archive.dnssab.on.caarchive.dnssab.on.ca/Files/DNSSABCommunityServicesReview_final.pdfPurpose This study was undertaken by the District of Nipissing Social Services Administration

District of Nipissing Social Services Administration Board (DNSSAB):

Community Services Review, Based on the Ontario Disability Support Program (ODSP) Client

Population.

October 2006

Purpose This study was undertaken by the District of Nipissing Social Services Administration Board (DNSSAB), in order to review the needs of Ontario Disability Support Program (ODSP) clients, for community social services within the District of Nipissing. This is a follow-up study to the report Nipissing District ODSP Caseload: An Analysis by Area of Residence, Age, Family Status and Primary Disability (MCSS /MCYS, Apr. 05) which indicates the highest provincial rate of ODSP per capita, within the District. Objectives As per the Terms of Reference, the objectives set out for this community services review were to: • Review the needs of the ODSP caseload, for community social services within the

District of Nipissing. • Review the capacity of the system to deliver services, in response to the needs of

the clients. • Identify current system alignment within the District of Nipissing. Scope The Community Services Review identifies other, relevant socio-economic characteristics that are unique to the District and which differentiate it from Ontario in general. This is presently in the form of a separate report, Nipissing District: A Socioeconomic Profile & Report (DNSSAB June 2006). The community service areas that are reviewed in this study are; Financial supports, Housing & supports, Food security, Transportation, Child & Family supports, Special & Discretionary benefits, Counseling, Assessment & Referral and Legal /Advocacy. It should be noted that health services delivered under the Health Act, public health services and education or employment supports and assistance, were not reviewed as they are beyond the scope of this study. The study examines gaps, barriers and best practices within the current service-delivery system, and makes further recommendations. Methodology The information in this report was primarily gathered through focus groups, surveys, interviews, meetings, community consultations and existing research reports and studies. Quantitative data was obtained from the Ministry of Community and Social Services Statistics & Analysis Unit and through community service organizations, where possible. The report was written by David Plumstead, MBA: DNSSAB Researcher, under the guidance of a DNSSAB Steering Committee and in consultation with an external Reference Committee.

DNSSAB: Community Services Review, Based on the ODSP Client Population; Oct. 2006 1

ACKNOWLEDGEMENTS

This Community Services Review is the result of a collective participation process, and contains data, information, input and feedback from many service organization representatives and ODSP clients. The DNSSAB thanks the following community organizations and individuals for their valuable contribution and participation in this study: Algonquin Child and Family Services Alliance Centre Canadian Mental Health Association Community Counseling Centre Community Living West Nipissing Disabled Adult & Youth Centre (DAAY) DNSSAB: Steering Committee, Senior Management and Executive Secretary Low Income People Involvement (LIPI) Near North Community Care Access Centre Nipissing District Housing Corporation Nipissing Legal Clinic Nipissing Mental Health Housing & Support Services Nipissing / Parry Sound Children’s Aid Society Nipissing / Parry Sound District Health Unit North Bay Crisis Centre North Bay and District Association for Community Living ODSP Clients ODSP & OW Support Network Ontario Works (OW): Team Coordinator & Intensive Case Management Team People For Equal Partnership in Mental Health (PEP) PHARA (Physically Handicapped Adults Rehabilitation Association) Sturgeon Falls Family Resource Center The Gathering Place West Nipissing Non Profit Housing

Special thanks go to the 30 ODSP clients who participated in the focus groups, giving freely of their time to provide valuable input and first-hand knowledge. A special thanks also to the following people for their assistance in organizing the focus groups with their clients: Rhea Funnell, Lana Mitchell and the OW Intensive Case Management Team: Aimie Caruso, Crystal Coleman, Patricia Talentino and Dave Vaillancourt (OW Team Coordinator). The Reference Committee gave freely of their time and provided valuable information and guidance for this project - their efforts are greatly appreciated:


Reference Committee Lana Arsenault, Manager of Supported Independent Living; North Bay & District Association for Community Living Stuart Bailey, Lawyer /Director; Nipissing Community Legal Clinic Bob Barraclough, Director of Operations & Client Services, DNSSAB Tracey Bethune, Tenant Services Manager; Nipissing District Housing Corporation Aimie Caruso, OW Case Manager, DNSSAB Cindy Ciancio; Low Income People Involvement (LIPI) Carol Conrad, CEO; Nipissing District Housing Corporation Cathy Craig, Manager of Services; Nipissing /Parry Sound Children Aid Society (CAS) Doug Davidson, Supervisor; North Bay Crisis Centre Shannon Desrosiers, Executive Director; Nipissing Mental Health Housing & Support Services Ivan Evers, Team Leader, Intensive Case Management Program; Nipissing Mental Health Housing & Support Services Rhea Funnell, Program Manager; Canadian Mental Health Association (CMHA) Celine de Grosbois, Chair; The Gathering Place Lana Mitchell, Executive Director; Low Income People Involvement (LIPI) Alice Radley, Executive Director; Physically Handicapped Adults Rehabilitation Association (PHARA) Christine Redden, Program Director; Community Counseling Centre of Nipissing Shirley Renaud, Director of Administration; Disabled Youth and Adult Centre (DAAY) Gerry Roy, Mental Health Counselor, Case Management Program; Alliance Centre Dave Vaillancourt, OW Team Coordinator; DNSSAB Luisa Valerio-Mohr; North Bay and District Association for Community Living Carol Vezina-Giroux, Mental Health Counselor; Case Management Program; Alliance Centre Kris Woods, Executive Director; North Bay Crisis Centre Nancy Sauvé, the ODSP Community Program Manager and staff from the MCSS Northeast Region, have also provided Ministry input into this report, which is appreciated. Additionally, the MCSS Statistics & Analysis Unit, Policy Research & Analysis Branch, Social Policy Development Division provided valuable and timely data. The DNSSAB Board of Directors is to be acknowledged for initiating this review and special thanks go to the Communications Task Force Members: George Jupp, George Maroosis and Claire Smerdon. The DNSSAB Steering Committee of Bob Barraclough, Tom Belanger and Bill White offered valuable project feedback and helped keep things on track. And a final thank you to DNSSAB’s Executive Secretary’s – Lianne Bettiol (Former Executive Secretary), Renée Beaupré and Sylvia Cayen, for all their note-taking and general administrative support.


INTRODUCTION

The following report outlines the findings of the community services review for people living on the Ontario Disability Support Program (ODSP), in Nipissing District. In keeping with the objective of client needs and community service capacity, the research is framed around two primary stakeholders: the ODSP clients and the community organizations who deliver services to them. This report is based upon qualitative and quantitative analysis and is descriptive-explanatory in nature. Where data is limited such as in particular areas of the community services, the report is more descriptive and relies upon the anecdotal information of the study participants. In terms of content, the report can be summarized by reading the Key Findings (pages 5-8), the Recommendations (pages 9-13) and the Conclusion on page 116. The report starts off with a brief project background on page 17, which describes the District of Nipissing Social Services Administration Board (DNSSAB), information about the ODSP report that preceded this one, and Nipissing District in general. Section I covers pages 19-29 and presents a summary of the Government’s policies and legislative framework for disability. It also looks at the definition of disability and introduces the Ontario Disability Support Program (ODSP). Section II begins on page 30 and involves the quantitative analysis of Nipissing’s ODSP Beneficiaries. This section continues the analysis from the original ODSP report (Stuart 2005) and includes ODSP family structure, dependents and trends. Pages 42-115 represent the bulk of the report and cover the nine areas of community review: financial supports, housing, food security, transportation, general services and child / family supports, special & discretionary benefits, counseling, assessment & referral and legal /advocacy. The analysis of income, housing and food is extensive and takes up pages 42-80. These are followed by transportation, general services /child & family supports and benefits (pages 80-102) and counseling, assessment & referral and legal /advocacy. Finally, it is hoped that the identified shortcomings and ensuing recommendations are taken within the context of the report and viewed from a perspective of an opportunity for service improvement, with the client at the centre.


SYNOPSIS OF KEY FINDINGS

iii

70% of the caseload are singles ‘at risk’ – they are paying 53% to 63% of their income on rent, indicating they are living in insecure housing.

Most Nipissing ODSP clients who are paying market rent are in core housing need. Depending upon family size and area, affordability gaps range from $71 (Mattawa) to $320 (North Bay).

Housing

Many clients would benefit from financial management assistance – there are presently waiting lists for Trustee Programs in Nipissing District.

The loss of income security and benefits are the main reasons clients do not want to work.

Due to the current policies of clawback on earnings, the net financial benefit of working varies between families, and is dependent on family structure and circumstance.

On average, monthly disposable income ranges from $177 for singles, to $540 for couples without children. On average, a couple with two children has $347 to spend after rent, utilities and food.

Only 12% of the caseload has earnings in addition to their ODSP income, with approximately half of these averaging $335 /mo. Singles have the lowest participation rate and earnings, while couples with children have the highest participation and earnings. For those living below the LICO, earnings are insufficient to raise them above it.

The majority of the District’s ODSP families are living below the Low Income Cutoff Point (LICO) by approximately $90 to $385 per month. The 2% increase to benefits in 2006 will not raise them above LICO.

Financial

There are 441 ODSP dependent children (49%) living in single-parent households. 80% of these households are single mothers.

Caseload growth is coming primarily from singles – the number of ODSP dependents has decreased by 13% since 2003.

The District’s caseload is the highest in the province per capita, and has been since 2000. The caseload is basically remaining steady, having grown only marginally (1%) compared to Ontario (11%), in the past five years.

REPORT KEY FINDINGS FOR NIPISSING DISTRICT: General Caseload


The social housing in Sturgeon Falls and Mattawa does not include any modified (supportive) units, i.e., it can not accommodate people with physical disabilities.

7% of Nipissing’s caseload lives in areas where there is no social housing.

The use of the District’s shelters is on the rise, having increased 27% since 2003. The profile of user is also changing, with more shelter users having a mental illness.

Food Security

ODSP clients rely heavily on the local emergency food-supply network (food banks, soup kitchens, The Gathering Place, churches, etc.).

The minimum food expenditure required to meet nutritional requirements within the District, consumes on average, 24% of a clients income (depending on family structure & size).

The operating schedules of the local food security organizations do not always match the times of high client demand. 21% of the caseload lives in West Nipissing where the local food bank is only open 1 day a week, every 3 weeks.

Not all clients who are eligible for the special diet allowance are receiving it. This is mainly due to a lack of Doctors and Dieticians for referrals.

Transportation

For West Nipissing service providers, the biggest barrier to delivering client services is transportation. Many North Bay service organizations also struggle with transportation issues.

North Bay has limited bus schedules in areas that have relatively large numbers of ODSP clients. In particular, the West Ferris, Chippewa St. and Ski Club Rd. routes.

There is presently confusion amongst clients and service providers around the guidelines and eligibility, of North Bay bus discounts.

Clients and service organizations are not clear on what transportation costs are, or are not, covered by ODSP. The process of tracking and reporting costs is difficult for many clients.

REPORT KEY FINDINGS FOR NIPISSING DISTRICT: Housing continued

There is a lack of affordable (social) housing in the District. There are approximately 1,000 people on the central housing waiting list, of which 25% are ODSP clients. The waiting time for a 1-bdrm. apartment in North Bay is four years. There are an additional 50 + people with developmental disabilities who are waiting for group /family homes and approximately 55 people with serious mental illness (SMI) waiting for supportive housing.


Local trends are indicating more complex cases of mental illness requiring different types of programming.

Average waiting lists for therapeutic counseling (excluding fee-for-service) are 6 months.

There is a misunderstanding amongst clients and service providers as to the benefits covered by ODSP and the discretionary benefits covered by OW.

There appears to be a high need for dentures and orthotics and a lack of coverage. LIPI is the primary source of funding for dentures in Nipissing District, yet less than 0.5% of the caseload actually received dentures through LIPI in 2004 /05.

Counseling

Approx. 43% of Nipissing’s ODSP clients have serious mental illness (SMI), yet they lack access to therapeutic counseling (psychotherapy).

Nipissing District’s communities lack specific therapeutic counseling programs such as those for dual diagnosis and mild to moderate mental illness (MMI).

Service organizations in North Bay are not integrated and many work in silos. Communication, coordination and collaboration is lacking amongst service organizations.

While there is a lack of service in certain program areas (mental health, addictions, children programs, etc.), there are duplications in others (applications, child screening, referrals).

The ODSP system is difficult to understand and hard to navigate. Written communications are very technical and hard to understand. Accessing the ODSP office is difficult for clients.

Approximately 30% of the Nipissing child welfare clients who receive ongoing protection services are ODSP dependents.

Waiting lists at Algonquin Child & Family Services range from 1 to 8 months, depending on the type of program.

There is a lack of youth-transition programs in North Bay (i.e., youth at risk who will be leaving their home to move into the community on their own).

Benefits

REPORT KEY FINDINGS FOR NIPISSING DISTRICT: General Services, Child & Family Supports

Many clients are unaware of what services or support systems are available in the community.

There is no central point of access to information and services, for both clients and service organizations.


ODSP clients comprise 46% of the Nipissing Legal Clinic’s caseload.

DAU appeals account for 72% of the clinic’s time working with ODSP clients.

Other: Information, Data Collection & Research

Overall, there is a lack of information and knowledge transfer within the community, specifically:

i) There is a lack of evidenced-based data at the District and service-organization level, or to put it another way, there is a lack of accessible data that service organizations can use collectively, for measuring key indicators, outcomes and program /policy effectiveness. In some cases, organizations are reluctant to share information (including aggregate data) due to their internal policies (Information Protection Act, etc.).

ii) No one is monitoring trends, indicators and community data within a system framework (i.e., across multiple service areas or disciplines) – community partners and local planning tables are not benefiting from information dissemination.

iii) No one is monitoring and analyzing ODSP Beneficiary data at the District level on a regular basis. Additionally, ODSP-specific activities in other areas are either not being measured, or are being measured, but are not being monitored or analyzed. This includes social housing utilization and waiting list details, the use of shelters, the use of front-line crisis services such as LIPI, OW Special Benefits utilization & outcomes, OW referrals & outcomes and children services (subsidized childcare utilization and outcomes).

It appears that many clients do not have Doctors and thus can not get the referrals required, to apply for ODSP or access community programs and services.

Legal /Advocacy

Many clients reported waiting 1-2 years to get onto ODSP, and describe the process as very frustrating and complex.

Approximately 45% of Nipissing’s OW referrals are not granted ODSP.

REPORT KEY FINDINGS FOR NIPISSING DISTRICT: Assessment & Referral


RECOMMENDATIONS SUMMARY A note on the recommendations

The following is a summary of the recommendations that have emerged from this report. Some of these are at the provincial level, requiring a change in legislation and policy, and requiring resources to implement. Others are at the District level and present opportunities to act locally. Viewed from the perspective of ‘all at once’ the following list appears extensive. Viewed from the perspective of incrementalism however, the following recommendations could be prioritized taking into account cost and the impact on outcomes for the clients. There could also be a net benefit to the communities through an improvement in their general social infrastructure. The following recommendations are listed by the order in which they are found in the report, not by priority: 1. Recommendation: Ministry of Community and Social Services (MCSS) page 50

That the Ministry further explore the need for trustee programs within the District, and work with the relative community organizations to develop adequate, sustainable programs & services to meet the needs of clients (note: MCSS action is in progress).

2. Recommendation: MCSS (page 52, see also #8 on next page)

Increase ODSP incomes, based upon an index of average household expenditures (LICO or market basket measure). Alternatively, make changes to the Shelter Maximum which better reflects the national components of core housing need (affordability, suitability & adequacy), and provide a food allowance in addition to Basic Needs.

3. Recommendation: MCSS (page 60) Review the current ODSP Shelter Maximums:

i) With the view of making the shelter maximums more reflective of the local housing markets. Also, to align the shelter maximums to the national components of core housing need (affordability, suitability and adequacy). ii) With the view of considering a different scale for clients who are not able to access social housing or any affordable housing programs, and who are paying market rent. The initial focus should be on single clients as this is where the largest affordability gaps are (for example, the shelter maximum for one person is $427 /mo. and yet the average rent for a 1-bdrm. apartment in Ontario’s 11 CMA’s is $774 /mo.).

4. Recommendation: Ministry of Health & Long Term Care (MOHLTC) page 65

i) That the Ministry of Health and Long Term Care review their benchmarks for housing supports in Nipissing District. These benchmarks should consider not only population, but actual prevalence, which takes into account Nipissing District’s large ODSP caseload. ii) That based upon this review, a plan is developed and implemented that will establish adequate supported /supportive housing capacity in Nipissing District.


RECOMMENDATIONS SUMMARY cont’d. 5. Recommendation: DNSSAB & MCSS (page 66)

Streamline the existing shelter reporting format, so that specific information is captured (such as user profile), beyond that which is needed for policy conformance and reports. This will facilitate effective planning for programs and services, as well as provide measurements for the monitoring of program effectiveness (results).

6. Recommendation: MCSS, MMAH, MOHLTC (page 69)

That the Ministries review the present Strong Communities Rent Supplement Program funding allocations for Nipissing District, with the view of reducing the waiting lists (Table 13, page 63). This should include providing support-services funding that matches the rent-subsidy funding.

7. Recommendation: MCSS (page 69) That the Ministry enhances its Homelessness services and increases the

Community Homelessness Prevention Program (CHPP, previously PHIF), specifically the Housing Guarantee Program and the Community Housing Transitional Support Worker program.

8. Recommendation: MCSS (page 72)

Increase the basic needs benefit by an amount that will decrease the clients’ food-to-income ratios to that of the District’s median, or approximately 10% of income. Calculations would probably show that this approaches the Low Income Cutoff Levels.

OR Create a food allowance which would be added to the basic needs and shelter allowance. This allowance would be indexed to the local nutritious food basket (published annually by Ontario’s Public Health Units) and would change as the family moves through its life cycle. The food allowance could be calculated through a weighted index, and could either be administered as a separate benefit or added into basic needs.

9. Recommendation: MOHLTC (page 74)

It is recommended that funding be secured for a Coordinators position for the Food Security Advocacy Group. With this staff position, the organization could move forward on many of the local food issues and work towards establishing a Food Charter for Nipissing District.


“….Some clients should be on a special diet under the guidance of a Dietician but they need a Doctor’s referral to do so. The problem is, many do not have Doctors”. The Ministry should meet with health professionals to discuss the extent of this issue and if warranted, look at possible solutions that could be implemented.


RECOMMENDATIONS SUMMARY cont’d. 11. Recommendation: Municipality of West Nipissing (page 82)

Conduct a feasibility study on extending the Para-Bus into West Nipissing. 12. Recommendations: MCSS (page 84)

Provide resources to a lead agency for the development and implementation of a Community Transportation Program. The program would utilize a staff and volunteer network of drivers, and would be evaluated on its effectiveness in meeting client needs, as well as specific performance measures;

OR Expand an existing service such as Para-Taxi to be more inclusive (i.e., move beyond just the physical disability aspect) and handle larger volumes of clients during the times of greatest need. This service would also be extended into West Nipissing.

13. Recommendation: City of North Bay (page 86)

That North Bay City Council reviews the following transportation issues through its Municipal Accessibility Advisory Committee, specifically: 9.2 (page 82): Limited bus schedules (no Sunday service) in areas where there are relatively large number of ODSP clients living (particularly the Lakeshore, Chippewa and Ski Club Rd. routes) 9.3 (page 84): The issuing of bus discounts to people with disabilities: current policy, procedure and eligibility criteria.

14. Recommendation: DNSSAB or MCSS (page 90)

Identify an organization that will take the lead in producing an annual Community Services Directory for People with Disabilities in Nipissing District, and fund this organization annually. The annual budget for this directory should be based upon production (overheads and direct costs), distribution (to community service organizations and clients throughout the District, and which may involve multiple mediums such as print, web based, and alternative formats for the disabled population) and maintenance (updates & improvements: quarterly, bi-annual, etc.).

15. Recommendation: North East LHIN (Local Health Integration Network) page 93

Under the LHIN’s mandate to plan, integrate and fund local health services: i) That the LHIN identifies the resources necessary to implement a community service integration model in Nipissing District, when developing its Integrated Health Service Plan with input from the community. ii) That within the above plan, LHIN develops and implements a fast-track strategy for Nipissing District which would accelerate the implementation of this service integration model (i.e., action items are being completed within 6-9 months.)


RECOMMENDATIONS SUMMARY cont’d. 16. Recommendation: DNSSAB (page 93)

That DNSSAB reintroduce and sponsor the type of networking event for service organizations and Ministries that occurred in the past. Example: a breakfast or luncheon held every 4 months. This includes providing the resources and organization for these events, on a regular basis.

17. Recommendation: DNSSAB (page 94)

That DNSSAB facilitates an initial forum with community service providers to check on the interest in, and viability of, forming a type of network /planning committee. The objective of this committee would be to move forward on integrative community services for the disabled population (see also # 15).

18. Recommendation: DNSSAB (page 96) In keeping with the new direction taken by the MCSS with regards to research and the development of its new Municipal-Provincial Research Network, that DNSSAB work with the Research Network towards developing and enhancing, community-based service data. This data would be used by Ministries, Municipalities, public agencies and community service organizations for evidence-based, policy & planning purposes.


That within its communication strategy, the Ministry considers holding regular community forums that will provide information about core services and Directives (such as Benefits). This could be in conjunction with its new Community Agency Network or with the networking group above (Recommendation #16).

20. Recommendation: DNSSAB (page 102)

That OW start manually tracking ODSP clients who apply for Discretionary Benefits (particularly dentures & orthotics), and the outcome.

21. Recommendation: DNSSAB & MCSS (page 102)

As there is a gap in coverage for dentures and orthotics, a review should be undertaken by DNSSAB & MCSS regarding their respective Discretionary and Special Benefits. As LIPI’s present Community Fund is insufficient for meeting the needs of clients, the review should include an estimate of the present shortfall and how it will be made up. Invariably this review will also involve reviewing the present Municipal contributions, and cost-sharing arrangements with the province.

ii) Regarding dentures, MCSS may want to check if this is a problem elsewhere

in the province - if it is, then an internal review of Policy Directive 9.7 would seem appropriate (i.e., consider including dentures under the dental benefits administered by the Ontario Dental Association). Additionally, this review should re-visit the exclusion of ODSP Dependent Adults from dental benefits.


