direct service via a contract through a service provider, everything is covered.
The second option, the direct funding, is where you as a parent get funding for your IBI therapist, but in all of those cases the parents are paying costs out of their pocket. They have to pay for the psychological assessments. There are additional costs that are not covered for them through that model. It gives them more flexibility, and I can tell you that every parent who has direct funding can find a therapist. There's not a problem of not finding therapists. But the dilemma then becomes, for many of those parents, that they are paying additional costs out of their pockets and they can't afford it.
So there are pros and cons to both. What I'm hoping is that the auditor can look at, if you're going to keep both options in place, how you can make them more effective. How can you deal with the problem of losing so many contracted hours, and how can you get those hours back if indeed they were supposed to be delivered?
If you're going to continue with the direct funding model, how can you cover more of the costs so the parents aren't trying to fund IBI out of their own pocket, in addition to the funding they're already getting from the government? What they end up doing is keeping track of the hours and submitting that to the ministry, and they get the money to fund their provider. But all of them pay out of their pockets for costs that are not covered.
Mr Leal: Could I get a copy of that information from you, if that's possible?
Ms Martel: Sure.
Mr Leal: I'd appreciate it.
I support this. I think it's crucially important for the auditor to review this. My wife is an elementary school teacher in Peterborough and has autistic children in her school.
A very important question here: Coming from a municipal background, we used to always have the debate, in terms of providing services to residents of Peterborough, about whether we provided the direct service model or contracted out to a third party to deliver those kinds of services. The city of Peterborough auditors would always review those aspects: the direct service model or a third party.
In light of the information provided by Ms Martel, certainly something I'll be looking for is the efficiencies of looking at those two service models. When you employ certain financial resources, you're expecting some outcomes from that. I think this exercise will shed a great deal of light on those two issues, which I think are crucially important.
Mr O'Toole: I think it's worthwhile. It's educational for us and perhaps instructive to the auditor, but I've really come to the conclusion over the last four or five years, working with this specifically, that the key thing here is consistency in the assessments and treatments. The two models don't provide the same consistency. That's one of the problems I see. Parents may be happy but the progress may not be improved. They're happy to get the support, however satisfactory the changes or improved outcomes are.
I think, as Mr Leal suggested, we should be trying to assess the outcomes for both the direct funding and the direct service model -- I really do. I support the idea of uniformity in assessments.
Some parents don't realize that the child isn't progressing. They may be getting service, and they're frustrated, but there's no assessment. They can't afford for the psychologist to come in and do the follow-up, to say the treatment is achieving the outcomes that are essential. They're just happy to get somebody to take care of the child, technically, and interact with them. I'm serious. I've talked to them. One is a very nice couple. He's a very well educated minister and his wife is a nurse with a master's degree. They're very capable people and they'd be happy to get the direct funding model, but the problem is the assessments. They can't afford the five grand. The assessments cost a fortune. They're really quite expensive.
Anyway, I think we may spend some time on that. The auditor is going to compare -- you shouldn't look at one model and say, "This is how to improve it: give them more money."
The Chair: As a former Attorney General, I understand, with regard to the autism case, that Ontario's funding of this program is probably the most generous in the world in terms of dealing with it. I think we should try to make sure that those funds -- that generosity which has been shown in the past and continues to be shown by the present government -- are spent in the right places. We want to help these kids as best we can.
Are we ready to call the question?
Mr O'Toole: I have one other question, if I may, with your indulgence. This is more of an observation, and Mrs Sandals may understand this one. When the children's treatment centres go to provide services in a school, it's problematic. I don't want to make this a political issue, but they can provide instruction and advice and do assessments in the hallway or some special ed room, but they actually can't provide the service in the classroom or in the teaching setting. It's a problem. They get money allocated and they can't provide the services to the children in schools. Mrs Sandals, are you familiar with that problem?
Mrs Sandals: Yes.
Mr O'Toole: It's a huge deal.
The Chair: Mrs Sandals, did you want to --
Mrs Sandals: Actually, I was going to comment on a couple of the issues that Mr O'Toole raised, if I can.
The Chair: OK. I think we're going to send this to the auditor. I think there's unanimity.
Mrs Sandals: Yes, I agree. I just wanted to briefly respond, if I may, to a couple of the issues he raised.
The Chair: Sure.
Mrs Sandals: One was talking about the train-the-trainer model. In fact, that is in the announcement the minister made and it ties into his last comment around wanting IBI services directly in the classroom. What will happen is that there will be training of teachers, spec ed, EAs, spec ed consultants to deliver a range of ABA therapies and then those can be used directly by EAs and teachers in the classroom, as opposed to this conflict between the IBI therapists and the -- so that is part of the model.
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The other concern we would share is the whole business around tracking the effectiveness of the therapy. At what point is this very expensive therapy actually achieving results? That's part of the issue around having a research chair actually looking at tracking the different therapies and what therapies are actually effective for which kid.
