Special Services at Home Program Guidelines - Ministry of Community and Social Services - Ministry Of Children ...
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Special Services at Home
Program Guidelines
Ministry of Community and Social Services
April 2018Table of Contents OVERVIEW OF PROGRAM 4 INTENT OF SSAH FUNDING 5 PERSONAL DEVELOPMENT AND GROWTH 5 FAMILY RELIEF AND SUPPORT 6 ELIGIBILITY 6 APPLICATION PROCESS 7 APPLICATION FORM 7 ACKNOWLEDGEMENT 7 ELIGIBILITY REVIEW AND SUPPORTS 7 COMMUNICATION 8 REVIEW PROCESS 8 FIRST LEVEL REVIEW 8 SECOND LEVEL REVIEW 9 ELIGIBLE AND INELIGIBLE SUPPORTS 10 ELIGIBLE SUPPORTS 10 INELIGIBLE SUPPORTS 10 OTHER SUPPORT CONSIDERATIONS 11 SUPPORTS NOT FUNDED 12 DECISION MAKING 14 ADMINISTRATION OF FUNDING 14 ACCOUNTABILITY 17 TRANSITION PLANNING INTO ADULT SERVICES SECTORS 18 APPENDIX A 19 GLOSSARY 24
OVERVIEW • Provide respite support to the family - families
can receive funding to pay for services that
The Special Services at Home (SSAH) program
will give them a break, or respite, from the
helps families who are caring for a child with
day-to-day care of their child.
a developmental and/or physical disability.
It is funded and managed by the Ministry of The purpose of the SSAH Guidelines is to
Community and Social Services. support consistent program delivery and
decision-making. The guidelines are intended
The goal of the SSAH program is to support the
to be a single source document that describes
government’s vision of:
all elements of the SSAH program, including
• Strengthening the ability of children and the application process, eligibility and decision-
their families to reach their potential; making factors, review processes and
• Reducing the need for intensive or accountability mechanisms.
intrusive social services in the future; and The Ministry of Community and Social
• Reinforcing personal dignity and Services supports the following service
independence. principles, which are reflected in these
The SSAH program is based on the guidelines:
understanding that family members are • Integration – community participation.
often primary caregivers for children with a • Independence – supports that encourage
developmental and/or physical disability. The greater independence.
program focuses on providing funds to assist
• Personalization – supports that take into
families to purchase supports not available
consideration personal capabilities and
elsewhere in the community.
enhance choice and self-direction.
Funding provided through SSAH helps families
• Quality of life – persons who are valued
pay for special services in or outside the family
for who they are and the role they can
home as long as the child is not receiving
play in the community.
support from a residential program. For
example, through SSAH funding a family can
hire someone to:
• Help their child learn new skills and abilities,
such as improving their communication skills
and becoming more independent; and/or
4INTENT OF SSAH FUNDING 1. PERSONAL DEVELOPMENT
AND GROWTH
SSAH funding is intended to help children
with physical and/or developmental disabilities The purpose of support in this area is to help
participate in their communities and to make use children learn and develop by achieving specific
of services available in their communities. SSAH goals in acquiring new skills. While family
does not duplicate existing services and is one members benefit indirectly from the assistance
of a range of community support services. and skills learned, the overall goal is to enable
children with disabilities to expand on current
Children with disabilities and their families
skills and/or acquire new skills. A broad range
identify a broad variety of needs. SSAH
of goals may be addressed including:
provides funding to assist with purchasing
necessary supports that cannot be met by • Activities of daily living
a service available elsewhere in the local • Behaviour programs
community in the following two areas: • Mobility
1. Personal development and growth • Communication
and/or
• Social skills
2. Family relief and support (RESPITE)
• Developmental programs
A special services worker provides respite to
Funding may be available for families to obtain
the family and direct assistance to the child
the services of a person to carry out the
with the disability to:
necessary programs to support the child
• Continue with established programming with a disability.
and routines,
The family develops a personal plan for the
• Receive appropriate care, guidance and child with the disability on their own or in
personal safety, conjunction with their community team.
• Participate in community life and In specialized areas of programming such as
learning, programs dealing with sign language or self-
• Address specific personal development injurious behaviour, goals and delivery plans
and growth needs, must be well defined and fit within the context
• Focus on a goal (expected outcome) of the total personal plan. A professional may
within a projected time frame, be involved, via the MEDIATOR MODEL, in
identifying goals, intervention techniques and
• Follow a plan for delivery of
activities, initial training of those providing
programming, and
direct service, and ongoing monitoring of the
• Periodically review progress and adapt designed program.
goals and plans accordingly.
5Services and supports may be provided at a Nursing respite may be provided by a person
variety of locations depending on the goals with qualifications, including:
established and on the needs of the family and • holding a certificate of registration as a
the child with the disability. These supports may registered nurse or registered practical
be provided at home, in community settings nurse
such as stores or parks, in vehicles while in
• fulfilling the requirements as outlined
transit, or at community recreational programs.
in the regulations under the Nursing
2. FAMILY RELIEF AND SUPPORT Act, 1991, if indicated by a professional
(Respite) assessment of the need, and
Families may have additional responsibilities • if all alternative resources, including
in caring for a child with a disability. SSAH Local Health Integration Network (LHIN)
provides funding for respite or PRIMARY Home and Community Care, (formerly
CAREGIVER relief and related supports. While CCAC) have been exhausted.
the child with a disability will likely benefit from
such support, the primary goal is to help the ELIGIBILITY
family to meet their identified needs.