RECOMMENDATIONS SUMMARY cont’d.

22. Recommendation: MCSS (page 104) i) For new ODSP clients who have been diagnosed with SMI, provide them with

access to therapeutic counseling services – these sessions can go a long way towards helping the clients, who otherwise may not have the opportunity for professional psychotherapy.

ii) Consider adding therapeutic counseling services to the Special Benefits program –this would provide access to services for clients who have a mental illness, but who do not fit one of the existing streams and cannot afford pay-per-use therapeutic counseling services.

iii) Communicate more effectively with the MOHLTC regarding funding for people with mental illness. This includes consolidating resources so there are no program duplications and ensuring that all those with a mental illness can receive effective therapeutic counseling. This also entails recognizing that clients will cross-over between separately funded (i.e., different ministry) programs. By making these funding and program changes, the Ministry can start to change the present service delivery culture of “who are you funded by and what’s your mandate” to “it’s o.k. to step outside the boundaries to serve the client”.

iv) Recognize the difference between the psychological and psychiatric needs of clients and design policies and programs accordingly. Central to the development of these programs would be the notion of access to effective therapeutic counseling for all clients with mental illness.

23. Recommendation: MCSS & MOHLTC / North East LHIN (page 107)

As the primary funders of therapeutic counseling services, the ministries should meet with Nipissing District’s mental health community services to discuss the lack of access to counseling programs and the lack of programs, and identify solutions and resources.

24. Recommendation: MOHLTC /North East LHIN page 107 (see also Recom. #15)

In partnership with the mental health service community, create a Gateway to Services for mental health services in Nipissing District. This would provide a central point of access for information, referrals, treatment and prevention.

25. Recommendation: MOHLTC (page 110)

i) That the Ministry of Health further research the issue of many ODSP clients not having a Doctor – good questions to start with are: how many of the 217,000 + Ontarians presently on ODSP, have Doctors? How many in the North have Doctors, compared to other Ontario regions? If the disabled population is disproportionately represented in Ontario’s Physician caseload, then Ontario’s health care system has one more important aspect to consider….. ii) That the Ministry of Health meet with representatives of Family Physicians, service providers and other key stakeholders, to discuss the implications of, and possible solutions for, ODSP clients who do not have family Doctors.


TABLE OF CONTENTS

1.0 BACKGROUND. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Section I 2.0 GOVERNMENT POLICY FRAMEWORK. . . . . . . . . . . . . . . . . . . . . . . . . . . 19 3.0 DISABILITY. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 3.2 Ontario Disability Support Program (ODSP)……………………………… 27 4.0 Section II: Present Caseload, Dependents and Beneficiaries 4.1 ODSP Beneficiaries…………………………………………………………. 30 4.2 ODSP Caseload, Family Structure………………………………………… 31 4.3 ODSP Dependents………………………………………………………….. 32 5.0 ODSP TRENDS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 5.1 Rate & Growth……………………………………………………………… 34 5.2 Factors Affecting the Caseload Trend……………………………………. 35 5.3 Caseload & Dependents…………………………………………………… 39

Section III: Service Areas Reviewed 6.0 FINANCIAL SUPPORTS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 6.1 Income……………………………………………………………………….. 43

i) Low Income Cutoff (LICO)……………………………………….. 43 ii) Employment & Earnings………………………………………….. 44 iii) Disposable Income………………………………………………... 47

6.2 Financial Management……………………………………………………... 49 6.3 Community Costs…………………………………………………………… 50 6.4 ODSP Changes in Progress………………………………………………. 52 7.0 HOUSING. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 7.1 Core Housing………………………………………………………………... 55 7.2 Affordability Gaps…………………………………………………………… 56 7.3 At Risk……………………………………………………………………….. 59 7.4 Affordable Housing Supply………………………………………………… 60

i) Social Housing a) Location…….…………………………........... 60 b) Demand………………………………………. 62 ii) Other Housing: a) Supportive /Supported………………………. 64 b) Shelters……………………………………….. 65

7.5 Canada-Ontario Affordable Housing Program (AHP)…………………... 67 7.6 Strong Communities Rent Supplement Program……………………... 68 7.7 Stigma & Discrimination…………………………………………………… 69 8.0 FOOD SECURITY. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 8.1 Income and Food………………………………………………………… 71 8.2 Present Emergency Food System, Nipissing District………………… 73 8.3 Nipissing Food Security Programs: Growth, Trends, Data…………… 74

i) Food Concerns for Dependent Children…………………………. 75 8.4 Special Diet Allowance……………………………………………………. 76 8.5 Food Supply………………………………………………………………… 77 8.6 Transportation……………………………………………………………… 78 9.0 TRANSPORTATION. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 9.1 Lack of Transportation, Service Provider Perspective ………………….. 81

i) West Nipissing & Other Areas……………………………………... 81 9.2 Limited Bus Schedules: North Bay ……………………………………….. 82


TABLE OF CONTENTS

9.3 Bus Discounts: North Bay ………………………………………………….. 84 9.4 Municipal Accessibility Advisory Committee (MAAC): North Bay……….. 85 9.5 Transportation Expenses …………………………………………………... 86

10.0 GENERAL SERVICES, CHILD & FAMILY SUPPORTS . . . . . . . . . . . . . . . 87 10.1 General Services …………………………………………………………… 89

i) Client Awareness……………………………………………………... 89 ii) General Services, Key points……………………………………….. 90 iii) Lack of Programs…………………………………………………….. 94 iv) Resources…………………………………………………………….. 94

10.2 Child & Family Supports…………………………………………………… 94 i) Algonquin Child & Family Services…………………………………. 95 ii) North Bay Crisis Centre……………………………………………... 95

11.0 SPECIAL & DISCRETIONARY BENEFITS . . . . . . . . . . . . . . . . . . . . . . . . . 97 11.1 Alignment & Barriers……………………………………………………….. 98

i) Process………………………………………………………………… 98 ii) Communications……………………………………………………... 100

11.2 Gaps: Lack of Coverage…………………………………………………… 101 i) Dentures……………………………………………………………….. 101 ii) Orthotics……………………………………………………………….. 101

12.0 COUNSELING . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 12.1 Barrier: Lack of Access to Therapeutic Services…..……………………… 104 12.2 Gaps: A Lack of Specific Therapeutic Counseling Programs……………. 105 13.0 ASSESSMENT & REFERRAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108 13.1 Lack of Doctors for ODSP Clients.………………………………………….. 108 13.2 ODSP Application Process………………………………………………….. 110

i) Lengthy Process……………………………………………………… 110 ii) Appeals………………………………………………………………… 112

14.0 LEGAL / ADVOCACY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114 15.0 CONCLUSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116

APPENDIX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118 i ODSP Rate Chart…………………………………………………………………. 118 ii Nutritious Food Basket (North Bay, Parry Sound)…………………………….. 119 iii Terms of Reference………………………………………………………………. 120 iv ODSP Client Focus Group Guide……………………………………………….. 126 v Reference Committee Survey…………………………………………………… 128 vi Community Services Inventory Questionnaire…………………………………. 129 vii Community Consultations, Break-out Sessions……………………………….. 131


LIST OF TABLES & FIGURES I Figure 1A: VRDP & EAPD Federal-Provincial Expenditure: ON 1979 – 2003. 24 Figure 1B: MCSS Estimated Expenditure (Income & employment), Ontario... 25 II Table 1: Present ODSP Caseload, Dependents & Beneficiaries……………... 30 Figure 2: ODSP Beneficiaries, Nipissing District……………………………… 31 Figure 3: ODSP Caseload by Family Structure…………………………………. 32 Figure 4: Caseload with Dependents…………………………………………….. 33 Table 2: ODSP Caseload for Nipissing District & Ontario, Dec. 2000 – 2005. 34 Figure 5: Caseload Trends, Nipissing District…………………………………... 36 Table 3: ODSP Caseload & Population, Nipissing & Ontario 2000 – 2005….. 37 Figure 6: Factors Affecting the Caseload Trend………………………………... 39 Figure 7: ODSP Trends: Caseload & Dependents, 2002 – 2004…………….. 40 Figure 8: ODSP Trends: Singles without Children, 2002 – 2004……………... 40 Figure 9: ODSP Trends: Caseload Family Structure, 2002 – 2004…………... 41 III Table 4: Key Points from Focus Groups & Community Consultations……….. 42 Table 5: ODSP Income Scenarios and Low Income Cutoff (LICO)………… 44 Figure 10: Low Income Cutoff Gaps for ODSP Families, Nipissing District…. 44 Table 6: ODSP Caseload with Earnings, Nipissing District……………………. 45 Figure 11: Chart for above table…………………………………………………. 45 Table 7: STEP Calculations………………………………………………………. 46 Table 8: ODSP Disposable Incomes in Nipissing District……………………… 48 Figure 12: District ODSP Caseload and Municipal Levy………………………. 50 Table 9: Key Points from Focus Groups & Community Consultations……….. 54 Figure 13: ODSP Families by Number of Children, Nipissing District………... 56 Figure 14: ODSP Dependents Age Structure, Nipissing District……………… 57 Table 10: Housing Affordability Gaps……………………………………………. 58 Table 11: ODSP Clients at Risk, Nipissing District……………………………... 59 Figure 15: Social Housing by Area, Nipissing District………………………….. 61 Figure 16: ODSP Caseload by Area, Nipissing District………………………... 61 Table 12: ODSP Caseload by Area, with no Social Housing………………….. 62 Table 13: Housing Waiting List Summary……………………………………….. 63 Table 14: Shelters in Nipissing District, 2005…………………………………… 65 Table 15: Nipissing District AHP Funding Allocations, 2006………………… 67 Table 16: Key Points from Focus Groups & Community Consultations……… 70 Table 17: Food as a proportion of ODSP Income, Nipissing District…………. 71 Table 18: Food Cost as a % of Income, Income Distribution Quartiles………. 72 Figure 17: Trends, The Gathering Place & The North Bay Food Bank………. 75 Figure 18: Children Food Hunger, North Bay…………………………………… 76 Table 19: Local Food Security Organizations & Schedules…………………… 78 Tables 20-22: Key Points from Focus Groups & Community Consultations… 80,87,97 Figure 19: ODSP Caseload by Location, Nipissing District …………………… 81 Figure 20: North Bay ODSP Caseload, Area of Residence …………………... 82 Figures 21-23: Lakeshore, Chippewa, Ski Club Rd. Bus Route ……………… 83 Table 23: Intent of Policy by Benefit Type………………………………………. 100 Tables 24-26: Key Points from Focus Groups & Community Consultations… 103-114 Figure 24: Geographic Distribution of Physicians in Canada ………………… 109 Figure 25: OW Referrals to ODSP, Nipissing District 2003 -2005……………. 112 Figure 26: Nipissing Legal Clinic: ODSP Case Type, 2005…………………… 114


1.0 BACKGROUND 1.1 District of Nipissing Social Services Administration Board (DNSSAB) Social services are administered in Nipissing District by Federal and Provincial Governments, the District of Nipissing Social Services Administration Board (DNSSAB) and community organizations, agencies and associations. In 1999, the Provincial government created 47 Service Managers throughout the Province, to accommodate the devolution of social services to the Municipal level. The DNSSAB is the Service Manager for Nipissing District, and is funded through a cost-sharing arrangement between Provincial Ministries, Member Municipalities and DNSSAB. DNSSAB administers Ontario Works, childcare, social housing and emergency medical services. Additionally it co-funds the Ontario Disability Support Program (ODSP) and provides discretionary benefits to ODSP recipients. The DNSSAB is governed by a Board of Directors comprised of 12 elected Municipal Officials, and has offices in North Bay, West Nipissing and Mattawa. Additionally, it operates part-time resource centers in Mattawa, Bonfield, Whitney and Temagami. 1.2 Nipissing District ODSP Caseload Report In April 2005, a report was released to the DNSSAB titled Nipissing District ODSP Caseload: An Analysis by Area of Residence, Age, Family Status and Primary Disability (Ministry of Community and Social Services, Ministry of Children and Youth services). This report identified a rate of disability within the District of Nipissing, which is more than twice the rate for Ontario, and is the highest in the province. The following are summarized, key findings of the report:

The Nipissing caseload is generally younger than the provincial average: a greater percentage of ODSP recipients are aged 25-54, while there is a smaller percentage aged 65 years or older:

ODSP Caseload, Nipissing District & Ontario

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

Nipissing District Ontario

Adults (18+)Children (17-)

Nipissing District has a caseload of 3481 people (age 18+) on ODSP support - more than twice the rate for Ontario and the highest in the province. There are an additional 922 children (under age 17) who are ODSP beneficiaries, which is three times the provincial rate.

ODSP Caseload by Age Group, Nipissing District and Ontario

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

18-21 22-24 25-34 35-44 45-54 55-64 65+

Nip.Ontario


ODSP Caseload by Area, Nipissing District

70%

1% 1% 7%

21%

North Bay North South East West Nipissing

0%

5%

10%

15%

20%

25%

Psychosis Neurosis

ODSP Mental Disability, Nipissing District and Ontario

Ontario Nipissing

Approximately 44% of the District’s ODSP caseload Approximately 91% of the District’s ODSP caseload is has a mental disability (psychosis or neurosis). This is approximately 8% higher than the provincial rate.

following up on this report, DNSSAB has conducted a community services review, in

.3 The District of Nipissing.

Incollaboration with community service providers, partners and ODSP Stakeholders. 1

of Nipissing is the oldest of the ten (10) Districts that 1 00

on

ity

ne Districts are Algoma, Cochrane, Kenora, Manitoulin, Parry Sound, Rainy River, Sudbury,

2.

4.nquin, Township of C lm,

he

Established in 1858, the Districtpresently make up the region of Northern Ontario. With an area of approximately 17,0square kilometers, the District spans North to Temagami, South to South Algonquin, West to West Nipissing and East to Mattawa. Although sparsely populated when compared to Southern Ontario, the District has approximately 5 people /sq. km. whicha District basis, is the highest density in the North.2 In 2001, the District’s population was 82,910 or approximately 10% of Northern Ontario.3 Nipissing District is comprised of eleven (11) Municipalities, two (2) Territories Without Municipal Organization (TUMO) and two (2) First Nations.4 With 62% of the Districts population (52,000 people), the Cof North Bay is the largest urban centre, followed by West Nipissing with approximately 16 % of the population (13,000 people).

in North Bay and West Nipissing (70% and 21% respectively). The remaining 9% is in the District’s Northern, Southern and Eastern outlying areas.

1. The other niThunder Bay and Timiskaming. The District of Muskoka was considered a part of Northern Ontario, but no longer is.

This excludes The Greater Sudbury Division which is a CMA, and has a density of 44 people /sq. km. 3. A present estimate of the District’s population (2005) is approximately 85,760. However, this is a post-

censal estimate that is based on the 2001 census count, and adjusted for census undercoverage and estimates of the components of demographic change, since the last census. Certain analysis within thisreport will refer to census 2001 populations and other analysis will refer to the more recent population estimates – whichever is being used will be clearly stated.

The municipalities include the City of North Bay, Township of East Ferris, Township of Bonfield, , Town of Mattawa, Township of South AlgoMunicipality of West Nipissing hisho

Township of Papineau-Cameron, Temagami, Township of Calvin, and the Township of Mattawan. TTUMO’s are Nipissing North & South. The First Nations are Nipissing 10 and Temagami First Nation – Bear Island.


SECTION I

RNMENT POLICY FRAMEWORK

s this is a review of community services for recipients of the Ontario Disability Support

the

ment

he following is a summary on the Government’s legislative environment for disability in

elivery

.1 Government Legislation, Policy and Political Environment

2.0 GOVE AProgram (ODSP), it would be beneficial to review the “disability” environment in general, including the Government legislative & policy framework, and the definition and general characteristics of disability. The District’s community service system for ODSP recipientsis in many respects, a reflection of policies, planning and initiatives that have been undertaken at the provincial and federal levels. Similarly, there are certain socio-economic characteristics that are shared by many people with disabilities across country. Looking at the bigger picture puts the local environment into context, and provides further understanding of the District’s community services, and the environin which they are delivered. Tgeneral. It should be noted that there is an additional perspective on disability legislation from the NGO’s (Non Government Organizations), at the federal, provincial and community levels. The Government framework however, sets the stage for the dof disability programs and services and establishes the level of supports for clients. Thusto put the District’s ODSP system into perspective, a historical review of Government disability policy is most effective. 2The Vocational Rehabilitation of Disabled Persons Act (VRDP) was implemented in

g

d

dent living movement in the early 1970’s greatly increased the profiles of

Pension Plan Disability (CPP-D) is currently the largest, long-term disability income program

2. mentary assistance on the basis of need could also be provided to persons under three prior programs: Old Age Assistance Act (1952), Blind Pensions Act (1937) and Disabled Persons Allowances Act (1954).

Canada in 1962, and provided the initial framework for helping those with disabilitiespursue education and /or find meaningful work. Under the 50 /50 cost sharing VRDP, Federal and Provincial Government programs were established to provide programminfor the vocational rehabilitation of people with disabilities. Following in 1966, the Canada Pension Plan was established, which later included disability benefits to contributors who became unable to work because of disability.1 Prior to this, assistance was limited to individual Government programs that included; benefits for disabilities due to injury atwork (workman compensation programs; 1915), pensions for persons in the armed services who suffered “demonstrated residual disability resulting from any war-relateactivity” (War Veterans Pension Act, 1919) and benefits for “unemployables cared for inpublic institutions” (Unemployment Assistance Act, 1955.)2

The indepenCanadian disability individuals and organizations, and advanced their activities into thepolitical arenas.

1. The Canadain Canada. Similar to the Government’s disability employment and income support programs, the disability benefits from the CPP have been the subject of many reports and studies over the years, with subsequent proposals for reform.

Under this act, supple


The civil rights movement and disability-lobbying activities south of the border (with the turn of Vietnam Veterans) also greatly influenced the Canadian disability landscape. re

Prior to these events, the voice of Canada’s disabled population had little effect within

artisan

s p

existing

th disabilities in the Canadian Charter of Rights and reedoms.5 This had a significant impact on the future lives of people with disabilities, as

an Rights and the tatus of Persons with Disabilities. These included the Pathway to Integration report

in

tral

tive involvement in disability related ember 3 is now recognized annually as the International Day of Disabled Persons.

e

5.

ing persons with disabilities in the ged

social policy-setting domains and advocacy activities netted minimal results. The International Year of Disabled Persons in 1981 is considered by many, to be the turningpoint on disability issues and pivotal in the advancement of Canadian disability policy and legislation.3 In respect of this year, the Canadian Government formed a non-pSpecial Committee on the Disabled, to perform an extensive review of Federal legislation pertaining to persons with disabilities. The outcome of this initiative was theproduction of the Obstacles Report which paved the way for the concept of “full citizenship” and inclusion, for persons with disabilities.4 In response to the recommendations made in the Obstacles report, a Federal-Provincial working group waestablished to conduct an extensive study into disability income reform. The grouproduced different costing scenarios and made proposals for changing theearnings and income support programs (these proposals were listed in a Joint Federal-Provincial Study released in 1985). Another significant event in the disability-movement that also occurred in 1981 was the recognition of the rights of people wiFit firmly entrenched their rights into the Canadian constitution. During the early nineties, key Government reports were produced on disability issues and policy, under the parliamentary standing committee on HumS(mainstream review 1992) and the Social Security Review (1994). Common themes within these studies were the marginalization and societal exclusion of persons withdisabilities, disparity in social and economic status (compared with the non-disabled population), and lack of accessibility to public services. At the First Ministers meetingJune 1996 (as part of the social renewal process), the Prime Minister and Premiers established a national priority of addressing the needs of people with disabilities. Cento this direction was the acknowledgment that Governments need to work together in helping people with disabilities participate fully in society.

3. This was followed by the United Nations declaration of the International Decade of Disabled Persons (1983–1992) which further stimulated the Government of Canada’s ac

rdissues. Dec

4. Ref: Obstacles, Report of the Special Committee on the Disabled and the Handicapped, Feb. 1981. The Obstacles report dealt with two major kinds of obstacles faced daily by over 2 million Canadians; the first being the deprivation of good health and use of facilities which other Canadians take for granted, and thsecond being the attitudes of non-disabled Canadians, who tend to disregard the needs of the disabled, when planning Canada’s protection of human & civil rights, health care services, employment opportunities, and general facilities and systems such as housing, shopping, education, recreation, communication and transportation. The report was considered groundbreaking as it consulted people with disabilities for the first time. The report put forward 130 recommendations and encouraged Canadians to embrace the principles of participation, responsibility and self-help.

The original version of the charter (proposed by the Government in 1980) did not mention disability in Section 15, which included “protection against discrimination on the basis of sex, race and religion”. Disability groups and individuals recognized the importance of includcharter, and lobbied intensively for charter inclusion. In January 1981, the Canadian Government chanits position, and added those with disabilities, into section 15 of the Canadian Charter of Rights and Freedoms.


