Discussion #3 – BCACDI’s Service Delivery Transformation Proposal
As part of its commitment to engage in meaningful dialogue with multiple audiences on the future of children and youth with support needs (CYSN) services in BC, the Province is promoting open discussion on important topics related to CYSN services through this online engagement portal.
On this page you can find a plan submitted to the Ministry of Children and Family Development (MCFD) by the BC Association for Child Development and Intervention (BCACDI) proposing a transformation of service delivery in BC for children and youth with support needs and their families – BC’s CYSN Service Delivery Transformation.
The ministry is asking parents, professionals, service providers, communities and others how they might envision a future of CYSN services in the context of this paper.
Background
MCFD is working to understand how children and youth with support needs can be better served. To ensure the system is as effective as possible, MCFD is undertaking an engagement process to gather ideas and suggestions from concerned parties.
This discussion forum is another method in this engagement process. In this case, a submission to MCFD from a third party is posted here for review and comment. Please note that the content in the submission reflects the views of the author and does not imply endorsement by MCFD.
Summary of the submission
BC’s CYSN Service Delivery Transformation (the paper) was developed by BCACDI, which is made up of 41 member agencies that advocate for and deliver services to children and youth with support needs and their families across BC.
The paper proposes solutions for provincial CYSN services in the following ways:
Maintain an agency coordinated not-for-profit structure, increasing and expanding service provision: This would include integration of mental health supports and developmental services and expansion of service provision responsibilities to include family support and behavioural therapy supports in all communities. Currently, not all non-profit agencies have the ability to provide these expanded services.
Maintain the existing individualized funding program structures for children and youth with Autism Spectrum Disorder (ASD), as well as create a more traditional funding model (e.g., contracts with community based not-for-profits) for agency coordinated behavioral intervention services. This places value on a family’s right to choose the service structure that best suits their needs and provides access to additional services (whether non-profit or private) to support families with more complex needs.
Strengthen and stabilize service delivery structures by avoiding procurement processes that destabilize services and community relationships; undertake a proactive workforce strategy; and improve accountability of investments and services through codeveloping service quality benchmarks
The proposal and its recommendations are informed by reports and research that demonstrate the challenges experienced by families and service providers. For example, some of the challenges identified include:
Mental health of children and youth with support needs, caregivers and parents
Difficulty navigating the current system of services due to complexity of contracts, multiple organizations delivering services, and lack of general awareness of services that are available
Workforce limitations across children and youth services that hinder families’ access to the services and supports they need
The paper proposes that agency coordinated services in the social sector – which are provided by local non-for-profit organizations, led by citizen board members and guided by client feedback– are well positioned to facilitate coordination and communication of therapies, programs and services. Under one organization with its network of community partners (including Indigenous and non-Indigenous and non-profit, public and private sector partners), multi-disciplinary teams of professionals would be involved in the intervention plans for a child or youth and their family.
MCFD’s response
The Province acknowledges that a family-centered approach to services for children and youth with support needs is important. This can mean different approaches to service delivery for different families.
At present, MCFD provides funding to community-based agencies to provide coordinated services (e.g., rehabilitation therapies through the CYSN foundational program stream). MCFD also provides individualized funding to families through the Autism Funding program. MCFD is keen to understand how this model is working for families across BC, particularly in terms of wraparound care, individualized planning, and service access.
Discussion question
In order to make good use of ideas from concerned parties, the Province is asking you to consider the following question for your review and comment. Please use the comment box below to respond.
- What role do agency coordinated services have in meeting the diverse and individualized needs of children, youth and their families?
I am an OT who works with children 0-19 in a community-based not for profit (CDC) agency in a mid-sized city. I have been an OT for over 25 years. Agency coordinated services play a critical role in meeting the diverse and individualized needs of children, youth and their families.
I agree with everything in BCACDI’s white paper and the “way forward” plan. It summarizes an extremely complicated system into a short document. It highlights the strengths and explains the inequities and flaws with the system we have to work in.
There are some extra details not covered in the document that support the use of a CDC community-based not for profit delivery system. Some of these details further illustrate why CDC’s have been unable to deliver service as fully as possible, at no fault of the organizations. Understanding these details will help readers appreciate how the solutions in the Way Forward plan will address these deficiencies.