Eligibility for SSAH is determined by
Respite enhances the PRIMARY CAREGIVER’S confirmation of a developmental and/or physical
capacity to provide care for the family member disability as documented by a physician,
with a disability living at home through the psychologist/psychological associate, or in the
provision of INDIRECT ASSISTANCE. Indirect case of hearing and/or visual impairment, an
Assistance can help provide relief to the primary audiologist or ophthalmologist, and the child:
caregiver so that they may take some time
• Is a resident of Ontario;
away from care-giving, or from one or more of
• Is under the age of 18;
their other responsibilities.
• Has ONGOING FUNCTIONAL
As part of family relief and support,
LIMITATIONS as a result of a disability
consideration may be given to supporting those
activities commonly associated with running • Requires support beyond that which is
a home, such as housecleaning, laundry, typically provided by FAMILIES; and
grass cutting, child-minding for siblings, meal • Is living at home with their family or is
preparation, etc. It is expected that the family living outside the family home and not
member works directly with the child requiring receiving residential staff support from a
support during the time for which indirect government-funded source (e.g. transfer
assistance is purchased. payment agency) or an OUTSIDE PAID
RESOURCE (OPR).
6In the majority of situations, basic eligibility is The completed application becomes the child’s
established only once – at the time of the first detailed service plan for SSAH funding.
application – with the following exceptions: The application form is divided into eight areas:
1. Where the functional limitations may change Section One: Family Caregiver
over time due to the type of disability, the
Section Two: Individual and Family Update
child’s age, situation, needs and skills.
Section Three: Requests for Service
2. Where an INFANT has been funded before a
definitive diagnosis is established. Section Four: Description of Strengths and
Interests, support provided
See Appendix A for detailed information
pertaining to each eligibility criteria. Section Five: Your Family Situation
Section Six: Support Networks that are
APPLICATION PROCESS Available to You
Section Seven: Paid Services and Supports
Each situation has a unique set of
circumstances. The family should describe Section Eight: Signatures
their own needs, establish their own goals and All new applicants must submit an application
define areas where support is required on the form, ensuring all sections have been
application. completed. An incomplete application form will
While families may receive help from a be returned to the family for follow up.
community agency or any other person to fill If and when there is a change in circumstances
out the form, it is the family who develops and or personal information, it is the responsibility of
controls the detailed service plan. Agencies the family to inform regional offices as soon as
and applicants should be aware that signing a possible to update their file.
blank application form (or any other document
pertaining to SSAH) is not acceptable. Signed STEP 2 – ACKNOWLEDGEMENT
blank application forms and documents will Families will receive a letter of
be disallowed and new documents will be acknowledgement when a completed
required. application form is received.
STEP 1 - THE APPLICATION FORM STEP 3 - ELIGIBILITY REVIEW and
The application form provides children and SUPPORTS
their families with an opportunity to outline The application is reviewed to determine
their current situation, state their strengths, eligibility and identify supports required.
needs, current services, goals, and requests.
7STEP 4 – COMMUNICATION A family will:
Families will receive written correspondence • Be provided with a copy of these
when: Guidelines and asked to provide
• A request has been approved with detailed evidence about how/why they believe the
information about next steps Guidelines have not been appropriately
applied to their own situation.
• A request has not been approved; the family
will be informed of their right to ask for a • Be invited to provide additional
review of the decision. supporting information.
• Have the opportunity for a meeting with
the Ministry of Community and Social
THE REVIEW PROCESS Services’ Regional Office Director or
When an application for SSAH has not been designate.
approved and a family feels they have not been
Upon receipt of a request for review, the
treated fairly in the decision-making process
Director or designate will select a person not
in accordance with the SSAH Guidelines, they
involved in the original decision to review the
may request a review.
situation and make a recommendation.
There are two levels in the review process, each
The Director or designate will respond to the
focusing on whether the decision made at the
request, in writing, within 20 working days of
previous level was fair and equitable.
the receipt of the request for review and/or
additional documentation. The response will:
FIRST LEVEL • Outline the reasons for the decision
A family may initiate a review by writing to the including evidence to support that their
Director or designate within 20 working days decision reflected the intent of the SSAH
of receiving the decision letter. A family can program as outlined in these Guidelines.
request this review on their own or with the help
• Demonstrate that the child’s application
of an advocate. If an advocate is involved, the
was treated fairly and equitably and
family must co-sign the letter requesting the
that the child/family, new or otherwise,
review.
was given fair consideration for the
available funds.
• Provide a description of the next step in
the review process.
8SECOND LEVEL • Provide recommendations to the ADM.
The review will focus on whether the
If, after receiving the decision from the Ministry
decision was made fairly at the first level
of Community and Social Services’ regional
of the review and, in particular, assess
office, the family continues to feel they were
whether:
not treated fairly according to these Guidelines,
they can request a review at a second level. • Decision-making reflected the content and
intent of these Guidelines which inform and
Within 20 business days of receiving the
guide SSAH program delivery.
decision of the first level review from the
regional office, the family can write to the • A personalized approach was taken, based
Assistant Deputy Minister (ADM), Community on the uniqueness of the situation of each
and Developmental Services Division to start applicant.
this review. If the ADM overrides a decision of a regional
The ADM will have access to all of the office, the region will determine a fair and
information and documentation prepared equitable funding approval.
for the first level of review. The ADM’s office The ADM will respond in writing within 20 days
will designate a person not involved with the of receiving the request for a review and/or
original decision to: additional information.
• Review the steps taken at the regional A decision made by the ADM is final.
level to determine whether the review Restrictions Relating to the Review
process at the first level was followed. Process:
• Collect information from the family to The review process is not intended to:
determine their understanding about
• Change or alter the current guidelines.
the process and any concerns they have
regarding the fairness of the decision • Be a mechanism that will lead to an
made at the first level. increase in the resources available to
this program.