Lre ole in the area of disability.6

their commitment to people with disabilities, and engaged in a ultilateral process to review the existing VRDP system and investigate means for

ed ich

vision and framework for guiding future policy form. The result of this collaborative effort was the production of In Unison, A

f

tween

ithin Canada. Not only does e agreement provide shared principles and approaches between Governments, it

s.

n

sistance for People with Disabilities (EAPD) Agreement

ater that year, the Scott Task Force Report was released, complete with 52 commendations made to the Federal Government, on how to improve the federal r

In February 1997, the Government of Canada and the Governments of the Provinces and Territories continuedmimprovement. While the program is considered to have generally improved the lives ofthose with disabilities up to this point, many agreed that it had shortcomings in terms of improving the labor market and economic participation of the disabled population in Canada. By October of the same year, a multilateral framework was approved by Ministers responsible for social services and in 1998, the new Employability Assistance for People with Disabilities (EAPD) initiative was implemented. This program respondto the needs outlined in the Scott Task Force, and replaced the VRDP program whhad been in use for the past 35 years. Also of significance in 1997 was a meeting with the Federal, Provincial and Territorial Ministers of Social Services to develop areCanadian Approach to Disability Issues. In Unison built upon the work of the previous reports (mentioned earlier) and created a shared vision and policy framework that wouldpromote full citizenship for Canadians with disabilities. Based upon the values oequality, inclusion and independence, In Unison established objectives and policy direction within three core areas of disability supports, employment and income. In Unison is still considered a key document for promoting dialogue and planning bethe disability community, stakeholders and Governments.7

The signing of the Social Union Agreement in 1999 was a significant event which provided a major framework for advancing social policies wthrecognizes that the first priorities are children in poverty and persons with disabilitieWorking within this framework, the Federal Government produced Future Directions to Address Disability Issues for the Government of Canada: Working Together for Full Citizenship (1999). This was a policy statement that set out future direction based upothe In Unison report, and it also outlined present gaps, areas for improvement and performance record. 2.1 i) Employability As

The EAPD was implemented in April 1998, in recognition of the fact that changes were ilities.

7. It

nted to key stakeholders from the disability community, and revised to reflect this additional

needed in order to better respond to the challenges faced by people with disab 6. This report is also known as Equal Citizenship for Canadians with Disabilities: The will to act. It was

commissioned by the Ministers of Human Resources Development Canada (HRDC), Finance, Justice and National Revenue, and involved extensive consultations with the disability community (HRDC was the project lead.)

. Quebec did not participate in the development of the In Unison document, as it wanted to retain control over its disability programs. In Unison was reviewed and approved by the First Ministers in March 1998was then preseinput. In Unison 2000 was released as a follow-up report, building upon the vision and framework of In Unison 1998.


Aaa hrough the funding of provincial programs and services, which supported

g

, ers

5-year period, from 1998-2003. The

greements were based on a 50 /50 cost-split, with the federal contribution set at $168

ng Term Care OHLTC) and the Ministry of Community and Social Services (MCSS). The Ontario

The Labour Market Agreements for ersons with Disabilities (LMAPD) basically emphasized the same areas as the EAPD

ing

s the name of the program suggests, EAPD was designed to focus on employability nd enhancing the economic participation of those with disabilities. This would be ccomplished t

people with disabilities to enter, and stay in the workforce. The EAPD program also would provide services and support to those with disabilities who were experiencinvocational hardships. The EAPD was a unique program when compared to those of the past, in that it provided an increase in accountability, both at the consumer level (i.e.those with disabilities) and at the general public level (the general public and consumcould now access the performance results of EAPD, thereby helping to ensure efficient funding allocation and program effectiveness). Within the EAPD’s multilateral framework, bilateral agreements between the Federal andProvincial Governments would be in effect for a 8

amillion annually. While each province was required to adhere to the broad objectives of EAPD, programming could be flexible and tailored to the individual provinces, so as tomeet the local needs of persons with disabilities and the labour markets. Within the first year of implementation, Ontario was delivering ten (10) programs under the EAPD agreement, through two ministries: the Ministry of Health and Lo(MDisability Support Program (ODSP) was one of these programs, and was implemented in 1999, thereby replacing the Family Benefits Act. In December 2003, the Canadian and Provincial Governments endorsed a new multilateral agreement to renew the existing EAPD. Pbut went into more detail in terms of accountability (annual reporting) and identifyoperational parameters such as areas of priority and performance indicators. 2.1 ii) Labour Market Agreements for Persons with Disabilities (LMAPD) The Labour Market Agreements for Persons with Disabilities (LMAPD) replaced the

by the Federal of improving

,

f ment Canada. Bilateral agreements with the provinces are based on a 50

0 cost sharing basis, with the Federal Government allocating $223 million /yr.9

8programming, in order to reflect the new focus on employability under the EADP initiative – this transition period was extended by one year (to March 31, 2002).

9. The initial Federal contribution under the LMAPD was $193 million, of which, $63 million was allocated for Ontario. This was increased to $223 million in the March 04 Federal budget.

EAPD in December 2003, and is the present multilateral framework used and Provincial Governments, to deliver disability programs. With the goal the employment situation of people with disabilities, by enhancing their employabilityincreasing the employment opportunities available to them and building on the existing knowledge base, the LMAPD built upon the successes of the former EAPD, while soliciting new input from the disability community, business & labour and aboriginal organizations. Implemented in April 2004, the LMAPD is administered by the Federal Department oSocial Develop/5 . A 3-yr. transition period was initially established to facilitate the provinces adjusting their present


Government reports on disability issues have continued, with the release of Advae Inclusion of Persons with Disabilities in 2002. As research indicated that people with

isabilities were still facing barriers to full partici

ncing thd pation in society, this report was

m of Persons with

undertaken by Human Resources Development Canada to review things further and ake improvements. A follow up report, Advancing the Inclusion

Disabilities (2004) expanded the framework presented in the original report, by includinginput obtained through numerous disability stakeholder consultations.

2.2 Provincial Policy and Legislation

While the above summarizes Federal-Provincial disability policy frameworks and gislation, the province of Ontario has also had its own policies and agle

dendas for the

elivery of social assistance, including disability-related programs.

as no provincial responsibility for poor or disabled elting

ernment recognized e need to extend assistance to those who were suffering hardship, and the first

was

d

on”) he

into the ntario Legislature. SARA replaced the existing General Welfare Assistance Act

l any

rce

Similar to the national picture, there wpeople leading into the early 1900’s. Jails and “houses of refuge” were used as mpots for diverse segments of the population that were destitute or enduring hardships. After the Great Depression in the 1930’s however, the provincial govthpolicies of aid were introduced. These policies were based upon the notion of “work in exchange for assistance” and varied from city to city. By the late 1960’s, there were two primary social assistance programs in effect in Ontario: the Family Benefits Act (FBA, 1967) and the General Welfare Assistance Act (GWA, 1958), and the responsibility for these programs was shared between the province and the municipalities. The FBAa provincial responsibility, and was intended to serve those requiring long-term support and who were deemed “unemployable” (specifically disabled people and single mothers). The GWA was administered and co-funded by the municipalities and targete“employable” people who were in need of short-term /crisis assistance. In 1986, the provincial Government established a Social Assistance Review Committee which conducted a comprehensive review of the above FBA & GWA programs. The result of this study was the Transitions report, complete with 247 recommendations. In 1995, the incoming Government (elected on a platform of “common sense revolutimade sweeping reform changes to social assistance programs in Ontario. One of tmost notable changes was an immediate 21.6% reduction in welfare rates (excluding disability). In 1997, the Social Assistance Reform Act (SARA) was introduced

10O(GWA) and the Family Benefits Act (FBA) with two new policy directives: Ontario Works (OW) and the Ontario Disability Support Program (ODSP). Under these changes, recipients of the Family Benefits Act were grandfathered in to the new ODSP while recipients of the General Welfare Assistance Act, and single parents receiving financiasupport from FBA, were transferred into Ontario Works. While SARA incorporated mchanges, one of the most notable was the elimination of the Permanently Unemployable (PUE) category, and the recognition that everyone would benefit from the labour foparticipation of disabled people and single parents. 10. SARA was a part of the incoming Governments election platform which included overhauling Ontario’s

30-yr. old social assistance programs by tightening up eligibility requirements, introducing workfare, reducing welfare fraud to zero and introducing a separate income & support program for persons with disabilities.


In December 2001, the Provincial Government passed the Ontarians with Disabilities Act r Bill 125, with the purpose of improving the opportunities for persons with

preBill e

e

y

(ODA) undedisabilities, and to provide for their involvement in the identification, removal and

vention of barriers to their full participation in the life of the province.11 Unfortunately 125 was criticized on a number of points which included: not adequately involving th

disability community; it only applied to the public sector; for not making the prevention and removal of barriers mandatory and for not being enforceable. In 2004, the recently-elected Government introduced the Accessibility for Ontarians with Disabilities Act (AODA), which became legislated the following year under Bill 118. This had a much broader scope than the previous legislation and included: achievement timelines, mandatory access standards and enforceability. Also under this act, an Accessibility Standards Advisory Council has been formed to advise the Minister of Community and Social Services on the development of accessibility standards, as well as assist with theimplementation of the AODA. Prior to this and dating back to 1994, the ODA Committehad been the primary advocate for “a new law that would result in a barrier-free societfor persons with disabilities”. 2.3 Government Funding

The Federal Government’s disability policy framework that has evolved over the years has clearly been enthusiastic and progressive as summarized earlier. The chart below hows the level of Federal-Provincial expenditure on the VRDP and EAPD programs om 1979 to 2003:

sfr Figure 1A: VRDP & EAPD Expenditure, 1979 - 2003

VRDP & EAPD Federal-Provincial Expenditure: Ontario, 1978-79 to 2002-03

$180,000,000

$160,000,000

$0

$20,000,000

$40,000,000

$60,000,000

$80,000,000

$100,000,000

$120,000,000

$140,000,000

1978-79

1980-81

1982-83

1984-85

1986-87

1988-89

1990-91

1992-93

1994-95

1996-97

1998-99

2000-01

2002-03

Expe

nditu

re ($

)

Data source: Social Programs Development Division, Human Resources Investment Branch, Human Resources Development Canada (HRDC). 11. Under this act, provincial & municipal governments are required to develop annual accessibility plans

which are available to the public. These plans will encourage the review of polices and programs while in their own Government services). essibility Advisory Committees.

addressing disability access and barrier issues (including withccAdditionally, Municipalities are required to form Municipal A


Since the late 70’s, disability program-expenditure increased annually and by 1998 (the the VRDP program), had reached $139 million (approximately 30% of the

doucor

he .

s (for framework, social services

ent Assistance

last year of total spending for Canada). Between 1986 and 1994, federal spending more than

bled, finally peaking at approximately $160 million in 1994. Not surprisingly, this relates to Ontario’s growing welfare system which between these same years,

experienced unprecedented growth in caseload and cost. In 1996, the Canadian Government underwent social reform, with the replacement of tCanada Assistance Plan (CAP) with the Canada and Health Social Transfer (CHST)Prior to 1996, Federal-Provincial welfare and social service programs were deliveredunder the Canada Assistance Plan (CAP) which had been in existence for 30 yearbetter or for worse, according to some). Within this funding were cost-shared between the Federal and Provincial Governments, usually on a 50 /50, conditional-grant basis. In 1996, the Canada Assistance Plan was replaced by the Canada Health and Social Transfer (CHST). This new funding model was expanded toinclude health care and post-secondary education transfers (which were previously funded under the Established Programs Financing or EPF) and replaced the previous dollar-for-dollar cost matching with the Provinces, with ‘block grants’. This had the effect of reducing federal cost and responsibility for social programs, and provinces such as Ontario found themselves with increased social costs and greater responsibility for program decision-making. Ironically, Ontario’s incoming Government in 1995 not only reduced the welfare caseload significantly through policy reform, but continued a similar transferring of social responsibility and costs down to the municipal level. The primary difference however, is that while the municipalities now deliver and fund more of social assistance, the eligibility criteria remains with the province. Regarding provincial and municipal ODSP funding, the chart below shows the caseload and the estimated expenditure for financial and employment assistance during the past five years: Figure 1B: Estimated Expenditure, ODSP Financial & Employm

MCSS Estimated Expenditure: ODSP Financial & Employment Assistance (Ontario),

2000 /01 - 2005 /06

2,11

4,52

2,70

0

2,38

4,12

9,80

0

2,15

4,09

9,80

0

2,22

1,05

2,00

0

2,12

5,30

0,00

0

1,950,000,000

2,000,000,000

2,050,000,000

2,100,000,000

2,150,000,000

2,200,000,000

2,250,000,000

2,300,000,000

2,350,000,000

2000-01 2001-02 2002-03 2003-04 2005-06

Expe

nditu

re ($

)

180,000

185,000

190,000

195,000

200,000

205,000

Ont

ario

Cas

eloa

d (#

Peo

ple)

2,400,000,000

2,450,000,000 210,000

ODSP Caseload MCSS Estimate Data source: Ministry of Finance, The Estimates, Ministry of Community and Social Services and Ministry of Community, Family and Children Services (2002/03, 2003/04).


ODSP program spending has averaged $2.2 Billion annually ($11,000 /client) of which approximately 97% is for financial assistance. As municipalities co-fund 20% of the financial benefits, municipal expenditure has averaged $430 million /year. On average, the caseload has grown 2% annually during this period while program costs have risen 4%. 3.0 DISABILITY 3.1 Definition of Disability Similar to poverty, a national definition for disability does not exist. Defining disability can be difficult due to the subjective and objective nature of the concept of disability, which can include a medical, social, environmental, functional or personal perspective. In many cases, disabilities reach far beyond the physical state and can include mental, stress-related or musculoskeletal disorders – not easily detected or diagnosed. Depending upon the context then, the meaning of disability can mean different things to different people. The definitions currently in use, primarily describe disability either as a condition

ction to )

this disability-definition issue simply a case of semantics? Not at all. The absence of n all-inclusive definition presents barriers to all disability stakeholders, including the

ners, the community service providers and most sumers themselves, i.e., those with disabilities who need to access

e programs and services. In terms of program and service eligibility, how disability is can and can not, access a given program or service.

isability definition also has caseload implications. For example, after the landmark case

or disease (i.e., a physical, mental, or sensory impairment), or as a restriactivities of daily living. While the first description focuses on a given condition (or causeof disability, the second emphasizes the consequence of the disability. Furthermore, disabilities do not necessarily affect people in the same way, or to the same extent. Disabilities run the gamut of being mild in nature, to severe and provocative. IsaGovernment policy-makers and planimportantly, the conthdefined will determine whoDof Gray vs. ODSP in 2002, the provincial caseload increased significantly as the interpretation of “disability” was now broader than under the former Family Benefits Act.While defining disability is not a straightforward matter, there are organizations that feel that a national definition is needed in order to eliminate many of the inclusion and accessibility barriers. Perhaps the most vocal of these is the Canadian Mental HealthAssociation which has been advocating for a national definition of disability for quite some time. The following are examples of disability definitions: International The International Classification of Functioning, Disability and Health (ICF) Impairment, Disability and Handicap (ICIDH) defines disability as a limitation in daily activities resulting from an impairment associated from physical or mental conditions or

ealth problems. h National The PALS Survey (Participation and Activity Limitation Survey) consider people to have a disability if they have a physical or mental condition or a health problem that restricts their ability to perform activities that are normal for their age in Canadian Society.


Provincial: Ontario As per the ODSP Act 1997, a person is identified as having a disability if:

(a) They have a substantial physical or mental impairment that is continuous or recurrent and expected to last one year or more;

(b) The direct and cumulative effect of the impairment on the person’s ability to attento his or her personal care, function in the community and function in a workplacresults in a substantial restriction in one or more of these a

d e,

ctivities of daily living;

irment and its likely duration and the restriction in the person’s activities of ations.

(c) The impadaily living have been verified by a person with the prescribed qualific

Note: As this study is primarily a review of services for those on ODSP, the above definition applies. 3.2 Ontario Disability Support Program (ODSP) As mentioned earlier, the Ontario Disability Support Program Act (ODSPA) came into

ffect on June 1 1998 (as the Family Benefits Act was simultaneously repealed) ane d had e as stated by legislation:

isabilities;

•

bove their ental

am is the acknowledgement that disabled people want to work, and an work, provided the appropriate support services exist and disability-related barriers

ividuals share a core tenet of the program.

stry staff in delivering the ODSP program and are inteens e ODSP Ontarians with disabilities. Employmentcoa in g and tran o devices, adaptive computer software, and training tools and equipment are also made available.

the following purpos

• Provide income and employment supports to eligible persons with d

• Recognize that government, communities, families and individuals share responsibility for providing such supports;

• Effectively serve people with disabilities who need assistance; and

Be accountable to the taxpayers of Ontario.

The Ontario Disability Support Program (ODSP) is delivered within the framework of the act and provides income and employment supports to eligible Ontarians witha

disabilities. It is designed to “meet the unique needs of people with disabilities and families who are in financial need, or who want to work and need support”. Fundamo the ODSP progrt

care removed. The belief that Government, communities, families and indhe responsibility for providing these supports ist

ODSP is administered by the Ministry of Community and Social Services (MCSS) through a set of policy directives which determine how the program rules and regulations should be applied. These directives assist mini

nded to “enable consistent decision-making across the province and to ur accountability for those decisions”.

offers a full range of goods and services to support services include employment preparation and planning, job

ch g and placement (with intervenor & interpreter services), skills traininsp rtation assistance. Products such as mobility


i) Income Support

Financial support is needs tested and is calculated on a monthly basis. The level of income is determined by family size, age of dependants, geographic location and the “individual circumstances” of the client (see appendices for rate sheet). The total income received is comprised of an amount for basic needs and a shelter allowance. Where eligible, the client may also qualify for a special diet allowance and Special or Discretionary Benefits. ii) Employment Support

Employment services and supports are offered to ODSP clients in order to increase self-sufficiency and become as independent as possible for full participation in community living. These programs are managed by the MCSS Regional Offices, who have servcontracts with local service organizations an

ice d agencies.

3.3 Eligibility

Generally a person can access the ODSP program in two ways: by being a membe“prescribed class” or by applying as “a person with a disability”

Members of a Prescribed Class

r of a

escribed class category, there are no disability determination g ODSP eligibility. This category includes Canada

t

were (grandfathered) into the new ODSP program in June 1998, and

ho were classified under the old program as “permanently unemployable (PUE)”, proximately 15% of Nipissing District’s present caseload was

if they are between the ages of 8-65, live in Ontario and meet the provincial disability definition (previous page).

he financial circumstances of the person and their dependants must be

i)For people in the prrequirements necessary for obtaininPension Plan-Disability recipients, residents of Psychiatric Hospitals, DevelopmentalService Facilities or Special Care Homes and people who are 65 years or older and noeligible for Old Age Security (OAS). Additionally, this category contains former FBA (Family Benefit Act) clients whoautomatically transferredw“disabled” and “blind”. Apgrandfathered in from the PUE category. ii) Persons with a Disability A person and his or her dependants, is eligible for ODSP1Additionally, tsuch, that their budgetary requirements exceed their income. Additionally, their assets must not exceed the prescribed limits as set out in the ODSP regulations. A person is not eligible if they are dependant on, or addicted to, alcohol, drugs, or some other

thorized by prescription, as stated in the regulations). s to carrying out daily living activities are the result of

chemically active substance (not auAdditionally, if a person’s restrictionthe use (or cessation) of alcohol or drugs, they are not eligible for ODSP assistance. 3.4 Application Process

Essentially, eligibility determination is made through a two-step application process: Step #1: Financial Assessment This first step assesses the financial situation of the ODSP applicant, through an Application for Financial Assistance, Part 1 form.


Step #2: Disability Determination Process Once the first step has been completed and financial eligibility confirmed, the next step

volves determining the applicant’s disability. This is done through a Disability ) which includes four (4) forms that are to be completed by

and a

he above DDU package is sent to the Disability Adjudication Unit in Toronto (Ministry of ervices), where an Adjudicator reviews the information and

nt of

concerning the decision of disability

inDetermination Package (DDUthe applicant and which include: a Health Status Report and Activities of Daily Living Index, a Self Report (voluntary), a Consent to the Release of Medical Information, Consent to the Disclosure, Transmittal or Examination of a Clinical Record (in accordance with the Mental Health Act). This DDU package must be received by the Disability Adjudication Unit (DAU) within 90 days (see below). As part of this step, the financial information of the ODSP applicant is reviewed again, as this could have changed during the time it took to for the DAU to review the file.

Selection Process TCommunity and Social Sdetermines whether or not the applicant qualifies for ODSP. Appeal Process If an ODSP applicant is turned down, or an existing ODSP recipient has the amoutheir income support changed or stopped, an appeal can be made by submitting a

ppeal written request for an Internal Review. An astatus is made through the DAU whereas an appeal concerning a financial decision is made at the local ODSP office (for Nipissing District, this is at the Ministry of Communityand Social services in North Bay).