1) School aged therapy services are severely underfunded and paid for by an inconsistent and untidy mixture of inadequate siloed funding systems. It is stark how dramatically OT and PT funding drops once children reach school age. There is a chasm between early intervention and when school aged program funding starts in kindergarten. While it’s true that the window of child’s development has the greatest potential for change when they are under 6 years, the functional problems don’t stop once they enter school. The government seems to think the education system will make up for this drop-in service, and it will somehow ensure children still get the services they need. But this doesn’t happen.
BCACDI’s Way Forward plan calls to extend early intervention program services several years beyond school entry. This will ease challenges created during that critical transition period. This makes sense.
OT and PT services for school aged children are administered differently across the province, from a blend of MCFD and Ministry of Education and Childcare sources. Each school district and MCFD contract is different. As a result, there are incredible variations in the amount of service between communities. So what a child can get will depend on where they live, and not on what they need.
Because of the drop in funding as children enter school, OT and PT services can often only see the most severely disabled school aged kids. The rest, in general, go without, or with very limited consultation. It isn’t that these kids aren’t important, it’s because services must be rationed due to funding limitations. Increasing the funding for the school aged therapy program, and fairly allocating the funding so it is delivered globally by CDC’s will allow for more equitable service.
In addition to serving the public school system, our CDC manages our funding so we can serve band schools and first nation communities. We work collaboratively with independent first nations social and health systems. The same is true for home schools or independent schools. But other CDC’s can’t do this, which is unfair and further entrenches inequity. The system needs to be managed so global funding matches each community’s unique needs and is administered fairly and equally.
2) MCFD doesn’t follow through with contract negotiations, and that worsens the financial stability of CDC’s. Historically, many CDC’s used to be funded by the Ministry of Health. For this reason, those CDC’s have the same collective agreement as those who work in hospitals. This changed in the early 2000’s, when CDC’s were moved to MCFD funding. As a result, although the collective agreement and wages are the same between hospitals and most CDC’s, over the years MCFD has often not honored collective agreement wage increases. When this occurs, CDC’s either have to dig into their own savings, or not provide the raise. Those CDC’s with deeper pockets can cover the raises, and those with less can’t. As a result, CDC’s from smaller communities or those with less savings struggle to meet staffing demands, and in the end can’t provide equal service.
If the CDC does cover the raise, they can only do so by cutting the services elsewhere. For example, to make ends meet, over the years our centre has had to cut travel expenses. This means we can’t go to a family’s home, and they have to come to us. That works for some families, but it acts as a barrier for many others. Some childhood disability concerns can only be figured out in the home environment, and a centre visit is inadequate.
To make it even more complicated, some CDC’s do not have the same collective agreement as others, so they can’t pay the same wages. Staff understandably don’t want to work in lower paying CDC’s, or if the wages are lower than in hospitals. Similarly, why work in a CDC when a therapist could make substantially more money in private practice?
3) Staff rural recruitment and retention incentives need to apply to CDC’s – The provincial government has recently announced new initiatives designed to increase recruitment of health science professionals in rural communities and among professions facing acute shortages in urban centres. These initiatives will provide signing bonuses to help recruit new health science professionals where they are most critically needed to address long-standing shortages. Like the historical MCFD funding shortfalls, it is not clear if these incentives will only apply to the Min of Health funded hospital and health sector, and not to MCFD funded CDC’s.
Our staff cover rural communities, school districts, and first nations that could be a 2.5 hour drive away. You can’t see a lot of kids if you spend 5 hours of a work day driving. It would make more sense if staff could spend several days in the rural community and stay overnight. Yet the MCFD contracts do not provide targeted funds that would allow for an outreach model. Health authority funded Sunnyhill outreach programs like seating and mobility, and assistive technology receive extra funding so they can get to remote communities and stay several days. Yet CDC’s don’t get this.
The funding models should consider the huge geographic area some CDC’s must cover, and provide adequate funding so outreach trips can occur. The alternative is to ask families to drive to our centre, which adds a lot of hardship and inconvenience on already overburdened and stressed-out families. This is another reason why funding needs to be tailored to individual communities and led by those who already know their region.
I agree. I don’t think it’s fair that in order for my children to receive the services they need that I need to take them not only from their home but their community. To ask a parent to chose between services and raising their children in their traditional territory, around their extended family and their language is not ok. Either way the child goes without.