• R
eview the information provided by the
regional office.
• Review information available from other
sources (e.g. local service providers
involved with the family).
9ELIGIBLE AND INELIGIBLE 8. 1
:1 support worker at camp or recreational
program
SUPPORTS 9. T
raining for a family member or worker that
Funds will be approved based on Ministry enhances the understanding of the child
service principles (as referenced on page 3) and with a disability’s needs
on the following factors specific to SSAH:
10. E
xtraordinary cost of childcare (for children
• Support needs as expressed by the child with aged 12 and above)
a disability and/or the family.
11. Nursing for medically fragile children
• Family’s needs in order to deal with stress and
12. R
outine homemaking tasks – light
enhance their ability to cope.
housecleaning, meal preparation, laundry,
• Complexity of the supports required. grass cutting, and snow removal
• Appropriate supports and services currently 13. G
ym membership fees for the special
available in the community. needs child
• Support networks of the child with the 14. D
aycare/nursery school as respite or if
disability. recommended for socialization
• Availability of funds.
Ineligible Supports
Eligible Supports 1. Tutoring and academic programs
1. Mainstream camp/recreation programs 2. Camp fees for siblings
2. Specialized camp/recreation programs 3. B
asic care (i.e. clothing, food, diapers,
3. A
dvertising for recruitment of a special routine medical costs)
services worker 4. O
ne-time admission costs (i.e. movies,
4. S
pecial Services/Support worker to provide amusement parks, museums)
respite and/or personal development 5. R
egular child care fees for children under 12
5. T
ravel costs associated with transporting years
special needs child for the worker 6. F
ees and tuition costs for education and
6. B
asic supplies to implement a program for employment
the special needs child (e.g: Flash cards) 7. A
ssistive devices, specialized equipment,
7. M
embership fees for special needs home modifications
associations (Special Olympics, Down 8. Dental Services
Syndrome Association.)
9. 1:1 support in a school setting
1010. P
rofessional services: junior and senior • P
ayment of the special services worker
therapists (e.g. IBI, ABA, speech therapy, while attending a training event
occupational therapy, physiotherapy) • F
ees and other out of pocket expenses
11. Sports equipment incurred by the worker being trained.
12. Electronics (i.e. phones, computers, tablets) • P
rofessional services only where
required for assessment and
SUPPORT consultation components of a mediator
model and only where not funded as part
CONSIDERATIONS of a service of an existing agency.
In some situations there may be critical Funding will not be considered for conferences,
supports and services required for personal degree or diploma courses.
development and growth or family relief and
support. Child Care – Extraordinary Costs
Where the cost of child care exceeds regular
Training
costs as a direct result of the child’s disability
Family members or special services workers (over 12 years of age) or where the services
may need training beyond initial orientation being sought are not typically met by families,
requirements to understand and respond to the regional offices may determine exceptional
needs of the child with the disability. Training is need at their discretion. Extraordinary costs
intended to: result when:
• Directly enhance understanding of the • The child requires supervision by
needs of the child who requires support a person with special skills. For
• Directly enhance the effectiveness of example, the child may be medically
meeting those needs fragile, requiring child care through a
• Maintain the skills and capacities of the registered nurse or registered practical
family member(s) or special services nurse. In this situation there should
worker be a professional assessment of need
obtained from an independent, qualified
Where these criteria are satisfied, funding may
professional such as a physician,
be considered for:
registered nurse, or health care
• S
pecialized needs, such as CPR or sign professional from a recognized agency
language such as the local Home and Community
Services, LHIN.
11• The child’s disability presents serious • A
pproval for the expense must be
difficulties in attending school for the received before the service is delivered.
normal hours each day that school is in
session. While exceptional, it is possible
SUPPORTS NOT FUNDED
for a board of education to adjust the
As SSAH is one of a range of community
length of the school day for a student.
services available, and as some costs are
The board of education may provide
borne by all families, there are services not
educational services at home for a length
recognized or funded through SSAH.
of time much less than the normal school
day. The following supports are not funded through
SSAH:
• A child 12 years of age or older with a
developmental and/or physical disability
BASIC CARE
requires supervision by another person
Basic care expenses are those that are typically
after school. At this age, the child’s
met by families for basic needs of children such
peers who do not have a developmental
as: food, clothing, diapers, child care, dental
disability may be left at home
care, and routine medical costs (including fees
unattended. Thus, the cost of care for the
in excess of the OHIP schedule).
child with a disability above and beyond
the costs of care typically provided by Assistance with these types of expenses may
families/caregivers may be considered. be available for eligible families or children
through social assistance programs, for
Services Outside Ontario example ASSISTANCE FOR CHILDREN WITH
While not normally funded through SSAH, SEVERE DISABILITIES (ACSD). In addition,
exceptional consideration may be given, with there may be programs funded by the
approval of the appropriate Ministry Regional Government of Canada that may be accessed.
Office Director, where the service outside
Ontario is more economical and accessible
CHILD CARE FEES
than a similar service in Ontario. For these SSAH funding may not be used to cover regular
exceptional circumstances to be considered costs of centre-based, family or informal child
the following is required: care or nursery school services.
• Documentation from an appropriate
professional or other resource stating the
need for the service.