3.5 Changes Underway

Currently the Ministry of Community and Social Services is making significant changesto its social assistance programs in terms of delivery and benefits. Many of these changes are the result of the Deb Matthews report, which made a series of

ations based upon Stakeholder consultations and inp

ut in 2004. For a es, see pages 52 & 53.

recommendsummary of these chang


SECTION II DNSSAB Community Services Review - Based on the ODSP Client Population: An Analysis of the Present ODSP Beneficiaries and Financial Supports The following is an analysis of Nipissing District’s present ODSP Beneficiaries (caseload

nd dependents). It helps to understand the needs of clients and the delivery of services meet these needs, by viewing them in context of the overall caseload and its

uantitative features. While the initial ODSP report focused on the actual caseload numbers and provided an analysis by area, age, family status and type of disability, this follow-up report focuses on client needs and the delivery of community services to meet these needs. Analyzing the caseload from this perspective will provide additional insight into the needs of the clients and the broader sabled community, and the services they require. 4.0 PRESENT ODSP CASELOAD, DEP NDENTS and BENEFICIARIES The table below summarizes recent data for Nipissing District’s ODSP caseload (December 2005):

able 1: ODSP Caseload, Dependents and Beneficiaries, Dec. 2005

atoq

di

E

T Dependents

Family Structure Caseload Children Adults Spouses BeneficiariesSingles without Children 2485 0 0 0 2485 Singles with Children 349 441 59 0 849 Couples without Children 451 0 0 451 451 Couples with Children 281 460 29 281 1051 Total 3566 901 88 732 5287 % Beneficiaries 67.4% 17.0% 1.7% 13.8% 100.0%

Source: CMSM’s Social Assistance Quarterly –Dec. 2005. Statistics and Analysis Unit, Ministry of Community and Social Services (MCSS). 4.1 ODSP Beneficiaries From the perspective of delivering community services, it is beneficial to start with the big picture, in an effort to better understand the clients and their needs. In terms of

elivering services to ODSP clients, the big picture includes not only the caseload (i.e., ose actually receiving the social assistance benefit), but also their dependents, which

nd eir dependents are referred to as ODSP Beneficiaries.

the caseload are the main focus of this review, these needs are artly determined and influenced by whether or not an individual has dependents. Thus

ity services required. For example, where dependent children are concerned, it may be necessary to offer addi rog serv will the e srequired by the children and their families.

dthinclude children under 18, adults (18 yrs. +) and spouses. Together, the caseload ath While the needs of pdependents to some extent, affect the type and volume of commun

tional community p rams and ices which provide supportiv ervices


Whether or not an ODSP client has dependents, also has ncial im tions: thow dependents (which is f the District’s caselo generally e the lowi plies a high need for dire me-der ervice as affo

he singles appeared to he frequent users of food banks, soup kitchens

).

fina plica se ithout 70% o ad) hav est

ncomes.1 This im ct inco ived s s such rdable housing and food provision (throughout the client focus groups, tbe most in need of housing, and were tand the Gathering Place Table 1 above indicates that Nipissing District presently has 5,287 ODSP Beneficiaries, comprised of a caseload of 3,566 recipients (also referred to as ‘clients’ in this report), and 1,721 dependents. The following chart illustrates the composition of the beneficiaries and shows that the largest share of dependents is children (52%) followed by spouses (43%) and adults (5%): Figure 2: ODSP Beneficiaries, Nipissing District

ODSP Beneficiaries: Nipissing District, Dec. 2005

3000

3500

4000

3566

500

1000

1500

2000

Peop

le

901 732

2500

880Caseload Dependent Children Dependent Adults Spouses

ODSP Caseload, Family Structure4.2

For community planning purposes, it is useful to segment the caseload into the following family structures: Singles without Children, Singles with Children, Couples without Children and Couples with Children. Within these segments, ODSP clients share common characteristics in terms of needs and this provides insight into the types of community services required to meet these needs. The family structures also indicate the proportion of the caseload that has dependents. For example, the chart on the following page reveals that the smallest percentage of the caseload (31%) has 100% of the dependents. Again, this is useful for analysis and service planning. The following chart displays the family structures of the District’s present caseload: 1. Singles without dependents have the lowest, average net earnings (above their ODSP income benefit) of

all the family structures, and also the lowest disposable income - see page 45 for more detail.


Figure 3: ODSP Caseload by Family Structure ODSP Caseload by Family Structure: Nipissing District, Dec. 2005

69%

10%

13%8%

Singles without Children

Singles with Children

Couples without Children

Couples with Children

Most notable is the fact that the largest share of the caseload is single without children.

s mentioned previously, this is the lowest income group and as such, presents specific

iffer eload,

ocus groups and ommunity consultations, it was noted that there is a severe lack of affordable 1- edroom apartments in the area. Looking at the chart above, it’s not hard to see where is pressure is coming from: 82% of the caseload is single or are couples without

hildren and require 1- bedroom apartments.

Aconsiderations in the high-need service areas such as housing, food and transportation. The chart also reveals a segment that requires particular supportive services that dfrom the rest of the caseload: the lone parent. Although only 10% of the ODSP caslone parents in general have very unique needs and in most cases, will rely on the community service organizations to meet these needs (on average, approximately 80%of this group are single mothers). Analyzing the family structures also helps to explain certain high-demand areas or pressure points within the community. For example, during the client fcbthc

4.3 ODSP Dependents

As noted previously, there are 1721 dependents comprising 32.5% of the ODSP beneficiaries. It would now be useful to look at the proportion of dependents as per the caseload’s family structure, in terms of actual numbers. This will further help to segment the ODSP beneficiaries for analysis and planning purposes. The following chart displays the ODSP beneficiaries by caseload and dependents:


Figure 4: Caseload with Dependents

Caseload with Dependents, Nipissing District: Dec. 2005

2485

349 451281

500451 770

0

500

1000

1500

2000

2500

3000

Singles withoutChildren

Singles with Children Couples withoutChildren


Num

ber o

f OD

SP B

enef

icia

ries

ODSP Caseload ODSP Dependents i) Dependent Children (17 and under) As mentioned earlier, the smallest share of the ODSP caseload has the total number of dependents. Referring back to table 1 (page 30), there are 901 dependent children (52% of the dependents), of which, almost half (49%) live with single parents. Children areparticular interest and concern due to the correlations between family income and child development. As noted in the initial ODSP report (Stewart, 2005)

of

Children from low-come families fare worse in almost every health indicator compared to children from

alth

hildren

unity nity has the capacity to deliver the

quired programs for dependent children in need, is paramount to the future well being f these children, their families and the community in general.

hild and family Services. They lso acknowledged that their children were in need of social and emotional supportive rograms.

. Two well known reports and studies documenting this are; the Early Years Study (McCain and Mustard, 1999, 2002) and the National Longitudinal Survey of Children & Youth, 1994-2003). The Deb Matthews Report to the Minister of Community and Social Services (Review of Employment Assistance Programs in Ontario Works and Ontario Disability Support Program, Dec. 2004) also highlights the concerns for

eholds.

inmiddle- and high-income families. These children are more likely to have chronic heproblems, visit a hospital emergency room, be admitted to hospital, have a psychiatric disorder and perform poor at school. Other reports and studies also indicate that cgrowing up in low-income environments are at risk of reduced early childhood development and health, as well as education and social skills.2 Thus from a commplanning point of view, ensuring that the commureo Presently the District’s rate of ODSP dependent children is approximately 3 times that of the provincial average. This suggests that the District may require a greater volume of children programs and services than would otherwise be expected, based on an area of comparable population. During the ODSP focus groups, some of the clients described difficulty in accessing programs for their children and they encountered waiting lists at one of the main children service agencies, Algonquin Cap 2

children living in low-income & poverty hous


ii) Dependent Adults (18+) & Spouses There are presently 88 dependent adults and 732 spouses who are ODSP beneficiaries in Nipissing District. Based upon the number of dependents, and the age of the dependent children, the ODSP recipient receives additional basic needs and shelter income (see appendix for ODSP Rate Chart). The increase for shelter income starts at 57% for one dependent (a spouse or child) and increases by an average of 8% for each additional dependent, up to 5 dependents (with 6 or more dependents, the increase is only 3.5%). The basic needs income increases by 48% for the ODSP recipient with a spouse (and no children), or by 49% for the single parent with a child under 12 (if the child is 13 yrs. or over, the increase is 59%). Under the STEP program (Support To Employment Program), working spouses and dependents can earn up to $235 /mo. in addition to the ODSP income support, after which deductions are than made from the ODSP income (the amount of which, depend on the family circumstances and scenario). For further financial details, see “STEP”, page 46. Currently there are ODSP program changes in progress that are intended to improve the employment supports part of the program. These changes address some of the issues that have surfaced in this study and could improve things for certain ODSP families

page 52 for more detail.) One of these hanges requires the mandatory participation of dependent adults and non-disabled

ities, in the Ontario Works program. The intent of

considerably (see “ODSP Changes in Progress”,cspouses without caregiving responsibilthis policy change is to provide enhanced employment support to the dependents, thereby facilitating greater financial independence for their families. This change came into effect April 1, 2006. 5.0 ODSP TRENDS 5.1 Rate and Growth

Analyzing the trends of the ODSP beneficiaries is beneficial from a services- planning perspective, as this can provide an indication of the direction of movement of the caseload and dependents, and the need for current (and future) services. The initial ODSP report revealed that in 2005, the District’s caseload was 2.3 times higher per capita than the provincial average and was the highest in the province. The table below ompares the ODSP caseload of Nipissing District and Ontario, c at the same point in time

over the past 5 years: Table 2: ODSP caseload for Nipissing District & Ontario, December 2000-2005 Caseload (December) 2000 2001 2002 2003 2004 2005 Nipissing District 3,534 3,452 3,497 3,612 3,545 3,566Annual change / -2.3% 1.3% 3.3% -1.9% 0.6%Growth from 2000 / -2.3% -1.0% 2.2% 0.3% 0.9%Ontario 192,156 191,990 195,685 201,160 206,884 213,494Annual change / -0.1% 1.9% 2.8% 2.8% 3.2%Growth from 2000 / -0.1% 1.8% 4.7% 7.7% 11.1%

SoSoUn

urce: CMSM’s Social Assistance Quarterly, ODSP Social Assistance Trends Quarterly Report-Dec. 2005, Ontario cial Assistance Quarterly Statistical Report and custom data for Nipissing District, 2000 & 2001. Statistics and Analysis it, Social Policy Development Division: Ministry of Community and Social Services.


It can be noted from the above table that the District’s caseload has actually been this high since 2000 and has remained relatively steady since then. The District’s precaseload of 3,566 is only 1% higher than it was at the same time, five years ago (200and has been growing marginally at an average annual rate of 0.2%. Ontario’s caseloadhowever, has on average, grown by approximately 11% during this same period, or 2.2% annually. So while the District has the

sent 0),

highest provincial rate of ODSP per capita, it has much slower growth than the provincial average. One implication of this is that the community service system has been servicing this caseload and their dependents, for quite some time. Although this study has revealed certain service gaps and areas for improvement, there is an extensive service system and framework in place which to some extent, has been accommodating the ODSP caseload up to now. This also indicates that the Dist

high

rict’s service organizations are well long the experience curve, with a strong knowledge base and certain operating

s.

ing strategies were based upon this premise (i.e., a caseload at is growing marginally vs. one that is growing significantly), then operating decisions

ould be made to reflect this. For example, based on this scenario, it may be more rces towards strengthening the existing service network and

liminating gaps and barriers, rather than adding more, general service capacity (such izations).

ng page displays the past 5-year trend of the District and

of growth a , fo by eriod eclin

Over the five years, the caseload has fluctuated w +/- 5% 78 c havb Sept. 200 (3,451), and the highest in Ma 04, . The s ings being equal, wil e a ra .

aefficiencies. Collectively, these organizations would have a high capacity for making service-system improvements and implementing change, given the opportunity and resources to do so. Another implication is for planning by community service organizations and funding agencies. To effectively meet the needs of ODSP clients, planning requires an idea of what the future caseload changes may be and how they will impact existing serviceTable 2 above indicates that growth has been negligible and may continue to be into thefuture. If community plannthceffective to direct resoueas new start-up organ While table 2 provides a cross-sectional view of the ODSP caseloads, it would be beneficial to look at the actual trends as this will help to further analyze the caseloadcharacteristics and help explain any causal factors that might impact change. Understanding how the caseload changes helps to paint the bigger picture and will be useful for analyzing other information, further on in the report. The chart on the followiProvincial caseload. Compared to the steady growth trend for Ontario, Nipissing District’s caseload has been a little more erratic, and shows cycles of periods

veraging 9-12 months llowed short p s of d e.

ithin (or 1 ases),(

ing een the lowest in

that all th1 rch 20 3,629) trend

uggests growth l continu t an ave ge of 0.2% annually

5.2 Factors Affecting the Caseload Trend

For community service organizations, identifying the factors that affect caseload trend nd growth is important for operational planning and for anticipating chana ges which can

impact the delivery of services. Identifying solutions for service gaps or addressing capacity issues is also done more effectively, knowing what the trends and their determinant variables are.


Figure 5: ODSP Caseload Trends, Nipissing District

ODSP Caseload 5-yr. Trend: Nipissing District & Ontario

3650 220000

3350

3600

180000

215000

3400

3450

3500

3550

Nip

issi

ng D

istr

ict C

asel

oad

185000

190000

195000

200000

205000

210000

Ont

ario

Cas

eloa

d

Mar2001

June Sept Dec Mar2002




June Sept Dec

Quarter / Year

Nipissing District Ontario Source: CMSM’s Social Assistance Quarterly 2003-2005, ODSP Social Assistance Trends Quarterly Reports, Ontario Social Assistance Quarterly Statistical Report, ODSP Social Assistance Statistical Digest (archives) and custom data for Nipissing District, 2000-2002. Statistics and Analysis Unit, Social Policy Development Division: Ministry of Community andSocial Services.

Note:

the purpose of the chart above is to compare the shape of the trend lines and the relative proportional changes(fluctuations) in each. Given the difference in population between the District and the Province, the scale used to measueach caseload is different and thus caution must be used, when making direct comparisons to caseload magnitude and trend position.

re

and

th

The factors that affect the ODSP caseload trend and growth rate are varied, and somehave longer-term affects (5 yrs. +) while others can impact the caseload very quickly.Both are important for planning purposes, but the short-term factors are likely of more interest to service providers and stakeholders at this stage, as these have more of an

mediate affect on the caseload and on service operations. im The following are some of the primary factors that can affect the caseload trends growth rate:

i) Incidence of Disability Obviously there is a strong correlation between the incidence of disability and the growof the caseload. As the incidence of disability varies by age group and type of disability however, this factor would come into play over longer periods of time. Also, as the average length of time on ODSP within the District is currently 10 years, this also

dicates that the incidence of disability would change gradually over longer periods. on each type of disability, over longer periods

Assistance (FBA) program was in effect. and ODSP, comparing data sets such as

primary disability types, might be difficult and would require extrapolation.

inAdditional caseload data and specific dataof time, would be required to further analyze this variable. It might be possible to use Ministry data on program entry and exit by disability type, to analyze this variable over a longer caseload trend.3 3. Prior to the implementation of ODSP in 1998, the Family Benefit

Due to the different data management systems between FBA


ii) Population The table below shows the average ODSP caseload for the District and Province during the past 5 years, and also the corresponding change in population: Table 3: ODSP Caseload and Population, Nipissing & Ontario 2000 – 2005 Nipissing District 2000 2001 2002 2003 2004 2005 ODSP Caseload (average) 3,534 3,475 3,475 3,554 3,558 3,568Annual change / -1.7% 0.0% 2.3% 0.1% 0.3%Growth from 2000 / -1.7% -1.7% 0.6% 0.7% 1.0%Population 86,125 85,962 86,192 85,962 85,700 85,760Annual change / -0.2% 0.3% -0.3% -0.3% 0.1%Growth from 2000 / -0.2% 0.1% -0.2% -0.5% -0.4%

Ontario 2000 2001 2002 2003 2004 2005

ODSP Caseload (average) 191,694 192,056 193,144 199,314 204,903 210,881Annual change / 0.2% 0.6% 3.2% 2.8% 2.9%Growth from 2000 / 0.2% 0.8% 4.0% 6.9% 10.0%Population 11,685,380 11,897,647 12,096,627 12,238,300 12,392,720 12,550,850Annual change / 1.8% 1.7% 1.2% 1.3% 1.3%Growth from 2000 / 1.8% 3.5% 4.7% 6.1% 7.4%

Source: Caseload averages calculated from the quarterly caseload data used for Figure 5 above. Population estimates and projections from the Ministry of Finance and custom data for Nipissing District & Ontario for 2000 (MOF /Statistics Canada). It appears there is positive correlation between ODSP caseload and population growth,

s can be noted from the data for Ontario. Using 2000 as the base year, the caseload l

in suggests some orrelation. As the incidence of disability generally increases with age, the rate of ageing

Effectiveness

AU).

DSP program in 1998. This legislative policy change brought bout a steep reduction in the provincial disability caseload over a short period of time.

aand population generally moved in the same direction, averaging 2.0% and 1.5% annuagrowth, respectively (correlations between annual changes are not as evident). In the case of negative population growth for Nipissing District, the relationship between caseload and population is not as clear. For general purposes, the District’s caseload and population can be considered as holding steady which agacis presumably a strong correlative factor. iii) Policy, Referrals and The report Ontario Disability Support Program, Factors Behind Recent Growth (MCSS January 2005), suggests that the incidence of disability and demographic changes are longer-term determinants of caseload growth. In the short term, caseload growth is moreaffected by policy changes, referrals and operating effectiveness (such as by the D

a) Policy changes Changes to disability policy and legislation can affect the number of applications that are “adjudicated disabled” hence changing the caseload numbers in a very short period oftime. The best example of this is the replacement of the former Family Benefits Act (FBA) with that of the Oa


In May 2002, a Court of appeals decision in Gray vs. Director of ODSP, resulted in a

significantly for

bT W cas , comp of thos face m barriee d have difficulty ex ing the OW program.5 M f these s are subsequently referred to the ODSP program b W Ca nagers ides. 2005, approximately 16.5% (293 of N Distr cas as ret 7% of the referral 6 Thus referrals represent a of the ODSP ca eload and link be the t eloadGiven that the Districts ODSP caseload has only been growing at an average of 0.2% annually, OW referrals are a sig t sour aselo wth (s Refec det

c ectiveness The report mentioned above (MCSS Jan. /05) d growth and “operational facto i re result in a direct change of cas volum ecially short-term. These operating considerations mainly p to the ncy of U,

rs be a strong, negative correlation between caseload growth and the backlog of

U

e

time,

uld

PUE category.

. Ref: SDMT OW Benefit Unit Summary Report, Intake Performance Report and Termination Details Report.

change to the interpretation of ODSP’s definition of disability, resulting in an immediate increase in the caseload.4 Referring back to figure 5 on page 36, this can be seen on the hart in June 2002, when the growth of the caseload started to increase c

both the province and the District.

) OW Referrals here is a segment of the O eload rised e that ultiple rs to mployment an it any o client

y the O se Ma and A In cases) ipissing ict’s OW eload w ferred

o ODSP, and 5 s were granted ODSP.pproximately 5% s form a tween wo cas s.

nifican ce of c ad gro ee “OW rrals hart on page 112 for more ails).

) Operating Effdraws the linkage between caseloa

rs”, and ind cates that a change in p ogram operations or fficiencies can eload e, esp in the

ertain efficie the DAprimarily because the growth of the ODSP caseload is directly related to the number of referrals and applications processed by the DAU. The report indicates that there appeatoapplications: as the DAU backlog increases, caseload growth decreases and as the backlog is cleared out, caseload growth increases. There have been two significant DAbacklogs & clearances since 2001, and the caseloads have moved in the opposite direction, at some point during these periods (In figure 6 on the following page, this would be easier to see for Ontario if the trend measurement was annual change ratherthan actual caseload, due to scale). Another operational example is the transition to thSDMT system in 2001 /02, which could explain the caseload decrease during this due to a disruption in operations. 4. This case was significant in that the Ontario Court of Appeal recognized that the ODSP definition of

disability is actually broader than the definition under the previous Family Benefits Act and that ODSP is designed to assist individuals whose disabilities are “significant”, but not necessarily “severe”. It also held that applicants must be considered in view of their specific circumstances and any misunderstanding in

e resolved in favour of the applicant. interpretation should b 5. These barriers include: not being able to keep an appointment, job retention issues, noticeable hygiene

issues, a frequent change of address and the inability to follow through with an ODSP application. Ref: Intensive Case Management in Nipissing District, D. Vaillancourt, Sept. 2005. Prior to ODSP being implemented in 1998, there was a “Permanently Unemployable (PUE)” category in the FBA disability program, where people facing these barriers could be placed. As PUE no longer exists, people who wohave qualified for PUE and FBA assistance no longer do so and remain in Ontario Works. Incidentally, approximately 15% of Nipissing District’s present ODSP caseload was grandfathered into ODSP from the

6


From the above analysis, the District’s caseload trend can now be viewed with some othe short-term causal effects factored in: Figure 6: Factors Affecting the Caseload Trend

f

ODSP Caseload 5-yr. Trend: Nipissing District & Ontario

195000

Ont

ari

3350

3400

Mar2001





June Sept Dec

Quarter / Year

Nip

is

180000

185000

190000

3450s

3500

3550

3600

3650

ing

Dis

tric

t Cas

eloa

d

200000

205000

210000

215000

220000

o C

asel

oad

Nipissing District Ontario

The above analysis suggests that the District’s ODSP caseload growth rate is depenmore on policy decisions, the adjudication process and program operating efficiencies inthe short-term, while the incidence of disability and demographic changes will affect the longer-term growth. Again, this can have implications at the local community level as community service delivery becom

dent

es somewhat reliant on program decisions and perations.

.3 Caseload and Dependents

o 5Knowing the trends of the ODSP dependents is equally informing and helps to determine the types and level of client services required. While the caseload has been growing

ry slowly as indicated above, the number of dependents has actually been decreasing.ince 2002, the District’s ODSP dependents have decreased by approximately 13% (or53 dependents). The chart below illustrates this de

ve S

clining trend:

2

DAU Backlog

Operating Factors (SDMT Transition)

Policy Change (Grey Case)

Tail-end of DAU Backlog

2003 /04: Highest number of DAU referrals and applications during trend period


Figure 7: ODSP Trends: Caseload & Dependents, 2002-2005.

ODSP Caseload & Dependents, 4-yr. Trend

3350

3400

3450

3500

3550

3600

Mar2002



June Sept Dec

Year

Cas

eloa

d

1550

1600

1650

1700

1750

00

1850

1900

1950

2000

Dep

ende

nts

3650

Mar2005

June Sept Dec

18

Caseload Dependents Note: 2001 data for parison age 36) is presently not available. This implies that caseload growth within the District is coming primarily from singles without children (i.e., no dependents). The following chart confirms this: Figure 8: ODSP Trends: Singles without Children, 2002 – 2005

5-yr. trend com to Figure 5 (p

ODSP Caseload Family Structure, Singles without Children: 4-yr. Trend

2400

2450

2500

2550

2350Cas

el

2200

2250

2300

Mar2002




June Sept Dec

Year

oad

he trend line is very similar to that of the caseload, confirming that the District’s ODSP

T aseload growth is coming primarily from this family structurec . Since 2002, singles have creased by 7% (176 clients). This is also mirroring the District’s long-term household end in general, which has seen a steady increase in single households over the past 5 years. Again, from a service planning & delivery perspective, this has strong plications for future services such as housing and low-income services.

intr2im


The chart below shows the 4-year trend in the District’s remaining ODSP family structures: Figure 9: ODSP Trends: Caseload Family Structure, 2002 – 2004

ODSP Caseload Family Structure, Nipissing District: 4-yr. Trend

0

50

100

150

200

250

300

350

400

450

500

Mar2002 2003 2004 2005

Year

June Sept Dec Mar June Sept Dec Mar June Sept Dec Mar June Sept Dec

Cas

eloa

d

Singles with Children Couples without Children Couples with Children Couples without children have remained very steady with less than a 2% change since

DAU backlog (refer back to Figure 6, page 39) and suggests that a large number of applications at that time were couples. Couples with children also started decreasing at this time, and have continued to do so – this group has decreased by 23% (83 families) since 2002. During 2003, Singles with children started increasing slightly after a period of decline and has remained very steady since. Interestingly, the trend of singles with children seems to move in opposite directions to that of couples without children, during most of this period.