I would share both of the concerns that you raised. In fact, those are concerns that we're trying to address.
The Chair: The last thing I would throw out to the committee is, as you know, there's litigation going on at the present time. We don't really want to affect either party in this litigation. Would the committee like me to write to the Attorney General and ask him for his advice with regard to our deliberations and what we produce in this, or do you want to just let him intervene as he sees fit?
Mr Peter Kormos (Niagara Centre): I'm vaguely familiar with the litigation, by osmosis. Obviously, the issues being litigated are far removed from the matter of cost-effectiveness. The issues being litigated are in two forums: one in the Human Rights Commission, in terms of the allegation of discrimination; and, in the civil litigation, a basic fundamental right to access to treatment.
I appreciate what you're saying, but I think there's a sufficiently clear delineation between what's being litigated and what's being proposed here. I don't think anybody here could entertain the prospect of a risk of trampling or in any way encroaching on the matters being litigated in those two forums. I appreciate your cautiousness, but there's some element of letting the auditor get going and proceeding with this. The Attorney General is in a peculiar position then, quite frankly.
Also, you know full well that the precedent surrounding committees is that the committee controls its own process. I think it's important for the committee to utilize that prerogative, that right, and not surrender it. The committee controls its own process. The Speaker doesn't even control the committee. The precedent is clear. I appreciate what you're saying, but with respect to the members of the committee and to you, I think it's risky.
It's one thing to ask the Attorney General to participate in the probe that's being requested of the auditor, but it's another thing to ask for the Attorney General to guide the committee when I don't think there's any suggestion or any appearance or any -- what do they say Ms Broten? Prima facie? Is that the right word? It's a Latin word, I think -- any prima facie overlapping of what the committee seeks to do and what's being litigated in those two forums.
The Chair: I guess my concern was once we table the report, it becomes a public document and then it could become part of the case. I just don't know what the timing of the case is. It might have an impact on the outcome on the case, as you gather conclusions and you gather research and those kinds of things. I'm just asking for advice, that's all.
Mr O'Toole: On the legal status, it's my impression that the issue here at the moment is in some arenas a human rights case. But really, the ultimate test here is the test that was brought to the court in BC, which really defined it as medically necessary. If or when that gets established, that's technically when the discrimination -- who is provided or not provided.
I think we're a little ahead on the issue technically, in terms of the province providing a service. Even the status of IBI and ABA are not universally validated as the appropriate therapy for each child. There's some discussion about that.
Ms Broten: Certainly the work undertaken by this committee and the auditor is important work and that work needs to continue regardless of litigation ongoing. I'm comfortable that the auditor, working with the Attorney General to get the information from the ministry, conducting a value-for-money audit and examining the issues that we've raised that relate to the work that is undertaken by the auditor -- that can be managed and can go forward.
In the room today, we've had discussions that I think, frankly, go beyond the role of the auditor to examine some of the things. I see the auditor nodding and agreeing. We get into that in this committee because we want to talk about policy and we want to talk about government direction. I know the auditor won't examine that direction, and that is possibly where some more areas of concern could have arisen.
So, if we're doing a value-for-money audit and we're looking at this information coming back to the committee with the information that Ms Martel's motion raised, I think we have a comfort level there. Examining all the extraneous measures that the minister is putting in place and where we might go in the future is separate and apart.
The Chair: OK, let's call the question, then. All those in favour? Carried.
The next matter of consideration for the committee will be the consideration of the draft report of the Family Responsibility Office in closed session.
The committee continued in closed session at 1056.
CONTENTS
Thursday 8 April 2004
Intensive early intervention program for children with autism P-237
STANDING COMMITTEE ON PUBLIC ACCOUNTS
Chair / Président
Mr Norman W. Sterling (Lanark-Carleton PC)
Vice-Chair / Vice-Présidente
Mrs Julia Munro (York North / -Nord PC)
Ms Laurel C. Broten (Etobicoke-Lakeshore L)
Mr Jim Flaherty (Whitby-Ajax PC)
Mr Peter Fonseca (Mississauga East / -Est L)
Ms Shelley Martel (Nickel Belt ND)
Mr Bill Mauro (Thunder Bay-Atikokan L)
Mrs Julia Munro (York North / -Nord PC)
Mrs Liz Sandals (Guelph-Wellington L)
Ms Monique M. Smith (Nipissing L)
Mr Norman W. Sterling (Lanark-Carleton PC)
Mr David Zimmer (Willowdale L)
Substitutions / Membres remplaçants
Mr Jeff Leal (Peterborough L)
Ms Deborah Matthews (London North Centre / London-Centre-Nord L)
Mr Richard Patten (Ottawa Centre / -Centre L)
Mr John O'Toole (Durham PC)
Also taking part / Autres participants et participantes
Mr Peter Kormos (Niagara Centre / -Centre ND)
Clerk / Greffière
Ms Anne Stokes
Staff / Personnel
Mr Ray McLellan, research officer,
Research and Information Services