12EDUCATION HOME MODIFICATIONS
• No requests related to an educational SSAH does not fund structural changes to
program for children under the age of 18 a home, installation of equipment such as
are approved. Families are encouraged to an elevator, or minor modifications to aid in
access school programs available to the mobility or accessibility. These requests should
public. be directed to federal, provincial, municipal or
• SSAH may not be used to provide other sources that may provide such support.
teachers’ aides, tutoring or other
PROFESSIONAL SERVICES,
educational services either during the
TREATMENT
school day or outside it.
Speech and language pathology, occupational
• Where a child is voluntarily withheld or
therapy, physiotherapy, psychology, and
suspended from any school program,
similar professional services will not be funded
SSAH funding will not be used during
unless they are required for the assessment
regular school hours.
and consultation components of a MEDIATOR
• Requests for additional support in MODEL service and are not funded through an
these areas should be directed to the existing agency or service.
appropriate school board or to the
SSAH does not fund costs of care or enrolment
Ministry of Education.
in treatment or medical residential centres
ASSISTIVE DEVICES AND in or outside Ontario, therefore, requests to
SPECIALIZED EQUIPMENT offset costs will not be considered. Applicants
should be directed to make their requests
Requests for equipment of a specialized,
for assistance to the Ministry of Health and
assistive nature should be directed to the
Long-Term Care, service clubs or insurance
ASSISTIVE DEVICES PROGRAM of the Ministry
companies.
of Health and Long-Term Care, ACSD, or other
sources that may provide such support.
DENTAL SERVICES
SSAH does not fund requests for dental
service. Such requests should be directed to
other programs through which such benefits
may be provided, such as Healthy Smiles.
13DECISION-MAKING • Shows a consistent interpretation and
application of the SSAH Guidelines; and
Regional offices are responsible for the
management of Special Services at Home to • Results in decisions which are
children and their families. Regional offices are consistent, objective, and yet
required to review applications and supporting personalized, and sensitive to families,
information and respond to the unique situation language and culture.
of each child with a disability and his or her
family within the context of the larger system. FUNDING
While the first and most basic decision is Once an eligibility determination has been made
eligibility, equally important decisions must and support and funding levels have been
be made concerning types of services (i.e. decided, regional offices are responsible to
personal development and growth, family relief ensure that funds are managed and monitored
and support [respite]), service levels, funding in accordance with the MCSS service principles
levels and other considerations. and these Guidelines.
Equitable Decision-Making
SSAH is not an entitlement program and
ADMINISTRATION
operates within a fixed allocation. It is expected The concept of personalized and direct funding
that applicants will be treated equitably and will fits with the SSAH program philosophy. It
receive fair consideration within available funds. provides children and their families with the
opportunity to state a preference for how
Applicants will be treated equitably and will
approved funding will be managed; for example,
receive fair consideration within available funds.
by the family, an agency or another third party.
For the purposes of this program, equity is the
When families choose to manage approved
end result of a fair process that:
SSAH funds, it is referred to as SELF-
• Provides a common application process ADMINISTRATION.
that gives all applicants an opportunity
to submit the information they believe Self-Administration
needs to be considered in their request Management by families may be beneficial
for SSAH support; because:
• Considers each family’s unique situation • If families can use the full amount of
and circumstances; funding authorized to them to purchase
services without paying an administrative
fee to have their funding managed by
14a third party, the amount of service supervision, recruitment, training and
that can be purchased within the funds liability insurance.
approved is maximized. • The administrative relief for families
• Families have the ability to directly If an agency charges an administrative fee, that
control service delivery. amount will come out of the approved funding
• Service can be readily customized and which will mean a reduced amount of available
adapted to fit ongoing opportunities and funding for direct service.
needs.
Exceptional Circumstances
Families who choose to self-administer need to
be aware of sources of advice they can access While staff who deliver SSAH respect the
regarding the potential legal responsibilities and preference stated on the application, alternative
liabilities associated with self-administering their arrangements for administration of funds may
contracts. be made when:
Families should contact any relevant agency/ • There is a history of operational
organization for further information about their difficulties, or
responsibilities as a result of their choice to • The family and Ministry agree the amount
administer their funding. These may include approved is too large for the suggested
organizations such as: party to manage.
Canada Revenue Agency (CRA) If this is the case, the regional office will:
Ontario Ministry of Labour • Work with the family to identify
Workplace and Safety Insurance alternative arrangements.
Board (WSIB) • Include the rationale for approving a
When families choose to have an agency different party in the decision letter.
manage approved SSAH funds, it is referred to
Administrator Responsibilities
as AGENCY ADMINISTRATION.
Whether the contract is self-administered or
Agency Administration administered by a third party, responsibilities
Agency administration may be beneficial remain the same. The party administering the
due to: SSAH contract must be aware of their roles and
responsibilities. These include:
• The type or complexity of the service
being delivered. • Understanding and fulfilling human
resource obligations under the
• The need for supports to workers, such
applicable laws.
as replacements for an absent worker,
15• Acquiring the appropriate human • A grandparent living in the same house as
resources. a parent and the child requiring support
• Maintaining program and financial could be compensated with SSAH funds to
records. provide support. However, if the grandparent
is the primary caregiver of the child requiring
• Retaining financial records for 7 years.
support they cannot be reimbursed using
• Completing claims regularly, including SSAH funds.
invoices and proofs of delivery.
• The spouse of a primary caregiver is
• Ensuring appropriate liability coverage considered to be a primary caregiver
is in effect. themselves.