2002. The dip during March-Sept in 2004 corresponds with the


SECTION III

his section presents the key findings on the community service areas reviewed. Each t emerged from the client

focus groups and community consultations, followed by a general analysis. It should be noted that the current ODSP program is presently undergoing policy changes

Tservice area begins with a table summarizing the key points tha

which directly address some of the main concerns that have surfaced during this review. These include changes to the employment support parts of the program and to the model of program delivery (i.e., from case pooling to an alpha-split structure). Additionally, the 2006 provincial budget has announced a 2% increase to ODSP income (basic needs & shelter allowance). As identified by the Terms of Reference for this study, the nine (9) service areas reviewed are as follows: financial supports, housing, food security, transportation, child & family supports, special / discretionary benefits, counseling, assessment & referral and legal /advocacy. 6.0 FINANCIAL SUPPORTS “Once everything is paid, it leaves me with a balance of $55 for the month” –Nipissing ODSP client.

Insufficient income clearly emerged as a dominant issue for ODSP clients and the llowing are some of the key points that came out of the research: fo

Table 4: Key points from Focus Groups & Community Consultations; Financial GAPS BARRIERS CAPACITY /

ALIGNMENT SOLUTIONS / BEST PRACTICES

Income is inadequate for housing, food and transportation. There have only been two benef

Barriers to employment: the fear of losing security & benefits (monthly cheque, drug and dental benefits, etc.).

ODSP Program benefits (Basic Needs & Shelter Allowance) do not cover the basic costs of living.

Increase benefits Allow clients to maintain medical another benefits fo

it increases the past 13 years:

in 2005 and 1% in 93.

rustee programs are short supply.

he basic exemptions r employment income 160 for singles and 35 for families) are

o low.

DSP is the primary urce of income for ost clients.

mited funding for pport services & ograms (trusteeship, ental health, dictions).

Financial management: many clients experience budgeting and cash flow challenges. Employment earning calculations are very hard to understand for recipient and spouses. This leads to budgeting and cash flow problems.

A lack of trustee programs. Given the District’s high need for supportive services (based on the high caseload), there is a mis-alignment in funding allocations.

d r a

longer period of time. Also, allow them to keep a higher percentage of their basic living allowance and for a longer period of time. Expand Trustee programs in area.

in3%19 Tin Tfo($$2to Osom Lisuprmad


6.1 Income

those who had “some” disposable income left after paying all

eneral social assistance increases for quite some time.8 To better cal level, this income issue can be

s: low income cutoff levels, employment and earnings,

ct that the incomes

It should be noted that of the clients who indicated they were lacking income and couldn’t make ends meet on a monthly basis, the majority were in market-rent housing. Those that were in social housing (rent-geared-to-income or rent supplement /subsidy) appeared better off and indicated they could get by, albeit with very little change to spare. As food and housing are strongly correlated to income, the clients not surprisingly indicated they are in need of more affordable housing and frequently rely on the community’s volunteer food outlets (food banks, soup kitchens, etc.) -both these service areas are described further on in this report. Low-income stories were numerous during the client focus groups and ranged from severe (those going further into debt each month) to not-so-severe (bills). Essentially, the underlying reason given in most cases was insufficient income. The sentiments echoed above reflect that of many ODSP clients province-wide. The Deb Mathews Report7 highlighted many of these income concerns and advocacy groups have lobbied for gunderstand this issue and what it means at the loviewed from four key perspectivedisposable income and community costs. i) Low Income Cutoff Level (LICO)

At the core of many of the social assistance income issues, is the faon average, are well below the recognized low-income cut-off levels established for communities througho ry.ut the count Statistics Canada uses Low Inc CO) ome Cut-off (LIas a measure for iden who are “in straightened” circum

lly worse-off” than average. LICO income als or b of lot b ity

flect cha umer P

llo plays LICO erage inon truc rage numin S elter) is based upon th d age

endents (childr ), ios n ages of the elo

ev ross lee of the o

b ter of Community and Social Snce orks isability Support Program, Dec. 2004.

P A , DAWN Onta (Disabled Women’s Network Ontario), Income y Advocacy Centre, Ontario Coalition against Poverty, ARCH Disability Law Centre, Community

o Coalition for Social Justice. Most recently, the Task Force on Modernizing Working-Age Adults (MISWAA) has just released a report; Time for a Fair Deal (May recommendations to the federal and provincial governments, for increasing social

ncomes.

re based on Ontario caseload characteristics (family structure, number of dependents esent the larger share of the caseload. As an example, singles and couples with 1 or 2

majority of the caseload: singles with 1 child represent 65% of that family structure, dren are 25%. Couples with 1 child represent 46% of that family structure and

th 2 children are 33%. Ref: Social Assistance Trends, MCSS December 2005.

tifying people stances or are level whereby “substantia represents the

families or individufood, shelter and cannually to re

are spending 20% mhing. LICO levels varynges in the Cons

ing page dis

e than average on they size of family and crice Index (CPI).

asic necessitiesand are adjusted ,

The table on the fofamilies, based upchildren. As ODSP of dep

w levels and avtures and ave

comes for ODSP ber of dependent e number ans that reflect the ad.

the common family scome (Basic Needs &en ages 0-12 & 13-17and childre

hthe table uses scenar present Ontario casthe province, this tabad in general.

average family sizeincome and LICO l

presentativ

9 As both ODSP can be considered els are standard ac

provincial ODSP casel

le Sandra Pupatello, Minis Programs in Ontario W

ction Coalition

re 7. Report to the Honoura

Employment Assista

8. To name a few: ODSSecurit

ervices; Review of and Ontario D

rio

Living Ontario and OntariIncome Security for2006) which makesassistance i

9. The scenarios weand age) and reprchildren comprise theand singles with 2 chilcouples wi


As can be noted from the following table and chart, the majority of ODSP families live below the Low Income Cutoff levels: Table 5: ODSP Income Scenarios and LICO Dependent Children ODSP After Tax

ODSP Families 0-12 yrs. 13-17 yrs. Income /mo. LICO /mo. Singles without Children 0 0 $959 $1,173 Singles with 1 child 1 0 $1,468 $1,428 Singles with 2 Children 1 1 $1,690 $1,778 Singles with 3 Children 3 0 $1,832 $2,218 Couples without Children 0 0 $1,460 $1,428 Couples with 1 Children 1 0 $1,631 $1,778 Couples with 2 Children 1 1 $1,872 $2,218 Couples with 3 Children 0 3 $2,161 $2,525

Source: ODSP incomes calculated from the ODSP Rate Chart – February 2005. LICO figures based upon Low Income cutoffs (1992 base), after tax 2004. Ref: Statistics Canada Catalogue no. 75F0002MIE-No. 003. Note: ODSP Income Includes the Basic Needs & Shelter benefit. Figure 10: Low Income Cutoff Gaps for ODSP Families, Nipissing District

Low Income Cutoff (LICO) for ODSP Families, February 2006

$959 $1

, $1,

$1, $1

,

$0

$500

Singleswithout

Children

Singleswith 1Child

Singleswith 2

Children

Singleswith 3

Children

CoupleswithoutChildren

Coupleswith 1Child

Coupleswith 2

Children

Coupleswith 3

Children

Low 46

8 6

$1,

460 63 $1, $2

,

90 832

1 872 16

1

$214

$88

$386

$147

$346

$364

$40 $32

$1,000

$1,500

$2,000

$2,500

$3,000

Inco

me

Cut

off (

afte

r tax

)

ODSP Income Below LICO Above LICO

ch

eL

The chart above reveals the monthly low income cutoff gap. Basically the top of the bar

art represents the low income cutoff level (LICO) and the green and red sections indicate the difference between income and the LICO, i.e. the amount of income that is

ither above or below the cutoff point. Only two of the family structures are above the ICO, and then only marginally by $30-$40. The others are all below LICO, with a

monthly shortfall ranging between $88 and $386.

Tb

ii) Employment & Earnings

he above analysis reveals that many ODSP families live below LICO, based upon the asic ODSP income benefit of Basic Needs and Shelter.


As employment support is also a key area of the ODSP program, it would be beneficiato know what the average earnings ar

l e in addition to the monthly ODSP support income

asic needs & shelter). This not only indicates what portion of the caseload has total income” starting point for doing further

income calculations. The ta ow t rict’s ith average earnings by family structure: T with E ings, Nipissing Distric

(bemployment income, but it also provides a “

ble and chart below sh he Dist caseload w

able 6: ODSP Caseload arn t ODSP With % E Number of mployment Ave. Net

load PFamily Structure Cas adelo Earnings Case articipation Earnings DependentsSingles without Children 2485 1 5.6 8.0 $279 0 98 % % Singles with Children 349 3 1.0 9.7 $390 500 4 % % Couples without Children 451 9 2.5 20.0 $751 451 0 % % Couples with Children 281 9 2.6 33.1 $1,003 770 3 % % Total /Ave. 3566 415 11.6% $606 1721

Source: CMSM’s Social Assistance Quarterly- December 2005. Statistics and Analysis Unit, Social Policy Development Division, MCSS. Note: Earnings represent wages, salaries, casual earnings or training allowance – they do not include

usiness income, farm income, nominal remuneration, etc. Mandatory deductions such as income tax, CPP, EI, union es, etc. have been deducted from the earnings.

bdu

Figure 11: Nipissing District Caseload with Earnings

Nipissing District Caseload with Earnings: Dec. 2005

$279

$390

$751

$1,003

0

500

1000

1500

2000

2500

3000

Singles withoutChildren

Singles withChildren

CoupleswithoutChildren

Couples withChildren

Cas

eloa

d

$0

$200

$400

$600

$800

$1,000

$1,200

Caseload

Caseload with Earnings

Net Earnings /mo.

The data above reveals that only 12% of the District’s clients have employment earnings

ad

een % of the earners. Presumably these

igher earnings can be attributed to the additional employment activity of the spouses

(which is higher than the provincial average of 9%), leaving the majority of the caseloto rely solely on the ODSP income benefit. Of this working group, approximately 55% are singles and lone parents earning a monthly average of $279 and 390 /mo., respectively. Couples (with or without children) have much higher earnings of betw$751 and $1003, and account for the remaining 45h(note: this does not take into account other sources of income such as WSIB, CPP,

es the level of earnings between the family structures and OAS, etc.).The chart indicatshows that the largest share of the caseload (singles) has the lowest participation rate (8%) and the lowest earnings.


The opposite holds true with the smallest share of the caseload, which has the highest participation rate at 33%, and the highest earnings. Somewhat surprising is the fact that couples without children have a lower participation rate (20%) than those with chi(33%). As this family structure has 60% more spouses and no dependent children, one might think that a greater percentage would be in the workforce and earning additincome. This has implications for targe

ldren

ional t programming, as there may be common

ng employment, which if s. U

changes tha ly s DS de re b

characteristics or factors within this group that are inhibitiidentified, can be addressed in the em ent progploym

, theseramdep

nder new ODSnt spouses a

P policy going tot are current in progres O P en e

requ in th W rired to participate e Ontario orks prog am – see p r T eflect gr arnings after mandatory deductions such a me t e O progra TEP rt Tow mployProgram) is then applied to these earnings to determine what percentage of the earnings may be kept by the recipient, before deductions wil de from e recipie SP

age 53 for mo e detail.

he earnings above r oss e s incoax, CPP, EI etc. Under th DSP m, S (Suppo ards E ment

l be ma th nt’s ODincome. The table below calculates the earnings with STEP applied. The table is based on four of the common family structure scenarios used in table 5 (page 44): Table 7: STEP Calculations Family Structure Singles without Singles with Couples without Couples with Children 1 Child under Children 1 child under

Calculations age 12 12, & 1 over 13Ave. Net Earnings $279.00 $390.00 $751.00 $1,003.00 Basic Exemption $160.00 $235.00 $235.00 $235.00 Variable rate @25% $29.75 $38.75 $129.00 $192.00 STEP $189.75 $273.75 $364.00 $427.00 Childcare/disability- work expense $0.00 $125.00 $0.00 $200.00 Chargeable Earnings $89.25 -$8.75 $387.00 $376.00 ODSP Income (no earnings) $532.00 $796.00 $788.00 $1,080.00 Income less Chargeable Earnings $442.75 N/A $401.00 $704.00 Total Income $632.50 $1,186.00 $765.00 $1,131.00 Difference from ODSP income $100.50 $390.00 -$23.00 $51.00 % Net Earnings Client Can Keep 36.0% 100.0% -3.1% 5.1%

Notes: Variable rate is 25% of Ave. Net earnings – Basic Exemption. STEP = Basic Exemption + Variable Rate, and represents the amount that is deducted from gross income for the purpose of calculating chargeable earnings. Chargeable Earnings is the amount that will be deducted from the recipient’s ODSP income. Chargeable Earnings = (Ave. Net Earnings – STEP) – childcare – “disability work- related expenses” (up to $140 /mo). Total Income = Income less Chargeable Earnings + STEP. If Chargeable Earnings are negative, no deductions are made from ODSP income. Childcare costs are estimates based on $25 /day for full-time and $12 /day for before & after school programs.

It should be noted that these scenarios are only two of many possible scenarios and are based on averages. Some families would presumably have higher incomes, and some lower. Also, the childcare or work-related deductions are significant in determining the amount of earnings kept or deducted. As an example, if the couples above had higherearnings and were able to deduct more childcare costs (up to the maximum of $780 /mo.) they would invariably have higher incomes. Additionally, clients also rely on other sources of income such as WSIB, CPP, etc. On a positive note, when living at these low income levels, any increase can be considered significant as marginal as it may seem (example: an additional $100 for a single client without children can represent a 10% increase in disposable income).


On a not-so-positive note, the above STEP examples reveal that the net financial benefof working varies considerably between family types and circumstances. In some cases, such as for couples without children, the system may act punitively and produce a financial loss. Additionally,

it

for those living below the low income cutoff point, none of theearnings in the above scenarios are enough to raise them above it. This example goes long way towards explaining the low-income trap phenomena and helps to see whthe client’s comments regarding employment (see below) are coming from.

a ere

10

Note: Having said the above and done all the calculations, ODSP policy changes are

currently being made to the employment supports and income support components of the program, and some of the above basic exemptions and STEP calculations are also changing! (see page 52 for more detail). Additionally, the ODSP Basic Needs and Shelter Allowance benefits are being increased by 2% in 2006. As this study commenced before the changes were publicly known or made, it is necessary to analyze the current program as this is what the clients and service organizations are referring to. Incidentally, the 2% increase in benefits will not bring any of the families in table 5 (page44) to the Low Income Cutoff levels.

ded e po n de e s ver pp loy eRegarding employment and ODSP the clien g mented o and disincentives t ork. Comments the follo ing sum up someo e can’t afford to go to work because we would lose our benefits; there a iers in getting establi e work community –it’s easier to sit back t about employment; if someone has ODSP for 10 years, who is going to hire them? The reason r not wo e varied ded e sed cot orking harder but not earning much more than presently, the fear o SP deduct etc. but on most ly g urity a P benefits

While delving into publicly funcope of this study, the crosso

mployment supfrom financial su

rt programs iorts into ‘emp

tail is beyond thment’ is inevitabl .

, many of ts in the focus roups comn the barriers o w such as w f their attitudes: wre too many barr shed in th

han having to worry been ons given fo rking wer and inclu

mployer disability stigma, increa sts resulting from the employment, ransportation issues, wf losing the job, having OD too much the reas commoniven was the loss of income sec nd ODS (such as medication and

dental).

Note: The MCSS policy changes cu eing impl , directly a the rrently b emented ddressconcerns of loss of income and benefits. With these new changes, ongoing health-related benefits will be provided to clients who leave ODSP for employment (these benefits include prescription drugs, dental and vision care). The benefits will continue along as needed or until the employer provides health coverage.

s

ying their essential bills.

,

despite living on subsistence welfare incomes.

iii) Disposable Income The LICO and earnings analysis above provides a good picture of the income levels of Nipissing District’s ODSP clientele, and to some extent validates what was heard throughout the focus groups, community sessions and various meetings. To complete the picture of income it is desirable to have an idea of the disposable income of clients, e., what they actually have to spend after pai.

10. The low- income trap is described in various reports and studies, but most recently TD Economics has

referred to it, in its series of reports on the standard of living. The low-income trap refers to the notionwhereby there is little financial incentive for people to get off welfare, so they end up staying on it,


While the actual household costs for the clients are unknown, an estimate of disposable income can be made based on the costs of basic living necessities such as housing, utilities and food. The table below takes the four common family types from above acalculates basic disposable incomes, for those with and without earnings (

nd note: for these

calculations, only the Basic Needs & Shelter income, and earnings are considered – no other special benefits, Gov’t transfers, etc. Also rent is market price, not rent-geared-toincome, rent supplement or social housing).

-

DSP Disposable Incomes in Nipissing District11 Table 8: O Singles without Singles with 1 Couples without Couples with 2 Total Children Child under 12 Children Children, 12 & 13 Caseload

Without Earnings 2287 315 361 188 3151 % Caseload 64.1% 8.8% 10.1% 5.3% 88.3% Basic Needs income $532.00 $796.00 $788.00 $1,080.00 Shelter income $427.00 $672.00 $672.00 $792.00 Total income $959.00 $1,468.00 $1,460.00 $1,872.00 Ave. rent $608.00 $662.00 $608.00 $696.00 Utilities $100.00 $150.00 $100.00 $250.00 Food $150.00 $210.00 $287.00 $513.00 Total costs $858.00 $1,022.00 $995.00 $1,459.00 Disposable income $101.00 $446.00 $465.00 $413.00 With Earnings 198 34 90 93 415 % Caseload 5.6% 1.0% 2.5% 2.6% 11.7% Income (see Table 6) $632.50 $1,186.00 $765.00 $1,131.00 3566 Shelter income $427.00 $672.00 $672.00 $792.00 Total income $1,059.50 $1,858.00 $1,437.00 $1,923.00 Ave. rent $608.00 $662.00 $608.00 $696.00 Utilities $100.00 $150.00 $100.00 $250.00 Food $150.00 $210.00 $287.00 $513.00 Total costs $858.00 $1,022.00 $995.00 $1,459.00 Disposable income $201.50 $836.00 $442.00 $464.00 Income Difference $100.50 $390.00 -$23.00 $51.00

For those without earnings, average monthly disposable income for the common family scenarios, range from $100 for singles, to $465 for a couple without children. Given that no other household or living expenses have been factored in, these incomes are clearly marginal. Even with the anticipated 2% increase in benefits, monthly disposable incomes

r the above families will only rise between $20 (singles) and $40 (couples with hildren). Earnings make a considerable difference for the singles with 1 child in the

posable income almost doubling that of the regular ODSP

d costs are a nutritious food basket – ref: North Bay & Parry Sound District Health Unit. The

10-

focabove scenario, with disincome. For the couples without children, the effect is opposite and from a financial perspective, employment does not seem like an attractive alternative. 11. For caseload earnings, refer to: CMSM’s Social Assistance Quarterly, MCSS –December 2005.

Caseload income is calculated from the ODSP Rate Chart –February 2005. Average market rents are for 1, 2, & 3-bdrm. units in North Bay, ref: DNSSAB Housing Dep’t., May 2006. Foocalculated fromscenarios are representative of the District’s caseload and are; singles without children = average for male & female ages 25-49, single with 1 child= single mother with child 4-6 yrs., couples without children= male & female ages 25-49 and couples with 2 children = previous couple, with 1 girl ages12 and 1 boy ages 13-15.


The remaining singles without children and couples with children see disposable income increases of 36% and 15% respectively, over their regular income level. Again, this illustrates that the financial benefit from employment can vary considerably amongst clients and is dependent on their family structure /composition. Throughout the focus groups, the single clients appeared to be the most vocal regardingthe lack of income and the analysis above pro

vides some explanation as to why. On

r those living in North Bayaverage, they have the lowest disposable incomes and fo (48% of the total caseload), their shelter allowance does not cover the average market rent (which also can b a bl eegiven that the District’s caseload grow om up, the col izations that provide low-income services to these ts can expectremain stretched into the futur A 5% of the Dis l child p ages 0-1 DSP depec iew of the previo and d income a t is evidemany of these children are living in low-income households. As d earlier ireport, this is a concern from a health, educat d social de nt perspeAnecdotally, the focus groups and community s indicated of child sein general (see “Child & Family Supports, pa I view of the above i ome analysis, obvious solut n might be to raise the level of ODSP income across the board. While this is presently being recommended by some s ance advocacy groups, it unfortunat not that simple. One factor thatplays into this and which surfaced during the in this study, is that of finanm y some of the The other factor is one of c d who beat n the event of a raise. 6 ancial Management

e attributed to lack of afforda e housing). As s n previously, th is coming fr this gro mmunity front-

ine service organ clien to e.

pproximately tricts tota opulation 7, are O ndent hildren. In v us LICO isposable nalysis, i nt that

mentione n this ional an velopme ctive. session a lack rvices

ge 87).

n nc an io

ocial assist ely is research cial

anagement b clients. osts, an rs hese costs i n income

.2 Fin

i geting Some of the nd managing household

g these pa clients an raise wou ecessarily

r

stee lients

on 12.