Typically they come with years of knowledge, experience and know how on being able to co ordinate what is specifically needed for each individual family. Being multidisciplinary they can provide these individualized services without many different appointments in different locations which can be a struggle for families. The staff in these agencies are already familiar and have connections with other agencies and the schools for when other services are needed by the family. Together this makes a cohesive approach for families with less stress
Due to MCFD requirements you know what the service they are providing are like, being accredited and use of funding.
Increase parent capacity by promoting interdisciplinary communication and collaboration on service delivery. Focus on whole family strengths and capacity building by identifying specific family quality of life outcome goals.
Providing families with streamlined service and fewer transitions between professionals. Increasing numbers of professionals base upon referrals in each discipline to decrease caseloads and improve quality of service provision.
I think that agency coordinated services won’t meet the needs of children and youth. From my experience and from what I take away from this paper is a colonial service model that is not going to work with indigenous and immigrant youth. It limits support options for our very diverse children. I also think that by it being left to agencies we will continue to leave those in remote and rural communities without support.
Currently services are mainly provided by agencies like CDC. When I moved to my community I was told that the CDCs did not work with children and youth living on reserve and the services that were available were available the next town over and their office was in the basement of a church. Given the history between indigenous people and the church how is this trauma informed or culturally aware? It was just one more barrier to getting services for some families.
Services need to be individualized to meet families needs.
The CDCs are already providing most services to families. And as we all know, this system is broken.
Some communities don’t have any help for families with complex needs. They are left to fend for themselves and find their own support services, leaving many in the dust if they don’t have the capacity and no services if entities don’t have the staff with the qualifications to help.
The role that agencies have is very well documented in the full BCACDI report attached. It clearly addresses the components that are need for Family Centered and wrap around that is provided by CDC’s. The key component is the provision of adequate funding that would allow for CDC’s to broaden their valued, appreciated and crucial services for children and youth and their families from birth to school entry.
Agency coordinated services must tailor their services to meet the unique needs of Indigenous families with support needs. Agencies have the ability to be allies and work collaboratively with Indigenous Nations to ensure that Indigenous families who have children and youth with support needs are services in a way that is culturally safe and reflectent of their traditional ways of care/support. However, Indigenous Nations must be included in the process of developing their supports and the policies that lays the foundation of the agencies practice.
And this engagement needs to be at the local level. Hiring a firm in West Vancouver who provide feedback using an “indigenous lens” is not adequate engagement. What is acceptable for one community might look completely different for another. Especially in the north.
Not working at all for some families. Some children/youth are being removed from family’s care traumatizing children, family, and extended family; setting the youth back decades, putting the children at risk of harm if fleeing abuse, potential risk of self harm, and refual of future services.
The agency on our area meets all the desires you are describing as what are needed services. This agency is a foundation for many family to receive services and support for children and families who are hurdled with processes , systems, and paperwork while trying to make care for their children their priority
Agency coordinated services play a significant role for families who require that style of service. In my experience, when families are deciding between agency and individualized funded services, they often choose agency services when they are seeking respite. They can drop their child/children off at the agency to receive whatever service they are accessing (behaviour intervention, OT, SLP, etc.) and can take an hour or two to themselves (either to get a coffee, run some errands, see a friend, etc.). Additionally, they may seek agency services over IF services if they cannot find service providers in their area, or cannot find the right-fit service providers. Alternatively, they may seek agency services because there is sometimes a social aspect that isn’t as easily provided through certain IF services. When families choose IF services over agency services, it’s often because they need/want to find service providers who align with their cultural and family values, and this cannot always be accomplished in services provided by an agency, in which there is oftentimes an intake professional who then decides which services are accessed or which service providers are accessed. IF services can also often be provided within the home of the client/family, which better allows for caregiver coaching and generalization of skills across a variety of environments. IF service providers are often more flexible than agency provided services, where families can get access to a service provider on evenings and weekends, and for specialized supports such as sleeping and eating supports. Additionally, IF service providers are not restricted by some of the elements that are inevitable when working with an agency, who often employ unionized workers. Though unions provide a lot of value to their employees, it’s sometimes at a cost or disservice to the youth being served (e.g., when strike action occurs, when employees shuffle around due to seniority, etc.). These minor setbacks are often not experienced by families who contract with service providers through IF. There is value to having both as an option – there is such a diverse set of needs for families and youth, and it calls for a diverse set of available services and choices for those families. The families who may not have capacity to utilize IF, can access exactly what they need from an agency; and the families who have capacity to tailor their service provider team to their child/ren and family, can do so through IF.