• Completing progress reports
with the family. Combining Funds
• Any other responsibilities that may arise To provide greater flexibility of choice and
by virtue of law or policy. to assist children and their families to meet
their needs, families may combine their SSAH
Compensating Family Members allocation with the SSAH allocation of one or
Primary caregivers can use their SSAH funding more family(ies). Rules related to administration,
to compensate eligible family members (except accountability, record-keeping and monitoring
those listed below) to provide services for of funds remain the same. Families/primary
personal development and growth and/or family caregivers (or the transfer payment agency,
relief and support (respite). if they are administering the funds on behalf
of families/caregivers) remain responsible for
Persons who are not eligible to receive
providing the required financial information
compensation are:
related to the submission of receipts, billing and
• Primary caregivers regardless of invoicing, based on individual allocations.
residence;
• A family member under the age of 18; Cost of Administration
Examples include: Administration costs for SSAH must be
consistent with MCSS policy on Administration.
• While a sibling over the age of 18 may be
paid using SSAH funding to provide respite
or to teach new skills, a sibling under the
age of 18 could not be compensated using
SSAH funds.
16ACCOUNTABILITY Monitoring may include:
Accountability for expenditure of funds is the • Contacting the family and/or case
joint responsibility of MCSS, families and, where manager to explain the original basis for
applicable, the administering agency. A key the approved funding.
feature of this accountability is monitoring the • Verifying that the services are eligible or
effective management of funds. not eligible for funding under SSAH.
• Conveying the expectation to the family
Monitoring
that the funds will be used for the
Monitoring determines that expenditures purposes for which they were intended.
have occurred within the parameters of the
Factors which indicate the need for monitoring
Guidelines.
may include:
Client records indicate what has happened
• Irregular pattern of usage where closely
through:
defined goals and delivery plans have
• Claims or invoices been developed by a professional.
• Payments • Majority of approved funds claimed at
• Proof of delivery beginning of 12 month approval.
Invoices should be honoured when they are • Requests for additional support prior to
submitted in good faith and supported by the end of the contract.
documentation, including: • Unauthorized items being submitted for
• Detailed information about the service payment.
purchased has been provided. If concerns arise about the management of
• The service occurred during the period funds, staff administering SSAH are required to
authorized. follow-up.
• The total amounts invoiced do not A regular billing procedure must be established
exceed the amount authorized for and followed. Staff will analyze the use of funds
that period. periodically and may contact families who have
When underutilization of SSAH resources not used their approved funds.
occurs, it is appropriate for staff who
administers SSAH to monitor the situation.
17Transfer of Service Commitment: TRANSITION PLANNING
When a child moves from one region of the
INTO ADULT SERVICES
province to another, continuity of SSAH
funding is important. The child and/or the SECTORS
family should experience a similar level of
TRANSITION PLANNING FOR
support and there should be no or minimal
CHILDREN WITH DEVELOPMENTAL
impact to service during the transition
AND/OR PHYSICAL DISABILITIES
period in the new community.
ADULTS with a developmental and physical
In order to enable continuity of funding, the
disability are not eligible for SSAH funding. It is
following steps are taken:
important to plan for the transition to adulthood
The originating office will: with children and their families well before their
• Continue to pay invoices on the contract 18th birthday. When SSAH funding is approved
until the end of the fiscal year. for a child who is 17 years old, staff will:
• Inform the receiving office at the time the • Inform the child and their family that SSAH
family moves. does not fund adults, i.e. those 18 and over.
The receiving office will: • Suggest appropriate community linkages
• Begin the contract review and renewal as and resources; for example Developmental
of the next fiscal year. Services Ontario (DSO) local office for access
to adult developmental services, and the
• Assist families in making appropriate
Ontario Disability Support Program (ODSP)
linkages with other services in the
local office.
community.
• Establish an end-date with the family for the
• Meet the ongoing responsibility for
SSAH contract.
providing service to the transferring
recipient within the existing SSAH • Not approve funding for applicants who have
allocation. Change of circumstance already reached 18 years of age.
updates from the family will be
considered on the same basis as other
children and their families.
18APPENDIX A UNDER THE AGE OF 18
It is the child with the disability who must be
ELIGIBILITY CRITERIA under the age of 18.
RESIDENTS OF ONTARIO Documents confirming age include but are not
limited to a:
It is the child with the disability who must be a
resident of Ontario. • birth or baptismal certificate;
Residents are those who, at the time of • Ontario health card; or,
application, have established their principal • Passport.
residence in Ontario by: Documents may be originals or photocopies.
• Citizenship The ministry reserves the right to view the
• Permanent Resident status original documents upon request.
• Minister’s Permit ONGOING FUNCTIONAL
• Permission to stay granted by LIMITATIONS AS A RESULT
Citizenship and Immigration Canada OF A DISABILITY
(e.g. refugee status)
Presence of a Disability
A copy of supporting documentation may
be required by the regional offices, at The child’s disabling condition must be
their discretion, when they consider that established through written documentation
confirmation is required. from a physician, psychologist/psychological
associate, or in the case of hearing and/
• Proof of Canadian citizenship, landed
or visual impairment an audiologist or
immigrant status or permission to stay by
ophthalmologist.
Citizenship and Immigration Canada:
With infants, determining a definitive diagnosis
• passport;
of disability can be difficult. Therefore, a
• naturalization certificate; written statement describing the probability or
• immigration documents; or presence of delay and risk of further delay is
• Minister’s permit. required from a physician or psychologist.
isitors are not eligible. They are
V While basic program eligibility is normally
considered to be residents of their decided once, in the case of an infant without
home province or country. a diagnosis, the determination of eligibility
must be undertaken again at approximately
6 years of age.
19Requests for continuation of service after 6 LIVING AT HOME WITH FAMILIES
years of age will be considered based on need, The definition of family as it appears in the
diagnosis and supporting documentation from glossary of these guidelines must be used.
a physician or psychologist.