) Household /bud ODSP clients report a difficulty with

inances, and givinbudgeting a

income

f rticular ld not nadvance their standard of living.12 This is also confirmed by some of the community service organizations such as the Canadian Mental Health Association and the Nipissing Legal Clinic, who work with these clients in managing their household incomes. Staff from the housing registry also said they sometimes assist clients with household budgeting, as do some of the landlords. It should be noted that a missed payment in this case, is not referring to an unpaid cable TV bill or monthly magazine subscription - fothese clients who are living on the margin, missed payments can result in the disconnection of utilities, or an apartment eviction that can lead to homelessness. Trustees can be an effective solution to this problem and the clients who had Trustees

ported that this was working well for them. The problem however, is a lack of trureprograms in the area. The Canadian Mental Health Association presently has 25 c

a waiting list for its trustee program.

This is not to imply that those with low-incomes are weak at household budgeting and lack money management skills. On the contrary, there is no correlation between income level and budgeting skills.Some families earning $25k /yr. will run much more efficient households than those earning $50k. Rather, this reflects the unique challenges some people with disabilities have, especially those with mental illness.


1. Recommendation: MCSS That the Ministry further explore this need for trustee programs within the District, and work with the relative community organizations to develop adequate, sustainable program

programs such as trusteeship, when compared to other areas of equivalent population. In making future program resourcing decisions, this should be a priority area for additional funding given the nature of this report.

s & services to meet the needs of clients.

he District’s high caseload per capita would indicate a higher-than-average need for

To qualify for this program, clients must have a demonstrated mental illness. While this serves the target group, the program is somewhat limited if others in need (such as those with cognitive disabilities) can not apply. T

The MCSS has indicated that it has recently met with a community agency to

discuss the trustee gap and that a Working Group will be established towards the end of 2006 to address this issue.

6.3 Community Costs and the Paradox Figure 12: District ODSP Caseload and Municipal Levy

Average ODSP Caseload & Municipal Levy, Nipissing District 2001-2005

3580

3540

3420

3440

3460

3480

3500

2001 2002 2003 2004 2005

OD

SP C

asel

$7,200,000

$7,400,000

$7,600,000

$7,800,000

$8,000,000

$8,200,000

$8,400,000

Mun

icip

al L

evy3520oad

3560

$8,600,000

$8,800,000

$9,000,000

$9,200,000

$9,400,000

ODSP Caseload

Municipal Levy

Source: Average caseload numbers taken from Table 3, page 37. Municipal levies obtained from DNSSAB Consolidated Financial Statements, 2001-2004. 2005 levy obtained from DNSSAB Schedule of Program Funding, (unaudited) Dec. 31 2005. Note: Municipal levy shown is for the direct ODSP income benefit only- it does not include ODSP administration or ODSP/OW benefits. The chart above shows the ODSP caseload from 2001-2005, and the corresponding

elevDNsubsidized childcare and emergency medical services.

municipal tax levies that have been allocated to the ODSP program. In 1999, Ontario’s social services were devolved from the province to the municipalities. Nipissing District’s

en (11) municipalities now subsidize social assistance costs through a tax levy to the SSAB, who administers the social services of Ontario Works, social housing,


In 2005, this levy was approximately $27.5 million.13 While the ODSP program is administered by the Ministry of Community and Social Services, the DNSSAB co-funthe program on a 50 / 20 cost sharing basis – it pays 50% of the ODSP

ds administration

osts and 20% of the direct ODSP income benefit. Thus, there is a direct communityc cost to increasing income benefits as the District’s taxpayers are subsidizing the ODSPprogram through municipal tax levies. The average annual municipal ODSP expenditure

has been approximately $8.5 million or $2,400 / benefit unit (approximately 84% of this is for benefits and 16% for a se to the ODSP benefits could result in direct tax ino (ABC’s) a s that involve raising taxes can quickly become contentious and must take into account many

dditional factors. This is not to say that raising ODSP income levels should, or should , just that there are additional considerations that must be factored into the

It t’s Municipalities are to some extent, reimbursed for

eir social expenditures through the Ontario Municipal Partnership Fund (OMPF). The etween municipalities and is tied to property at there are costs associated with increases to

meone – achieving social equilibrium is paramount to effective policy and planning. In 2005, ODSP income levels were raised by 3% but prior to this, there had not been any raise since a 1% increase in 1993 (during this period, Ontario’s inflation increased by 31%). Most recently, the Province has announced further increases of 2% to ODSP incomes for 2006. While these increases are welcomed, the income analysis in the last few pages offers compelling arguments for at least moving ODSP income levels to where they are above the low income cutoff points and indexing them more frequently to inflation (similar to OAS, CPP and other transfers). Based on the Low Income Cutoff levels on page 44, a 15% increase in benefits (basic needs & shelter) is required to bring the District’s caseload to the Low Income Cutoff Levels (or approx. $7 Million). In a rather paradoxical way, there is also a community cost in not increasing the income

dministration). Thus any increacreases to the District’s residents. Given the present Municipal climate of rising perating costs, increased budgets by the Agencies, Boards and Commissions nd limited revenue sources (property tax, user fees and grants), making decision

anot, be doneanalysis before making decisions.

should be noted that the Districthlevel of reimbursement however varies bassessment. The point being made is thsocial assistance payments which must be borne by so

levels. Not doing so results in a greater prevalence of low income clients which in turn, exerts more pressure on the community organizations to deliver increased levels of service and programs. Indirectly, public funding ends up flowing back into community organizations (albeit in a piecemeal, unsustainable fashion many would add) to fund this programming that otherwise would not be needed with higher incomes. Unfortunately, no

hat

, 2005

one currently knows what this community cost is – otherwise, it might suggest tinvesting the $7 million back into income benefits and reducing client needs and community costs, is the preferred option. 13. Ref: DNSSAB Schedule of Program funding, (unaudited) Dec. 31


A recent report by the task force on Modernizing Income Security for Working-AgeAdults (MISWAA)

l that they are unlikely to enter the paid labour force. (Note

14 makes many recommendations to the provincial and federal governments for income security reform, including the following specific to ODSP: • Provide and administer a national disability income support program for persons

whose disabilities are so substantia: this is significant given that 37% of Ontario’s present caseload (15% of

Nipissing District’s) was grandfathered into ODSP from the permanently unemployable category under the former Family Benefits Act).

• Reinstate earlier provincial policies to set disability benefits at the same levels received by senior citizens who have no other source of income.

• Upload all social assistance costs (benefits and administration) for the provincially delivered ODSP, from municipalities to the province (this recommendation was also made by the Northern Ontario Service Deliverer’s Association-NOSSDA in 2005).

2. Recommendations: MCSS Based on the analysis in section 6.0, it is recommended that an increase to ODSP incomes be made. It is recommended that these increases be indexed to average household expenditures (LICO or other accepted measure) or alternatively, to housing and food (see pages 60 and 72 respectively, for these recommendations).

6.4 OPSP Changes in Progress: Ministry of Community and Social Services (MCSS).

ied in is study and include the following:

-

4. Ref: Time for a Fair Deal (MISWAA, May 2006). MISWAA was formed in 2004 with a goal of reforming the income security system for working-age adults. The task force has extensive representation from employers, labour unions, policy institutes, academic institutions, community organizations, advocacy groups, foundations, governments, front-line staff and system consumers (low-income, working-age

As this report is being written, changes are being made to the employment and income support components of the ODSP program. On Feb. 8 2006, the Minister of Communityand Social Services at the time, Sandra Pupatello, announced program changes that aredesigned to help people with disabilities gain greater financial independence and increase their standard of living. The changes are intended to remove many of the barriers to employment and are being implemented in two phases: the first phase was implemented on April 1, 2006 and the second phase will start on Nov. 1, 2006. These changes address many of the employment-related issues that have been identifth

Helping ODSP clients and their families to find work through improved access to employment services.

Replacing the set of current, complicated earnings exemption rules with an easy-tounderstand flat rate: the current basic exemptions of $160 for singles and $235 for families, and the variable 25% rate, will be replaced with a 50% exemption flat rate.

A new $100 /mo. work-related benefit will also be introduced. Increasing the employment start-up benefit from $253 to $500.

1

adults).



Increasing the maximum childcare deduction from $390 /mo. To $600 /mo. Providing up to $600 /mo. for informal childcare costs to clients who are involve

an employment activity. d in

0 to

rk out (as long as

s are being made that will require dependent adults

tion load. The new requirement will make it mandatory for non-

isabled spouses without caregiving responsibilities, to participate in Ontario Work’s

Increasing the maximum deduction for disability work-related expenses, from $14$300. Providing ongoing health related benefits (prescription drugs, and dental /vision care)to clients who find employment, as long as is needed or until they receive employer health coverage. Creating a new, one-time employment transition benefit of $500 for ODSP clients who leave ODSP for employment. Improving rapid reinstatement rules for those whose jobs don’t wothe clients still qualify financially, they won’t have to go through the disability adjudication process again).

* Additionally, regulatory changeand non-disabled spouses without caregiving responsibilities, to access employment assistance available under the Ontario Works Program. Under the current program, dependent adults have been required to enter the Ontario Works program (some exemptions apply) and non-disabled spouses without caregiving responsibilities could do so voluntarily. The target rate for ODSP dependent participais 10% of the OW casedemployment programs (some exemptions do apply).

7.0 HOUSING “My friend is living on a mattress on the floor in a bachelor unit” – ODSP client.

Not only is shelter essential to life, it impacts heavily on a community’s social and

and fee elling they live in, many aspects of their daily living will likely be

s an orse. Considering that approximately 44% of the

regon

The importance of housing for all people in all walks of life cannot be underestimated.

economic infrastructure. Housing provides the necessary base for personal achievement advancement in areas such as employment, education and health - If people do notl good about the dw

compromised. For people with disabilities, inadequate and unaffordable housing makealready challenging situation much w

District’s ODSP caseload is estimated to have serious mental illness (SMI), this housing dilemma becomes even more abrupt. The following table summarizes the key points

arding housing that emerged from the focus groups (clients) and community sultations (service providers): c

Table 9: Key points from Focus Groups & Community Consultations: Housing GAPS BARRIERS CAPACITY /

ALIGNMENT SOLUTIONBEST PRACTIC

S / ES

The ODSP shelter allowance ($670 /mo. for couples and $425 /mo. for singles) is inadequate for suitable market-rent housing.

The waiting list for social housing is too long: ODSP clients reported wait times of 3-5 years on average. Average waiting time on wait list: 5-10 years for

Affordable housing is available in outlying areas such as Redbridge, Field, etc. but accessing services than becom

More rental unitsare all inclusive (i.e., include utilities) for those who havedifficulty in managi

Taf

here is a lack of fordable housing.

here is a shortage of bedroom apartments r singles and couples ithout children.

here is a lack of nding for supportive using - no new llars will be flowing

orth of Parry Sound upportive or rent bsidy).

group home, 3-5 years for supported independent living. Low-price market accommodations tend to be in a poor state; ODSP clients are reluctant to report these poor living conditions to authorities for fear of being evicted.

es too difficult. Stigma and discrimination from Landlords make it difficult to find rental units; some Landlords take advantage of ODSP /low income citizens. There is a lack of housing support staff for the developmentally delayed (DD) population.

that

ng

their finances. Add hydro and heat over the basic shelter Amount. Increase the shelter allowance so that clients are not in jeopardy of losing their current shelter. Subsidize more private Landlords. Convert vacant property /buildings into affordable housing (example: empty school in Sturgeon Falls).

T1-fow TfuhodoN(ssu

Given the strong correlation between income and housing, it was not surprising to hear at for many of the clients, affordable housing is a major issue. As mentioned

reviously, many of the clients who have housing needs are single. During the focus roups and community consultations, clients and service providers described many ousing issues, most of which fall into three main categories: core housing need (lack of come for suitable housing), housing supply and stigma & discrimination.15

. Incidentally, these are the same housing concerns outlined in the Mental Health Housing Issues Study in the Districts of Muskoka, Nipissing, Parry Sound and Timiskaming (Northern Shores Health Council, Sept. 2001).

thpghin 15


7.1 Core Housing

ome ODSP clients end up in unaffordable housing due to their incomes and shelter allowances, which don’t always reflect actual market rental rates (this assumes incto be the independent variable, i.e., housing outcomes are dependent on income). Based on the prior analysis of financial supports and the qualitative results of this study, many ODSP clients are in core housing need and many are considered at risk. These terms are defined below: (see page 59 for “at risk”). Core Housing

The Canadian Mortgage and Housing Corporation (CMHC) defines housing that meets the needs of Canadians, as core housing. Core housing is comprised of three elements: adequacy, suitability and affordability. If a family’s dwelling fails to meet one of these three standards, and if the family would have to pay 30% or more of its income o

arket rent (for a unit that does mn

eet all of the standards), it is said to be “in core

ability ffordability refers to the cost of shelter (rent or mortgage), which should not exceed

ld inc er eemct on th

erc c ayin in an ag

ain as nts n n the p r ly 6% are homeown

t size of the unit and whether or not the number of bedrooms is cc eetingn ct

bedroom should be llowin

b ths. and e ie

ndents ages 5-17 yrs. and only iblings of the same sex

Siblings under 5 yrs. and of the opposite sex are required to sha- A single individual can occupy a bachelor unit (i.e., no bedroom)

try

mhousing need”. i) AffordA30% of househoproblem as it is affeincomes, a large pis not in social houswith affordability m

ome. Of the three crited by low incomes andentage of the District’s), is paying more th

ia, affordability is dhigh rents. Basedaseload which is p30% (see table 10 p very few ODSP clieoximate

ed the most serious e average ODSP g market rent (i.e.,e 58). The concern own their ow

gly pertains to rentersrovincial average, apphome (based o

i) Suitability

ers).

iSuitability relates tosufficient for the sizethe National Occupa

heand make-up of the ocy Standard (NOS) di two (2), with the fo

edroom separate from older have a separat

upant family. In mates that the maximum number of people in g parameters:

suitability criteria,

a

- Parents have a- Those 18 yr

spouses - Children /Depe

with s

eir children bedroom unless marr

older are required to s

d or cohabitating as

hare a bedroom

re a bedroom -

Often within the community, the need for housing is talked about in terms of the affordability criterion. While understandably this is the most pressing issue, the suitabilitycriteria should not be discounted or ignored. During the focus groups, clients gave examples of where they were ‘bunking in together” or doubling up in rooms in order toand make ends meet (this includes single moms with their children, sleeping in one room). In these particular circumstances, while the affordability criteria may be being

et, m the suitability standard is not.


iii) Adequacy Adequacy refers to the physical condition of a building or unit – for example, if itmajor repairs or lacks proper plumbing, it is deemed inadequate. Some of the focus group participants described living conditions that clearly did not meet adequacy standards: apartments in dire need of repair, with no action or response from some of the landlords (in fairness, there will be a landlord side to this issue but landlords were notconsulted during this review). Clients are often reluctant to report these problems to a

needs

roper authority, for fear of eviction and not having anywhere else to go. Regarding the , some of the community service providers feel that some of these are d would not meet the fire code.

paffordable unitssubstandard an 7.2 Affordability Gaps

Given the above definitions of core housing, it would now be appropriate to put thininto context and look at ODSP incomes and average market rents. Performing scealculations that

gs nario

are reflective of the District’s caseload structure and rental market, will ation as to the extent of the housing affordability problem within

tion without

cprovide an indicNipissing District. In order to establish these scenarios, it is necessary to analyze the caseload further, particularly those families with children and dependent adults. Knowing the average sizeof the families and the ages and number of dependents, will help in determining the sizeof apartments required to meet the suitability requirements. Rents can then be calculated based upon the number of bedrooms required. From the caseload informain Table 1 (page 30), 82% of the caseload (2,936 clients) are single or coupleschildren and thus require a 1-bedroom apartment. The remaining 18% (630 families) are

ouples with dependent children and adults, who require different numbers singles and cof bedrooms, depending on the number and age of their children. The chart below displays these families by the number of their children: Figure 13: ODSP Families by Number of Children, Nipissing District

139

227

98 96

29 2310 3 4 0 1 0

0

50

100

Fam

ilies

with

150

200

250

Chi

ldre

n (#

)

1 2 3 4 5 7Number of Children

2005ODSP Families by Number of Children: Nipissing District, Dec.


Singles with Children

ource: Statistics and Analysis Unit, MCSS (Toronto), DNSSAB custom data. S


The above indicates that 97% of the families have 3 or less children and thus require 3-

e

bedrooms or less (based upon at least two of the children sharing a bedroom). Familieswith 4 or more children comprise 3% of the total and could require 4+ bedrooms, depending on the ages and gender of the children. Although there are just 18 of thesfamilies in the District, their housing needs are unique and social housing of this size isin short supply – there are only 5 units in the District that have 4+ bedrooms. The chart below presents the age structure of the dependent children and adults: Figure 14: ODSP Dependents Age Structure, Nipissing District

ODSP Dependents (Children & Adults), Age Structure: Nipissing District, Dec. 2005

100

7278

82

697078

88

60

70

80

90

pend

ents

6057e

4541

3639

3531

36

2621

25

0

10

20

30

40

50

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18+

Age of Dependents

Num

ber o

f D

Source: Statistics and Analysis Unit, MCSS (Toronto), DNSSAB custom data. With a median age of 12 ½ yrs., ODSP dependents tend to be olde25% of them are 16 yrs. and above. While this has greater implicat

r – approximately ions for other service

areas (such as for supportive living environments –see page 95), from a housing suitability perspective it could indicate a greater requirement for more bedrooms depending upon the gender of the dependents. Knowing a little more about the family structures, realistic scenario’s can now be used for calculating housing affordability. The table on the following page compares income for a range of common family scenarios, to average market rents in North Bay, West Nipissing and Mattawa (these areas account for 96% of the District’s caseload). The number of bedrooms required is determined by adhering to the suitability criteria described earlier. It should be noted that this is a general analysis only, taking into account average rents, basic needs income and shelter allowance. The scenarios use ages as defined by the suitability criteria (0-4 yrs., 5-17, 18+ -see page 55) and ODSP income (0-12 yrs., 13+), and incomes and rents are based upon the number of dependents and size of benefit unit (see ODSP Rate Chart in appendices). It should also be noted that apart from singles without children, the shelter allowance by itself, is in most cases, adequate to cover the local market rents. The fact that there are still affordability gaps is thus indicative of the low basic needs income benefit.


Table 10: Housing Affordability Gaps / Month

ms

Req

uire

d

ds

owan

ce

Bas

ic +

Ave

. nt

lity

Gap

ssin

g: A

ve.

Family & Housing Scenarios

o

me

(

Affo

rdab

ility

Gap

Mat

taw

a: A

ve. R

ent

Affo

rdab

ility

Gap

Bed

ro

Bas

ic N

ee

Shel

ter A

ll

Inco

Shel

ter)

Nor

th B

ay:

Mar

ket R

e

Affo

rdab

i

Wes

t Nip

iR

ent

enefit Unit =1 B Single Client 1 $532 $427 $959 $608 ($320) $600 ($312) $509 ($221) Benefit Unit =2 Client & Spouse 1 $788 $672 $1,460 $608 ($170) $600 ($162) $509 ($71) Client and 1 child under 12 2 $796 $672 $1,468 $662 ($222) $674 ($234) $565 ($125) Client and 1 child over 12 2 $848 $672 $1,520 $662 ($206) $674 ($218) $565 ($109)

Benefit Unit = 3 Client, Spouse, and 1 Child under 12 2 $902 $729 $1,631 $662 ($173) $674 ($185) $565 ($76) Client, Spouse, and 1 Child over 12 2 $949 $729 $1,678 $662 ($159) $674 ($171) $565 ($62) Client and 2 children under 5 2 $909 $729 $1,638 $662 ($171) $674 ($183) $565 ($74) Client and 2 boys or girls, ages 5-12 2 $909 $729 $1,638 $662 ($171) $674 ($183) $565 m($74) Client and 2 boys or girls, ages 12-17 2 $1,009 $729 $1,738 $662 ($141) $674 ($153) $565 ($44) Client and 1 boy and 1 girl, ages 5-12 3 $1,009 $729 $1,738 $696 ($175) $727 ($206) $667 ($146) Client and 1 boy and 1 girl, ages 12-17 3 $1,009 $729 $1,738 $696 ($175) $727 ($206) $667 ($146) Client and 2 Dep. Adults 3 $1,009 $729 $1,738 $696 ($175) $727 ($206) $667 ($146) Benefit Unit = 4 Client, Spouse and 2 boys or girls, under 12 2 $1,033 $792 $1,825 $662 ($115) $674 ($127) $565 ($18) Client, Spouse and 1 boy and 1 girl under 12 3 $1,033 $792 $1,825 $696 ($149) $727 ($180) $667 ($120) Client, Spouse and 1 boy and 1 girl over 12 3 $1,128 $792 $1,920 $69 ($120) $727 ($151) $667 ($91) 6 C $1,832 $696 ($146) $727 ($177) $667 ($117) lient and 3 children under 5 3 $1,040 $792Client and 3 children ages 13 a ($133) $667 ($73) nd over 3 $1,189 $792 $1,981 $696 ($102) $727

enefit Unit = 5 BC 07) $667 ($47) lient, Spouse and 2 girls under 12, and 1 boy over 13 3 $1,213 $853 $2,066 $696 ($76) $727 ($1C 41 ($93) N /A N /A lient, Spouse, 1 child ages 13-17 and 2 dep. adults 4 $1,308 $853 $2,161 $720 ($72) $7

C ,089 $853 $1,942 $696 ($113) $727 ($144) $667 ($84) lient and 2 children under 5, and 2 girls ages 6-17 3 $1

Client & 1 boy and 1 girl ages 5-12, & 2 dep. adults 4 $1,269 $853 $2,122 $720 ($83) $741 ($104) N /A N /A Source; Average market rents, DNSSAB Housing Department. These rents are based on newspaper surveys and do not include utilities. Notes: * The average rent for 4-bdrm. units in West Nipissing is based on social housing market rent which is velimited, as there are only 2 units. Rent for 4-bdrms. In North Bay is an estimate only. 4-bdrm. rent inMattawa is currently unavailable. Income only includes

ry fo. for

shelter and basic needs and does not take into account any earnings or other

s,

*sources of income. * Family sizes (benefit units) with 6 people or more, only represent 3% of the District’s ODSP caseload and would require apartments or houses with 4 + bedrooms. The above reveals that for the District’s common ODSP family structures and scenarioall are paying more than 30% of their income on rent, and thus are in core housing nee

d.