Sometimes, due to the nature of a disability,
Ongoing Functional Limitations: the child may need to be away from home for
a period of time, but still be in Ontario. Three
Ongoing functional limitations resulting from a
special circumstances are considered within
disability are established through statements
this criterion:
made by the applicant as to needs, goals and
requests, and written documentation from 1. Specialized Schools
professionals.
A student attending a school in a residential
DOCUMENTATION capacity as a result of a disability may be
eligible for SSAH funding during the time he/she
Documentation of the applicant’s disability
resides with the family (for example, weekends
is required from a physician, psychologist/
and school holidays). This means that the family
psychological associate, or in the case of
is responsible for the care and upbringing of the
hearing and/or visual impairment an audiologist
student and remains responsible for basic care
or ophthalmologist to establish basic eligibility;
items such as clothing, basic medical care, etc.
in the instance of hearing or visual impairment,
documentation may be provided by an 2. Residents of Hospitals
audiologist or ophthalmologist.
A child residing in a general or convalescent
Documentation may also be required to hospital as a result of a disability may be eligible
demonstrate that the applicant is legally entitled for SSAH funding if:
to live in Canada and is a resident of Ontario.
• The stay in the institution is intended
See the Eligibility section for further information.
to be short-term with an expected
SUPPORT BEYOND WHAT IS discharge within 6 months, and
TYPICALLY PROVIDED BY FAMILIES • A treatment/discharge plan is in place,
Expenses typically met by families or persons and
include such items as food, clothing, diapers, • The plan includes regular, consistent
child care, recreation, camp, education, weekends and holidays at home.
employment costs, dental care, ROUTINE In these situations, SSAH funding may be
MEDICAL COSTS and medical fees in excess approved for use during the time spent in the
of the Provincial fee schedule. hospital or at home. For time spent in hospital,
20funding may be approved to provide continuity Regional offices must consider the role of
of care and activities related to personal transfer payment agencies in supporting the
development and growth and services not transition of children and whether the approval
typically provided by hospital staff. The other of SSAH funding would duplicate or replace a
conditions regarding short-term stay and service which could be provided by the transfer
discharge must be met in order to approve payment system.
SSAH funding for use in hospitals. Children are not eligible for SSAH funding if
their primary residence is in an accommodation
LIVING AT HOME ON A
where residential support is provided by a
PART-TIME BASIS:
government-funded source or Outside Paid
A child who lives in or spends extended periods Resource (OPR). This includes (but is not
of time in a GROUP HOME, in foster care, limited to) children living in accommodations
eligible only for the time he/she resides at the that are typically referred to as:
home of a family member, either for visits or as
• Group homes
part of a shared care arrangement.
• Foster Home programs
Staff should consider time away from the family
home as an additional form of support which • Rental accommodation with staff
may help the family in terms of relieving stress supports
and enhancing their ability to cope. This should • Any other living arrangement where
be considered as a factor in decision-making residential staff support is provided by a
and prioritization. government-funded source (e.g. transfer
payment agency) or OPR.
NOT LIVING AT HOME WITH
Children are not eligible to receive SSAH
FAMILIES / TEMPORARY
funding where supports for the activities usually
RESIDENCE:
funded through SSAH are already provided by
Children with a physical disability and/or a (or available from) a transfer payment system.
developmental disability can also be considered
for SSAH funding when: OTHER CONSIDERATIONS
They need to live away from the family To assist staff in the application and
home temporarily because of family illness interpretation of eligibility criteria, this section
or other emergency. (In these situations, includes guidance for decision-making in the
SSAH funding may continue to be provided following situations:
to offer as much stability and continuity in
the care of the child as possible).
21INFANTS This fact, coupled with the value of early
intervention, has a significant impact on the
Early Intervention demand for SSAH supports.
Infancy is one of the most crucial periods in While it does not mean infants automatically
the development of a child. Early intervention have a higher priority, it does mean that staff
services and supports are designed to assist must consider these factors. This consideration
with developmental needs at an early stage. makes the review, analysis and decision-
Problems may be less likely to become more making process more complex. Along with the
serious or chronic later. Early intervention usual decision-making principles, the following
supports can minimize or even eliminate the three factors should be considered:
negative consequences associated with an
• The family’s special challenges.
infant’s needs.
• The value of early intervention.
Challenges for Families • The possible lack of definitive diagnosis.
The care of an infant can be challenging and With infants, a definitive diagnosis of
stressful. These factors may multiply when developmental or physical disability may be
an infant has a special need. In addition difficult to determine. Where this is the case,
to the demands of professional supports, the presence of a delay or significant probability
appointments and special training, families of delay is considered.
may be under great personal stress. They
might need to find out what supports exist in AUTISM
their community. They may be separated from People with AUTISM differ in the number of
their hospitalized infant. They have to identify characteristics displayed and the severity of
their own needs for emotional and physical symptoms. Although the disorder is severe and
support. They may be starting to assess and lifelong, symptoms change over time and many
process their new situation but their child may skills can develop with appropriate intervention.
not yet have a definitive diagnosis. They may
Note: Documentation that refers to only
be coming to terms with a serious problem
“tendencies” cannot be accepted as
affecting the future of their child and family.
equivalent to a diagnosis of the disorder;
Challenges for SSAH Staff for example, a statement that the child has
autistic-like features is, on its own, insufficient
As technological advances are helping to
documentation of disability.
increase life spans, an increasing number of
infants require a high degree of home supports.