The amount that they are paying over 30% is referred to as the ‘affordability gap”. This gap is the highest for singles, and ranges between $220 and $320 per month. This is the only group where the shelter allowance is insufficient to cover market rents, which is why the gap is significantly greater than the others (note: the abo doe t take countbachelor units which would meet suitability stand s a re e th ordability gap through lower rents. However, the supply thes nits ve limi Single parents in West Nipissing and North Bay also have significant gaps, n$234. Affordability gaps are significantly less in Mattawa due e r re

2% increase to ODSP benefits will sunts, it won’t be enough to decrease their ford ility gaps to 0

ve ducry

rangi to threly be welcomed by the

sn’e aff

ted).

into

nts.

ac

As a

arde u

nd is of 16

g between $206 and lowe

side note, although theDistrict’s clie af ab $ (i.e. enable

ay 30% or less of their income on ntthem to p re ). 7.3 At Risk

“At risk” can be considered an emerging term that came about during the Td families who have formal shelter or adequate housing, but

latile or dubiou O t a u ier costs – if a fa ily d a yi o n

90’s. his term applies to individuals anwhose circumstances are vo

ts. ne quantita ive me sure sed to ident fy

this segment is that of shel m or in ividu l is pa ng m re tha 50% of their income for housing, they are consider ‘a ’ f g e

above, and sh s e a in o

sk, Nipissing D r v t o n

ed t risk . The ollowin tabl looks at thesame family scenarios from ow the p rcent ge of come spent n market rent: Table 11: ODSP Clients at Ri ist ict

A e. Ren / % Inc me o Rent N b al tum er Tot North West Ma tawa

Family & Housing Scenarios drooms om Bay Nipissing Be Inc e

Benefit Unit =1 Single Client 1 9 60 % 0 % 0 $95 $ 8 63 $6 0 63 $5 9 53%Benefit Unit =2 Client & Spouse 1 6 60 % 0 % 0 $1,4 0 $ 8 42 $6 0 41 $5 9 35%Client and 1 child under 12 2 6 66 % 7 % 6 $1,4 8 $ 2 45 $6 4 46 $5 5 38%Client and 1 child over 12 2 $6 44% $67 44% $56 37% $1,520 62 4 5 Benefit Unit = 3 Client, Spouse, and 1 Child under 12 2 3 66 % 7 % 6 $1,6 1 $ 2 41 $6 4 41 $5 5 35%Client, Spouse, and 1 Child over 12 2 $1,678 $662 39% $674 40% $565 34%Client and 2 children under 5 2 $1,638 $662 40% $674 41% $565 34% Client and 2 boys or girls, ages 5-12 2 5 34% $1,638 $662 40% $674 41% $56Client and 2 boys or girls, ages 12-17 2 $1,738 $662 38% $674 39% $565 33% Client and 1 boy and 1 girl, ages 5-12 3 $1,738 $696 40% $727 42% $667 38% Client and 1 boy and 1 girl, ages 12-17 3 $1,738 $696 40% $727 42% $667 38% Client and 2 Dep. Adults 3 $1,738 $696 40% $727 42% $667 38% Benefit Unit = 4 Client, Spouse and 2 boys or girls, under 12 2 $1,825 $662 36% $674 37% $565 31% Client, Spouse and 1 boy and 1 girl under 12 3 $1,825 $696 38% $727 40% $667 37% Client, Spouse and 1 boy and 1 girl over 12 3 $1,920 $696 36% $727 38% $667 35% Client and 3 children under 5 3 $1,832 $696 38% $727 40% $667 36% Client and 3 children ages 13 and over

$667 34% 3 $1,981 $696 35% $727 37%

16. An average rent for a bachelor apartment in North Bay is $440 /mo. Ref: CMHC Rental Market Report –Ontario Highlights, Oct. 2005.


The above analysis indicates that based upon the general scenarios, the single ODSP client (70% of the District’s caseload) is at risk.17 While the proportional income spent on rent identifies this vulnerable segment, their housing insecurity could be for reasons such as: their shelter costs consume too much of their income, they are prone to rent arrears and eviction; they are ‘couch surfing’ (living temporarily with a friend or relative,with no permanent fixed address); they are personally at risk of physical or mental abuse, or they have disabilities which may result in them losing their housing. Hopefully some of these single clients have alternative scenarios (such as additional income, family support, etc.) and are not necessarily “at risk” or even need improved housing. But the above reinforces the fact that on average, the single caseload is the most vulnerable in terms of finances and housing.

arly demonstrates the housing This clevulnerability of the District’s single clients and prompts action in the policy arena. All the othetwo children

3. Recommendation: MCSS Review the current ODSP Shelter Maximums: i) With the view of making the shelter maximums more reflective of the local

housing m

arkets. Also, to align the shelter maximums to the national bility, suitability and adequacy).

) With the view of considering a different scale for clients w or any affordable housing programs, and who e initial focu e le clie

components of core housing need (affordaii ho are not able to

access social housingpaying market rent.

are Th s should b on sing nts as th

argest affordability gaps are (for example, the shelter maximum erson is $427 /mo. and yet the erage r a

in Ontario’s 11 CMA’s is $774 /mo.).

is is where the lfor one p av rent fo 1-bdrm. apartment

r family scenarios range from paying 31% of income on rent (a couple with living in Mattawa) to 46% (a single parent with one child living in West

7.4 Supply

Nipissing).

Affordable Housing D ly heard from oth clie d s idt ordable housing in Nip is b report, housing supply refers to affordable housing

uring this study, it was frequent b nts an ervice prov ers, that here is a severe shortage of aff issing D trict (for the asis of this

, i.e. l as r ah ps, clients dis yed fru n a aa wait for yea on wait s. A acb es without children wa rim n 7 Housing

There are two main issues regarding the soci housing supply for ODSP clients in the D mand aT cial assistan e units in Nipissing Distrmix of Municipal and private non- profits, public housing, provincial reformed and urban native housing.

, socia sistance o ssisted ousing). During the focus grou pla stratio t not being ble to find ffordable housing and having to rs ing list gain, the l k of 1-drm. units for singles and coupl s the p ary concer .

.4 i) Supply: Social al

istrict: supply location and housing de .

) Location here are approximately 1,630 so c ict, which are a

17. While this is not yet an accepted measure like that of CMHC’s definition for affordable housing, many in

the industry are using this percentage to identify this particular housing segment.


Approximately 90% of these units are rent-geared-to-income (RGI), with the remainder being rent supplement. The location of this housing can be seen on the following chart: Figure 15: Social Housing by Area, Nipissing District

Nipissing District Social Housing by Area, 2005

North Bay76%

North Bay

Sturgeon Falls

Mattawa

Temagami

Verner

Field

Mattawa5%

Field1%

Temagami1%

Verner1%

Sturgeon Falls16%

S The in the follFig

ource: SMAIR Reports, Dec. 31 2005

location of this housing basically aligns with where the clients live as indicatedowing chart: ure 16: ODSP Caseload by Area, Nipissing District

Nipissing District ODSP Caseload, by Area of Residence

1.0%Verner1.5%

7.0% 1.0%

North BayNorth Bay

Sturgeon Falls

Mattawa & Area

Temagami

Verner

Field

Other

69.5%

Temagami

Mattawa & Area 5.5%

Sturgeon Falls 14.5%

OtherField

Source: Nipissing District ODSP Caseload, An Analysis by Area of Residence, Age, Family Status and Primary Disability, MCSS & MCYS April 2005. Note: See table 11 below for Other”

omparing the abC ove charts reveals that 90% of the caseload lives in North Bay, Sturgeon Falls and the Mattawa area, which is where 97% of the social housing is.


Having said that, of the social housing currently available in Sturgeon Falls and Mattawa, there are no modified units, i.e., there is no supportive housing for people who are physically disabled. Temagami, Verner and Field also have a social housing supply

ad (3.5%). There is also a small which can to some extent, support the ODSP caselopercentage of the caseload which lives in outlying areas where no social housing exists. The “other” category in the above chart accounts for 7% of the caseload and represents the following areas: Table 12: ODSP Caseload Area with no Social Housing Supply Area Town/City ODSP Cases % of Total

Caseload

Cache Bay 57 1.6% Crystal Falls 10 0.3% Lavigne 16 0.5%

West

Hwy 17 West 61 1.8% Martin River 2 0.1% Thorne 12 0.3% North Tilden Lake 3 0.1% Madawaska 26 0.7% South Whitney 17 0.5%

East Redbridge 42 1.2% Total 246 7.0% Source: Nipissing District ODSP Caseload, MCSS /MCYS, April 2005 (Susan Stewart). The above caseload data is for Feb. 2005. This identifies a housing gap, although further researcwould be required in order to assess actual housing n

h specific to these outlying areas, eeds and the extent of the gap.

In many of these smaller communities, clients may be living with family or relatives, or their housing costs may be within affordability due to lower-than-market rents (excess market supply). However, the fact that 56% of the clients (138 people) in these outlying areas are single and potentially at risk, warrants concern and should be brought onto the planning radar screen. b) Housing Demand For the larger share of the caseload living in the larger cities such as North Bay and Sturgeon Falls, the lack of affordable housing is more related to excess demand and inadequate supply – simply, there are not enough affordable housing units for those that need them. As a key indicator, the waiting lists are revealing: there are presently 1,040 people on Nipissing District Housing Corporation’s central housing waiting list, of which approximately 23% are on ODSP. The average waiting time for a single, 1-bdrm. apartment is 4 years, and for a 2-3 bdrm apartment the waiting time is approximately 2 years. Nipissing Mental Health Housing & Support Services provides mixed housing (RGI and market) and also supportive housing for those diagnosed with serious mental illness (SMI). Their supportive housing waiting list has approximately 40 people on it, with an average waiting time of 6 years. They also have an additional 200 p

r rent-geared-to-income (RGI) housing, although the number of ODSP clients oeople waiting

n this

folist is unknown.


The Canadian Mental Health Association –Nipissing Branch, presently has 15 clients waiting for supported independent living, and the North Bay & District Association foCommunity Living has 100 people waiting for supported living and group & family homes. The Physically Handicapped Adults Rehabilitation Association (PHARA) currently has 24 people with physical disabilities waiting for modified (supportive) units and they have 36 new units under construction, of which 8 will be supportive housing for people with physical d

r

isabilities.

nity organizations:

Table 13: Housing Waiting List Summary

The table below summarizes the waiting lists of these Commu

Com nization munity Orga Social Group Supportive/ Family Total Housing Home Supported Home Nipissing District Ho poration 233using Cor 233 North Bay & District Community Living 42 51 12 105Association forCanadian Mental He on 15 15alth AssociatiNipissing Mental He ing & Support Servi 40 40alth Hous ces Physically Handicap ehab. Assoc.(PHARA) 24 24ped Adults RTotal 42 130 12 417233

Source: The respective organizations listed in the table. Note: may be s lication as clients can be on more e waiting list. The supportive /supported living waiting li wever, ar plicated. Nipissing Mental Health

ort Service ther 200 people on I waiting li s not known how many of these

ply shortage, they do not reveal the clients indicated that they got off the

g

ount an additional 1,700 residents who are on Ontario Works, r “the working poor” – those people who are not necessarily on social assistance, but

$ 20k /yr.). Even if the District’s entire social housing stock was

there ome dupthan on sts ho

n RGe not dust but it iHousing & Supp

s also has ano a

While the waiting lists are indicative of a housing supentire picture. During the focus groups, manycentral waiting list due to frustration and not wanting to maintain false hope. Others stated they didn’t bother to apply for social housing as they thought it was futile. If these responses are indicative of the ODSP population, one could infer that the central waitinlist could actually be much larger (and the need much greater). In terms of social housing, with 3,566 low-income ODSP clients and only 1,630 affordable units available, there is a large affordable-housing void in Nipissing District this doesn’t take into acc(

oare earning less thanvacated tomorrow, a new waiting list would likely emerge. In terms of trying to maximize the housing that exists, the geographic nature of Nipissing District combined with limited transportation options, makes this a difficult exercise. For example, while the District currently has an average waiting time of 4 years for a 1-bdrm. apartment, there can be much shorter times in the outlying areas. The current waiting time in Field for example is only 1 month. Moving to Field is not a viable option for most clients however, as accessing services would be very difficult for them. During the focus groups, clients said that they would consider moving into the smaller communities but the lack of transportation prevents them from doing so (see “Transportation” page 80).


7.4 ii) Supply: Other Housing: a) Supportive & Supported Housing18

Supportive housing is a type of non-profit housing whereby people can receive thesupport they require, which enables them to live independently within the community. The population segments that require this type of living usually include Senior Citizens and people with mental illness and physical disabilities. There are two aspects to upportive /supported housing; the

bricks and mortar aspect (i.e., the physical buildings se in

g for those wit ou l in Nipissing District iknown as iatives). Presem the North Bay area, and a w w ing time for their supportive l , as people generally don’t move out of these units o ocia on-Nipissing Branch, also has 8 h n supplement its. The th Bay & District Association for Community Living has 68 in nden ng units are

r

sto house those in need) and the services aspect (i.e., the delivery of services to tho

eed, so they can live independently within the community). n The primary s nupplier of supportive housi

s Nipissing Mental Health Housing & Support Servicesh a seri s menta illness (SMI)

(formerly North Bay Community Housing Init

ortar’ and an additional 8 rent-suppntly they have 92 ‘bricks &

lement units in service inaiting list with 40 people. As mentioned earlier, the ait

iving units is approximately 6 yearsnce they are in. The Canadian Mental Health Ass tiigh-supportive living units and 15 supported living, re t un Nor

depe t livi thatprimarily allocated to people with developmental disabilities – as mentioned earlier, bothorganizations have waiting lists. PHARA is the primary supplier of supportive housing fo

e physically disabled population and currently has a total of 108 units. Of these, 28 thunits are modified to accommodate physically disabled people and the rest are a combination of market rent and RGI /rent supplement. Approximately 44% of the District’s caseload (1,570 people) has a serious mental illness (SMI) which is 7.5% higher than the provincial average. It stands to reason that the localized, per-capita need for supportive housing would also be higher than the average

clearly the District’s supply is falling short of demand. This information however is –nothing new! The report, The Face of Homelessness in Nipissing District (Oct. 9highlighted the need for increased supportive living capacity in Nipissing District. More recently, an extensive report by the Northeast Mental Health Implementation Task Force(Dec. 2002) also points to this need. Since that report, 28 ‘bricks & mortar’ units and 11 rent supplement units have been added with funding through the MOHLTC. As of Augu2006, additional funding has been initiated for 16 more rent supplement units of which

re designated for individuals with SMI who have connectio

9)

st 8

ns to the justice system, i.e.

was

ch is ve in the

e throughout the community and services are delivered to them, independently of one another. In reality, given the complex nature of disability and mental illness, the District will likely require a range of supportive housing which includes both the “group home” and “independent living” models. Ref: The Time for Change is Now: Building a Sustainable System of Care for People with Mental Illness and Their Families in the Northeast Region, Final Report Dec. 2002; Volume 1, Section 8.

alow-risk offenders. This housing is obviously welcomed but the fact remains that there is still a significant shortfall in dedicated supportive /supported housing for Nipissing District. 18. Supportive housing started to replace the custodial housing models in the 1970’s. With custodial

housing, people with SMI were housed in institutions, “special care homes”, etc. The earlier versions ofsupportive housing integrated both the living accommodations and the services - everything delivered under one roof such as in group homes and cooperatives. A more recent approasupported housing which involves the separation from services and housing, i.e., people liexisting housing that is availabl


4. Recommendation: MOHLTC i) That the Ministry of Health and Long Term Care review these benchmarks and consider not only population, but actual prevalence, which takes into account Nipissing District’s large ODSP caseload. ii) That based upon this review, a plan is developed and implemented that westablish adequate supportive/ supported housing

ill capacity in Nipissing District.

nada-Ontario Affordable Housing Program there are no Additionally, under the current Casupport dollars available for supported housing in Nipissing District, (see Affordable

00 adult population and for

Housing Program, page 67). In 1995, the Ministry of Health set 5 & 10-year community benchmarks for adequate housing supports for the mental health population. These benchmarks were based on population and used an SMI prevalence rate of 2.5% of the total population. Assumptions were made that 0.8% of the adult population would use mental health services and that housing supports should be available for approximately 33% of these people. The benchmarks worked out to 207 spaces per 100,0the combined Districts of Nipissing & Timiskaming, equaled 255 spaces (approx. 182 spaces for Nipissing and 73 for Timiskaming, based on population). As pointed out in theNortheast Mental Health Implementation Task Force Report (Dec. 2002), the province has not met these benchmarks. At that point in time, there was a shortage of 135 spaces (96 and 39 respectively, for Nipissing and Timiskaming Districts).19 When one factors in Nipissing’s high prevalence rate for serious mental illness (SMI), this shortfall becomeseven more pronounced.

es

b) Shelters Moving along the housing continuum, shelters provide short-term stays for those whoare homeless, in need of transitional housing, or experiencing extreme circumstancsuch as physical abuse. As an indicator, they reflect a vulnerable segment of the population who are in dire need of shelter and assistance. There are presently five (5) shelters in Nipissing District: Nipissing Transition House (North Bay), the North Bay Crisis Centre, Sturgeon Falls Family Resource Centre, Mattawa Family Resource Centre and the Salvation Army (North Bay). The shelters offera total of 57 beds and the Resource Centres and Transition House serve females only: Table 14: Shelters in Nipissing District, 2005

Shelter # Beds Clients Served Nipissing Transition House 14 Females North Bay Crisis Centre 19 Co-ed, singles & families Sturgeon Falls Family Resource Centre 10 Females Mattawa Family Resource Centre 10 Females Salvation Army 4 Co-ed, singles only Total 57

19: Ref: The Time for Change is Now: Building a Sustainable System of Care for People with Mental Illness

and Their Families in the Northeast Region: Final Report, Dec. 2002; Volume I. The number of spaces excludes SRTR (Specialized Residential Treatment Rehabilitation), and also respite and crisis beds.


5. Recommendation: DNSSAB & MCSS Streamline the existing shelter reporting format, so that specific information is captured, beyond that which is needed for policy conformance and reports. This will facilitate effective planning for programs and services, as well as provide measurements for the monitoring of proements for the monitoring of program effectiveness (results).

rs due to the various data management systems currently in

se. These systems do not specifically track shelter users by income status (OW, tus

a e North

ls

gram effectiveness (results).

rs due to the various data management systems currently in

se. These systems do not specifically track shelter users by income status (OW, tus

a e North

ls

The Salvation Army is co-ed but serves singles only, and the Crisis Centre is co-ed and serves individuals and/or families. Gathering user-specific information from the shelteand public agencies is difficult

The Salvation Army is co-ed but serves singles only, and the Crisis Centre is co-ed and serves individuals and/or families.

uu

Gathering user-specific information from the shelteand public agencies is difficult

ODSP, earnings, etc.) and thus segmenting shelter consumers by socioeconomic staand demographics is somewhat difficult. The limited data available however, does offersnapshot of some of the clients who use the shelters. For example, in 2005 th

ODSP, earnings, etc.) and thus segmenting shelter consumers by socioeconomic staand demographics is somewhat difficult. The limited data available however, does offersnapshot of some of the clients who use the shelters. For example, in 2005 thBay Crisis Centre served approximately 50 male ODSP clients and the Sturgeon FalFamily Resource Centre served 5 (male & female).20 Both the Nipissing Transition House and the Mattawa Family Resource Centre indicate that anecdotally, many of their clients are ODSP recipients. Given the utilization of shelters by ODSP clients, it would be beneficial to look at overallshelter use as an indicator of housing pressure experienced by this vulnerable population. The shelter data gathered by DNSSAB’s Housing Department indicates that

Bay Crisis Centre served approximately 50 male ODSP clients and the Sturgeon FalFamily Resource Centre served 5 (male & female).

there has been an increased dependency on shelters

20 Both the Nipissing Transition House and the Mattawa Family Resource Centre indicate that anecdotally, many of their clients are ODSP recipients. Given the utilization of shelters by ODSP clients, it would be beneficial to look at overallshelter use as an indicator of housing pressure experienced by this vulnerable population. The shelter data gathered by DNSSAB’s Housing Department indicates that there has been an increased dependency on shelters in general. For the first three quarters of 2005 (i.e., to Sept 30), there were approximately 730 shelter stays in Nipissing District (excluding the Salvation Army). In 2004, there were 915 stays and in 2 Sa2 , thscame from couples with children and single parents (60%), followed by couples without children. The number of singles using shelters actually decreased by 2%. In 2004

was the opposite: the largest increase in shelter use was from singles (26%), couples with children and single parents, actually decreased 6%.21 The

elter

s.

F t to a conventional housing waitin gency a an eed, obviously a 20: Ref: DNSSAB monthly reports. The shelter billi r m s goes through DNSSAB while the billing for

oes through the MCSS. At the time of this report, data on shelter use for females was not

21.

003, 751 stays.21

ince 2003, the total number of shelter stays in Nipissing District has increased pproximately 27%. The annual increases however, do not appear to be consistent: in 005, shelter use was up approximately 5.5% from the previous year whereas in 2004e number of shelter stays increased by 22% over 2003. Also inconsistent is the family

tructure of those who use the shelters: In 2005, the largest increase in shelter use

however, it while use byprofile of shelter client may also be changing –according to the Nipissing Transition House, “more people coming into the shelters seem to be suffering from mental illness,than before”. Additional data and research is needed in order to further analyze shuse and trends, and improve accuracy for planning purpose

or shelters, the equivalen g list is emerd there is someone in nccommodations. When shelter capacity is full

waiting list is ineffective.

ng fo alefemales gavailable.