22SENSORY IMPAIRMENTS It is important to take the following factors
Within the definition of physical disability, there into account when considering whether the
is a reference to people with other sensory disability is developmental or physical in nature:
impairments. This refers to either significant • The nature of the ongoing functional
visual impairment or hearing loss. A child with limitations arising from the injury.
a sensory impairment may be considered • The child’s perception of himself or
eligible for SSAH funding as a person with a herself as having a developmental or
physical disability on the basis of a physician’s physical disability or multiple disabilities.
assessment.
• The family perception of the child as
A child who has multi-sensory deprivation due having a developmental or physical
to a combined incidence of DEAFNESS AND disability or multiple disabilities.
BLINDNESS is considered eligible for SSAH
• The physician’s assessment.
funding. An assessment to establish mental
impairment is not required in such cases.
BRAIN INJURIES
An application for a child who has acquired a
brain injury during his/her FORMATIVE YEARS
(whether sudden – for example, as a result of
a stroke – or as a result of a tumour or other
causes) may be considered for SSAH funding
either within the context of developmental and/
or physical disability. The variable nature of the
injuries and the circumstances in each situation
make it inappropriate to classify all such injuries
exclusively under one category.
23GLOSSARY ASSISTIVE DEVICES PROGRAM
A program of the Ontario Ministry of Health and
ACTIVITIES OF DAILY LIVING
Long-Term Care that provides Ontario residents
The basic activities that we perform for
who have long-term disabilities with assistance
ourselves, such as feeding, transferring out
in paying for certain necessary equipment
of bed, brushing teeth, combing hair and
and supplies (e.g. wheelchairs, artificial limbs,
dressing. A child with special needs would
respiratory equipment, braillers).
require help with such activities and the primary
caregiver is the person who provides most of AUTISM (Autism Spectrum Disorder)
this assistance. Autism Spectrum Disorders (ASD) describes
a subset of the Pervasive Developmental
ADAPTIVE BEHAVIOUR
Disorders (PDDs) currently outlined in the
Those aspects of a person’s development
Diagnostic and Statistical Manual of Mental
that are related to the acquisition of functional
Disorders (DSM-5). These disorders share three
skills required for everyday life (e.g. self-care,
common areas of concern:
independent living, and appropriate social
behaviour). • Qualitative impairments in social skills
ADULT • Qualitative impairments in verbal and
Person eighteen years and over. nonverbal communication
AGENCY ADMINISTRATION • Restricted and repetitive interests or
Agency administration occurs when children behaviours.
and their families enter into an agreement When using the term ASD, most professionals
with a transfer payment agency to manage are referring to the subset of PDDs that
approved SSAH funding. includes Autistic Disorder (usually referred to as
ASSISTANCE FOR CHILDREN WITH Autism), PDD-NOS (pervasive developmental
SEVERE DISABILITIES (ACSD) PROGRAM disorder-not otherwise specified).
A program that provides a monthly benefit CHILD/CHILDREN
to eligible families to help offset the ongoing Person(s) under the age of eighteen years.
extraordinary costs associated with the care of DEAFNESS AND BLINDNESS
a child who has a severe disability and is living (Deafblindness)
at home with his/her family. Eligibility for the A person who, because of a combined
program is based on four factors: the age of incidence of deafness and blindness, is
the child, household income, the extent of the multi-sensory deprived resulting in significant
child’s severe disability, and the extraordinary difficulties in pursuing educational, vocational,
expenses related to the disability. and social skills. (Task Force Report on Service
to Deaf/Blind Persons in Ontario, 1984).
24A child who has multi-sensory deprivation due • Daily dependence on device-based support
to a combined incidence of DEAFNESS AND for tracheotomy tube suctioning, oxygen or
BLINDNESS is considered eligible for SSAH. tube feeding;
DEVELOPMENTAL DISABILITY • Prolonged dependence on other devices
A condition of MENTAL IMPAIRMENT present which compensate for vital body functions,
or occurring in a person’s formative years and on daily or near daily nursing; or
that is associated with limitations in adaptive • Medically fragile according to care
behaviour. (Child and Family Services Act requirements, but does not use a
R.S.O. 1990, CHAPTER C.11). technological device.
EARLY INTERVENTION SERVICES ESSENTIAL PHYSICAL ACTIVITY
Services designed to address problems A fundamental and necessary activity that is
at an early stage before they develop into part of everyday life (e.g. eating, breathing,
more serious or chronic problems requiring mobility, hygiene, toileting, communication).
increased levels of social services in the future.
FAMILY/FAMILIES
In addition, they enable children to develop to
Persons related by kinship as recognized in
their optimal potential by intervening early with
law but limited to: spouses, parents, siblings,
appropriate services.
grandparents, children, aunts, uncles, and
ENHANCED RESPITE FUNDING cousins, and including step-parents and
Funding provided to families who are caring for step-siblings, where there has been a settled
a child who is medically fragile and/or depends intention to treat the child as a member of the
on a technological device needing care 24 family.
hours a day, 365 days a year and is paid in
Children will be considered to be living at home
addition to other respite services.
with their family during the time they reside with
Families may be eligible for up to $3,500 per family members.
child, per year.
FORMATIVE YEARS
To be eligible for enhanced respite funding, a Years of growth from birth up to, but not
child must fit one of the following five categories including, a person’s eighteenth birthday.
of care needs:
GROUP LIVING/GROUP HOME
• Ventilator dependent; A residential setting where 24-hour support
• Requires prolonged intravenous is typically provided for groups of three to six
administration of nutritional substances or persons with a developmental disability who
drugs; need supervision with activities of daily living.
25HEARING LOSS MAINSTREAM SERVICE A chronic physiological hearing impairment so Service that is available for use by the general severe that speech cannot be understood with public. They are generally not designed for any optimum amplification through the ear. Speech particular group but are generic in nature. discrimination is at 40% less in the better ear. MEDIATOR MODEL (Helen Keller National Centre). Intervention by parents or non-professional, INDIRECT ASSISTANCE direct service staff under the supervision of Assistance which relieves family members of a professional. The role of the professional in specific family or household responsibilities and the mediator model is to assist the family to enables them to play a greater role in meeting develop a program plan, including goals and the needs of the child with the disability. specific interventions or activities, and to train DIRECT FUNDING and supervise the person carrying out the The allocation of public funds to persons rather program. than to agencies or programs. MEDICAL FEES IN EXCESS OF INFANT OHIP FEE SCHEDULE From birth to 36 months of age Costs for services that are over and above (chronologically), a child is considered what OHIP will cover (e.g. additional visits to a to be an infant. chiropractor or optometrist). LOCAL HEALTH INTEGRATION MENTAL IMPAIRMENT NETWORKS (LHINs) Delays or distortions in normal mental LHINs are funded and regulated by the Ministry development that may lead a child to require of Health and Long-Term Care and coordinate a special supports and services. Examples variety of health services to maintain a person’s include: health, independence and quality of life. They • Significant sub-average intelligence as shown are responsible for: by the results of a personally administered • Service information and referral to all long- intelligence test, or as clinically adjudged (e.g. term care services, including the volunteer- levels of mild moderate, severe, or profound). based community services. • Multiple areas of qualitative distortion of • Coordinated service planning and monitoring; normal mental development (e.g. autism, • Eligibility determination. pervasive developmental disorder). • Case management. • Placement coordination services for long-term care facilities. 26
This definition does not include impairments PHYSICIAN
that are primarily attributable to emotional or A person who is a member of the College of
psychiatric disorders or delays to progress Physicians and Surgeons of Ontario.
in specific areas of skill acquisition, such as PRIMARY CAREGIVER
Specific Developmental Disorders (e.g. learning A person who is primarily responsible for the
disabilities). care of a child where:
MINISTRY or MCSS • The child is living in a family-type
The Ministry of Community and Social Services. situation
ONGOING FUNCTIONAL LIMITATIONS • There has been a settled intention to
Limitations in a child’s capacity to carry out treat the child as a member of the family
those activities of living that are necessary
• The family is not receiving assistance
to acquire independence and well-being.
from a child welfare authority or other
Tasks associated with typical age-appropriate
service provider (e.g. foster home, family
developmental stages cannot be accomplished
home program) toward the support of the
without assistance.
child.
OUTSIDE PAID RESOURCE (OPR)
A primary caregiver may or may not be related
A private for-profit operator that delivers
to the child with a developmental disability.
residential programs for persons.
For the purposes of the SSAH program, the
PHYSICAL DISABILITY
designation of primary caregiver also extends to
A restriction or lack of ability to perform an
a spouse of a primary caregiver.
essential physical activity in a manner or
within the range considered normal for a A special services worker cannot be considered
child. This shall include children with other a primary caregiver.
sensory impairments (deafness, blindness or PSYCHOLOGIST
deafblindness). A person who is a member of the College of
The effects of the disabling condition may be Psychologists of Ontario.
visible (as with neurological, neuromuscular,
spinal cord injury disorders, or conditions
described as “medically fragile”) or invisible (as
with sensory impairment and conditions such
as heart disease, epilepsy, etc.).
27RESIDENTS OF ONTARIO SELF-ADMINISTRATION
People who have established their principal Self administration occurs when children and
residence in Ontario by: their families choose to manage approved
• proof of Canadian citizenship, landed SSAH funding. It is generally referred to as
immigrant status or permission to stay by self-administration, self-management or direct
Citizenship and Immigration Canada: funding.
• passport; SIGNIFICANT CHANGE
Families will likely have their own definition of
• naturalization certificate;
what a significant change means for them.
• immigration documents; or Their definition should be used in conjunction
• Minister’s permit. with the following, where a significant change
RESPITE may include:
Respite assists with the activities of daily living • A change in the developmental, medical
and helps improve the quality of life for the and/or physical care needs of the child;
family while enabling the child with special and/or
needs to continue to reside at home. • A change in the family’s available
Respite enhances the primary caregiver’s community supports; and/or
capacity to provide care for the special needs • A change in the family’s capacity to
family member living at home, through the provide care.
provision of temporary relief supports.
SPECIAL SERVICES WORKER
ROUTINE MEDICAL COSTS A person who provides direct assistance to a
Fees for assessments, filling out forms, child with special needs who has functional
transferring records, registration of new limitations. Such assistance may include:
patients, and other procedures not insured
• Addressing specific personal
under the Ontario Health Insurance Plan (OHIP)
development and growth needs.
(e.g. naturopaths, podiatrists, etc.). Any costs
covered under the Ontario Health Insurance • Focusing on a goal (expected outcome)
Plan (OHIP). within a projected time frame.
• Following a plan for delivery of
programming.
• Periodically reviewing progress made and
adapting goals and plans accordingly.
28TEMPORARY RELIEF SUPPORTS
Those supports that enable the primary
caregiver to take some time away from care-
giving or from one or more of their own
responsibilities. Consideration may be given
to supporting those activities commonly
associated with running a home, such as
housecleaning, laundry and grass cutting/snow
removal.
VISUAL IMPAIRMENT
Any long-term eye condition that:
• Cannot be corrected medically, surgically
or with refractive lenses, but where there
is some residual vision.
• Complicates performance of age-related
visual tasks
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