Ref: DNSSAB Shelter Statistics – Number of Stays per Family Unit, 2003, 2004, Jan. – Sept. 2005. Dueto a change in information systems, data for 2005 is currently only available for Jan. – Sept.


In these circumstances, clients are housed in emergency accommodations such as hotels. For the first three quarters of 2005, the North Bay Crisis Centre had 210 emergency accommodations, or approximately 28% of all shelter stays. Between 2003 and 2004, the Crisis Centres’ emergency placements increased by 37% (92 placemand have averaged 24 emergency placements /month (data for the other shelters is not available at this time).

ents)

22 7.5 Canada-Ontario Affordable Housing Program (AHP)

On a more positive note regarding the District’s affordable housing supply, the Canada-Ontario Affordable Housing Program is currently being rolled out with the specific

bjective of o increasing Ontario’s housing supply. This initiative is a collaborative effort by all three levels of Government that will see $735 million invested into the creation of 20,000 affordable housing units in Ontario. These new units will be created within four main program areas: Housing Allowance Program, Home Ownership Fund, Northern /Remote Housing and Rental /Supportive Housing. What does this mean for Nipissing District? The following table shows the District’s AHP allocations: Table 15: Nipissing District AHP Funding Allocations, 2006

AHP Component Funding Allocation # Units Financing /Unit Housing Allowance Program $408,000 40 $170 max. / mo. Home Ownership Fund $153,000 24 $7500 or 5% of purchase cost Northern / Remote Housing $2,200,000 110 $20K /unit, average Rental / Supportive Housing $0 0 N /A Total $2,761,000 174

Source: AHP / DNSSAB Eligible AHP projects include: the conversion of existing rental units and/or non-residential units, to affordable housing; first-time home purchases and projects that demonstrate energy efficiency savings, measures and affordability. Additionally, projethat will facilitate

cts the development of transitional housing for target groups such as

people with mental illness and physical disabilities are included. This is a priority area forDNSSAB as

currently the only transitional housing in Nipissing District is 501 Morris

which is a high-support, 8-bed facility funded through CMHA Nipissing. These projects will rely upon private and non-profit and RFP’s are s rogram is welcomed, but there are also c A

sector involvement and partnerships, cheduled to go out in early 2007. The AHP phallenges that lie ahead:

HP Underway

he AHP will result in the first affordable housing development in Nipissing DT istrict since 1994 and one project is already underway: PHARA (Physically Handicapped Adults

its which

at more is needed, the potential creation of 174 new units for ipissing can only be viewed as positive.

helters. An example would be for placement of a dangerous offender.

Rehabilitation Association) is moving forward with the construction of 36 new unwill be a combination of RGI and supportive housing for the physically disabled.23 While there are those who think thN 22. Ref: DNSSAB Hostel Statistics - Per Diem; 2004, Jan.-Sept. 2005. It should be noted that in some

cases, emergency accommodations are used for other purposes, even when there is space available within the s

23. PHARA’s project was implemented under Strong Start - a fast-track component of the AHP, to facilitate the development of housing projects that are ready for construction.


The impact this can have on peoples lives and the positive knock-on effects within thcommunities, clearly offers a net benefit. AHP Challenges

e

The fact that the Northern / Remote component is counting on the private sector to step p to the plate with via le u b business plans, leaves some room for concern. With low profit

lords must own or operate the be elusive. Additionally, under

margins and long operating timelines (Proponents / Landproject for 20 years), realizing all 110 units may prove tothe AHP, no support dollars for supported housing have flowed North of Parry Sound. Although local business plans can still be put forward for MMAH consideration, onlcapital expenditure for new buildings will be considered. The operating expenses required for delivering the new support services will need to come through either the MCSS or MOHLTC (read: complex business plan and no guarantees). Given the natureof this ODSP report and the high level of need within Nipissing District, this is discouraging.

y the

7.6 Strong Communities Rent Supplement Program

The Strong Co mfacing s, are a of homp hree di istries a here ain c upplement for regular units (MMAH), tf e speci iatives CS ial n ent supple t for suppor housing and in ase of the MOHLTC, are predominantly for long term care, people with substance abuse and

illness. The supportive housing allocations under the MCSS are for unities

mmunities is a valuable program which enhances the mix and increases affordability. However, there are concerns amongst munity supportive /supported housing providers that relate to the

mmunities Rent Supplem unaffordable rent

ent Prograseeking housing or

is geared towards people who are re at risk elessness. The

rogram is funded through t fferent min nd t fore has three momponents: the rent s he special needs initiative or MOHLTC clients and th al needs init for M S clients. The speceeds initiatives pertain to r men tive the c

people with mentalvictims of violence and people with developmental disabilities. The Strong Commprogram is administered by Provincial Service Managers such as DNSSAB and the program is flexible in that, it can provide support directly to tenants (i.e., direct RGI assistance or in-situ), or the support can be provided through community organizations, agencies, landlords, etc. While the delivery of the program is flexible and has local input, the allocation of funding amongst the regions and client groups, and the funding eligibility criteria for local support service agencies, is centralized at the Ministry Head Offices (their regional offices authorize and monitor the funding, and provide program support).

ithout a doubt, Strong CoWDistricts housingsome of the comservices-side of the equation. In otherwords, while funding is available to subsidize rents, it is not available for providing the support services required to keep people in their homes. As an example, there are cases where units have become available but service providers have had to turn them down because their case managers have full workloadsand cannot provide the required support services – people remain on waiting lists while subsidized rent dollars go untapped. Needl

ess to say, this concern is growing as the ressure for community housing support services increases due to the restructuring of

pNorth Bay’s Psychiatric Hospital.


6. Recommendation: MCSS, MMAH & MOHLTC That the Ministries review the present Strong Communities Rent Supplement

g allocations for Nipissing District, with the view of reducing the Program fundinwaiting lists (Table 13, page 63). This should include providing support-services funding that matches the rent subsidy funding. 7. Recommendation: MCSS That the Ministry enhances its Homelessness services and increases the Community Homelessness Prevention Program (CHPP, previously PHIF) specifically; the Housing Guarantee Program and the Community Housing Transitional Support Worker program.

.7 Stigma & D7 iscrimination

ct of discrimination came up more d unsympathetic landlords and

n).

in

ce for

e

e, which maintains that some clients are very difficult to house and don’t pay eir rent, create property damage, etc.). Supported units of rent supplement housing

ee the

uick, ing

s), with the goal of an accessible Ontario by 2025. hese accessibility standards will define what needs to be done (and when) to remove nd prevent barriers for people with disabilities, throughout industries in the private and ublic sectors. Either directly or indirectly, there is a good chance that AODA will be able address housing barriers such as stigmatization, in the future.

During the focus groups and consultations, the subjethan once. In the context of housing, clients describediscriminatory actions, such as being denied rental opportunities due to their source of income or being taken advantage of (as stated earlier, landlords were not consultedduring this review and hence their opinions and responses to this issue are unknow Disability stigma is a national issue that is somewhat complex, and it has existed forquite some time. At the core of many Government disability programs, is the intention of reducing stigma and promoting social inclusion. Over time, progress has been madethis area but it is a long and continual process. At the provincial level, one of the issues raised in the Deb Matthews Report (Dec. 2004), was the need to change internal and external attitudes about social assistance recipients, why they are on social assistanand what they have to offer society. This is at the heart of the matter: the necessity ongoing community education and awareness pertaining to disability and the promotion of social values. Stigma within the housing sector suggests that more awareness work can be done withthe private landlord sector (other research suggests that there is also the landlord’s sidto this issuthappear to help counter some of this stigma, since the landlords have a chance to stenancy successes and have stability in rent payments. This only holds true however, forthe rent supplement dollars that have support attached. Unfortunately there is no qeasy solution to the stigma problem. DNSSAB will be conducting an affordable housneeds study in 2006 /07 and this will provide a further opportunity to look into this issue with the local housing community and stakeholders. The housing-disability stigma problem may also be addressed through the new Accessibility for Ontarians with Disabilities Act (AODA) which became legislation in 2005. The AODA calls for new, mandatory province-wide accessibility standards to be implemented in 5-yr. stages (or lesTapto


8 “mF ger in developed countries. Similar to housing, there is a strong relationship between income and food security – put simply, the lower the income, the fewer the food options and lower the quality of food, re d nutrition. In addition, as with low income and poor hp G t come as a surprise that many of the focus

.0 FOOD SECURITY

You have to limit yourself with food to make sure you have enough money for the onth” – ODSP focus group participant.

ood insecurity is the term often used to describe hun

sulting in poor eating habits anousing, food insecurity can lead to poor health outcomes and have negative sychological, physical and social consequences.

iven the earlier income analysis, it does no group participants reported a dependence on the local volunteer food outlets. In

articular, use of the foodbanks seems commonplace and The Gathering Place is very participants.

ppopular amongst focus group The following table summarizes the key points regarding food security that emerged from the focus groups (clients) and community consultations (service providers): Table 16: Key points from Focus Groups & Community Consultations: Food Security GAPS BARRIERS CAPACITY / SOLUTIONS /

ES ALIGNMENT BEST PRACTIC Many ODSP clients use community food banks, soup kitchens and the Gathering Place on a regular basis. Additional sources such as the Salvation Army, Church Groups and the

Fruit, vegetables and meat are not available at the food banks so general nutrition can suffer. Food banks do not have the specific foods for clients who are on a

Food bank and church hours don’t always correspond to the needs of clients. Reduced public transportation in certain areas (mainly in the

Have the District Health Unit bridge the gaps and support clients with their nutrition needs. Introduce a type of food-stamp system.

Fruit, vegetables and meat are not available at the food banks so general nutrition can suffer. Food banks do not have the specific foods for clients who are on a

Food bank and church hours don’t always correspond to the needs of clients. Reduced public transportation in certain areas (mainly in the

Have the District Health Unit bridge the gaps and support clients with their nutrition needs. Introduce a type of food-stamp system.

entre of Friends

special diet.

evenings and on Allow for alternative e of Friends

special diet.

evenings and on Allow for alternative C

(CMHA) are also utilized often. Lack of Doctors: Some clients should be on a special diet under the guidance of a Dietician but they need a Doctor’s referral to do so. Many however do not have Doctors.

Increasing transportation costs will mean eating less.

Sundays – see “transportation” on page 82) limits access to the food banks and kitchens. The ODSP Special Diet Allowance is not flowing through to all those who are eligible and in need.

health needs and medicines, including vitamin supplements, to be included in the Special Diet Allowance.

(CMHA) are also utilized often. Lack of Doctors: Some clients should be on a special diet under the guidance of a Dietician but they need a Doctor’s referral to do so. Many however do not have Doctors.

Increasing transportation costs will mean eating less.

Sundays – see “transportation” on page 82) limits access to the food banks and kitchens. The ODSP Special Diet Allowance is not flowing through to all those who are eligible and in need.

health needs and medicines, including vitamin supplements, to be included in the Special Diet Allowance.

Collecting information on consumer profiles for the District’s food banks, soup kitand community food outlets is difficult based upon existing information. As many of these are volunteer based, independently run organizations, their operations and information systems vary significantly and data on client sociodemographics is very limited. This was quickly revealed when calls to some of the foodbanks for user-specificdata, came up empty. This was also emphasized in a report by DNSSAB’s Director of Operations in Dec. 2004, which states that the capacity of most of the food programs for data collection, analysis and sharing is limited.

chens


While the focus groups conducted for this study are not statistically representative of the DSP population, qualitatively, they indicated a high utilization rate of the emergency

oration of the Hunger Task Force

further determine the profiles of ommunity food bank users and also identify cause & effects. The Gathering Place and

Ofood system. Based on other reports however, approximately 15% - 18% of Ontarian foodbank users are ODSP recipients (ref: Daily Bread Food Bank and N.E. Mental Health Task Force). In 1999, the Church Collabconducted a survey in North Bay to obtain a user profile of the foodbanks and raisecommunity awareness on food issues. 44% of the participants in this survey were on”medical disability” and 89% derived their income from Government income support programs. More research is needed at the District level that willcNipissing University will be conducting a survey on the Characteristics and Needs of North Bay Soup Kitchen Users, in 2006. This will be a scientific survey representathe soup kitchen users and thus will be a valuable tool for future analysis and planning.

tive of

8.1 Income & Food

igh utilization rate of food banks, soup kitchens and the Gathering Place on a Hregular basis. A reliance on emerge rams trans nto a lac y. This can best be understood in terms of the c mes and

roportion of income that food consumes. Similar to the housing STIRS (shelter-to-e di t o ne

req .

arry ound District Health Un ts an annual survey for the health easur ea current nutrition

. Th riced ssm y eati sult is

k med acro by the looks fo t

family str repre ricd number of childrene verages were used to ca os

proportion of ODSP Incom

ncy food prog lates directly ilient’s low inco

k of food securit the relatively high

pincome ratios), thto meet nutritional The North Bay Pregion, which mrecommendationssurvey represents a Nutritious Food BasThe table belowbasket. The

sproportionate amounuirements is revealing

f income that clients

it conduc

ed to spend in order

Ses the cost of healthye food items are pinimum for healtht and is perfor

ting based on at the lowest cost pong. The survey ress the provinceod costs, based uponsentative of the Dist. As the nutritious food

ible, and thus the called the

e public health units. he nutritious foodt’s actual caseload basket is based ts:

at client income anducture caseload is the in terms of clients an

upon gender and ag Table 17: Food as a

, a lculate the food c

e, Nipissing District OPSP Food % District Food as % ODSP Family Structure Caseload Income /mo. Cost /mo. of Income Single Male 39.0% $959 $186 19% Single Female 30.0% $959 $136 14% Couple with no Children 12.5% $1,460 $322 22% Single Parent with 1 Child 6.5% $1,520 $307 20% Single Parent with 2 Children 2.5% $1,690 $433 26% Couple with 1 Child 4.0% $1,678 $440 26% Couple with 2 Children 3.0% $1,872 $552 29% Single Parent with 3+ Children 1.0% $1,933 $575 30% Couple with 3+ Children 1.0% $2,113 $711 34% Total / Average 99.5% $1,576 $407 24%

Note: Income includes Basic Needs and Shelter. Food costs calculated using NBPS Nutritious Food Basket 2005.


8 CSS. Recommendation: M I enefit amou dec the cliefood-to-income ratios to that of the District’s , or ap ately 1 f income (average onl , based on examp lculatio d p roach e Low Cutoff ls. C llowance which would be added to the basic needs and shelter

basket (published annually by Ontario’s Public Health Units) and would change as the family moves through its life cycle. The food allowance could be calculated through a weighted index, and could either be administered as a separate benefit or added into basic needs.

In

lients y

sities.

,

On average, nutritional food spending requires 24% of ODSP income. To put this into context, this is approaching the percentage of income required for affordable housing. other words, to maintain nutritious eating, clients would need to spend close to what they should be spending for affordable housing, on food! For most clients, this disproportionate amount of income spent on food results in their food insecurity. Care not able to ration their limited monthly income so as to eat nutritiously – the monejust isn’t there. The disposable income analysis on page 48 illustrates the difficulty clients have in trying to eat in general (let alone nutritiously) while handling the other basic neces When considering income-based solutions to the above, it is beneficial to look at this relationship between food costs and income in further detail. When doing so, it can be seen that the proportion of income needed for nutritious food decreases exponentiallyas income increases. This is illustrated in the table below, which displays Nipissing District’s income distribution by quartiles (25% segments): Table 18: Food Cost as a % of Income, Nipissing District Income Distribution Quartiles

Nipissing District Income Distribution (2000) Average Food Costs 1st Quartile 2nd Quartile 3rd Quartile 4th Quartile <$1K - $10K $10K - $20K $20K - $38K $38K - $100K> Food Cost /yr. (single) $1,932 $1,932 $1,932 $1,932 Food as a % of income 190% to19% 19% to 10% 10% to 5% 5% to 2%

Source; Income distribution: Statistics Canada Census 2001, Cat No. 95F0492XCB2001001. Quartile incomes are approximations and rounded off. Food Costs are calculated from the Nutritious Food Basket and are averages for a man & woman, ages 25-49. In this example, the table represents Nipissing’s total income distribution for all

n be noted of

antly as

individuals (2000). The income analysis done earlier in this report, indicates that the majority of single ODSP clients are represented in the lower 2nd quartile. It cafrom the above that food costs consume the greatest share of income at the lower end the income distribution and that this share of income decreases the most significincome rises, in the first two quartiles. Thus the greatest impact on reducing proportionate food costs can be made with marginal increases at the lower income levels. This has implications for determining what level of increase would be necessary to move clients into food security. For example, increasing the client’s income so theymove from the lower end of the 2

e

od-to-income ratio by almost 50%. In terms of relative measures, this also approaches f a level playing field

with everyone else. Incidentally, the upper 2n le ($20K) also approa w I t surpri O b “a ily expenditures on food, clothing and shelter.

nd quartile to the upper end, results in decreasing thfothe median distribution of the District, i.e., places clients on more o

d quarti ches the Loncome Cutoff levels - no sing as LIC is a measure ased upon verage” fam

ncrease the basic needs b by an nt that will rease nt’s medianle). Ca

proximns woul

0% oy above

robably show that this app

es th Income Leve OR reate a food a

allowance. This allowance would be indexed to the local nutritious food


8.2 Present Emergency Food System, Nipissing District

The District has an extensive emergency food network involving many faith-based organizations and Non Governmental Organizations (see page 78 for list). The majority of these programs are in North Bay although some outlying areas, in some form or other,also offer emergency food programs. Generally these food programs are run by passionate volunteers who extend financial and human resources to those in need. Without their efforts, many more people would be going hungry in Nipissing District. Nto detract from the efforts of these volunteers however, this network appears to be ragmented and som

lunteers however, this network appears to be ragmented and som

ot

ewhat unorganized with very limited financial resources.

ey

similar programs is high ood ay.

rough charitraisin nding ie pro

on a Stakeholder survey that was done).

,

It is also d

To address these system-wide challenges, the creation of a Coordinators function individual organizations.

n Nutrition ported through

od security report, although the linkage between the programs is

ewhat unorganized with very limited financial resources.

ey

similar programs is high ood ay.

rough charitraisin nding ie pro

on a Stakeholder survey that was done).

,

It is also d

To address these system-wide challenges, the creation of a Coordinators function individual organizations.

n Nutrition ported through

od security report, although the linkage between the programs is

ff The internal DNSSAB report Food Security Programs (Barraclough; Nipissing District, Aug. 2004), offers an analysis of Nipissing’s food network. This report is significant in that, apart from some players entering and leaving the food security system, there havebeen no structural changes since the time the report was written. The following are k

oints noted in this report: 24pp

The internal DNSSAB report Food Security Programs (Barraclough; Nipissing District, Aug. 2004), offers an analysis of Nipissing’s food network. This report is significant in that, apart from some players entering and leaving the food security system, there havebeen no structural changes since the time the report was written. The following are k

oints noted in this report: 24

The level of demand on food banks, community kitchens, open cupboards and The level of demand on food banks, community kitchens, open cupboards and , and most communities have numerous on-going f, and most communities have numerous on-going f

donations underwdonations underw

The majority of these food securitydonations and fund

The majority of these food securitydonations and fund

programs are funded th programs are funded th able able g, operated by volunteers – adequate fugrams. g, operated by volunteers – adequate fugrams.

and areand are ss a a major issue for thesmajor issue for thes

Securing adequate resources is an issue across the full range of food programs in Nipissing District (based

Securing adequate resources is an issue across the full range of food programs in Nipissing District (based

Often these organizations become overwhelmed by the magnitude of the demandresulting in the necessity to adopt restrictive measures (such as limited hours, limits on food amounts and limits on number of visits).

Due to a lack of consolidated data and coordination of programs, it is difficult to compile a complete list of organizations engaged in charity food delivery. difficult to develop profiles of the client population, estimates of their numbers anthe extent of their needs.

There is no accounting of the collective resources being expended in the food programs, nor indication of the shortfall (which providers maintain there is).

There is no specific federal or provincial funding available for food security programs(social assistance “basic needs” is to be used for food and other basic necessities of life).

Often these organizations become overwhelmed by the magnitude of the demandresulting in the necessity to adopt restrictive measures (such as limited hours, limits on food amounts and limits on number of visits).

Due to a lack of consolidated data and coordination of programs, it is difficult to compile a complete list of organizations engaged in charity food delivery. difficult to develop profiles of the client population, estimates of their numbers anthe extent of their needs.

There is no accounting of the collective resources being expended in the food programs, nor indication of the shortfall (which providers maintain there is).

There is no specific federal or provincial funding available for food security programs(social assistance “basic needs” is to be used for food and other basic necessities of life).

would probably be more effective then funding to would probably be more effective then funding to

24. In this report, the distinction is made between food security programs which provide food to people i

need, and nutrition programs, which target the entire community, regardless of income.planning & counseling is mainly performed by the public health care system, and is supGovernment funding. A local example is the Breakfasts for Learning Program. Only fo

24. In this report, the distinction is made between food security programs which provide food to people i

need, and nutrition programs, which target the entire community, regardless of income.planning & counseling is mainly performed by the public health care system, and is supGovernment funding. A local example is the Breakfasts for Learning Program. Only foprograms are within the scope of this ODSPprograms are within the scope of this ODSPevident. Noteevident. Note: in this ODSP report, the term “emergency food” is used when talking specifically aboODSP clients and their inability to meet their own food needs.

ut


9. Recommendations: MOHLTC

It is recommended that funding be secured for a Coordinators position for the ood Security Advocacy Group. With this staff position, the organization could

es

dependant on donations and ity

ween NSSAB staff and staff from key stakeholder groups to more clearly define

ating, a new Food Security Advocacy Group has formed with the view of ithin

the are aware of the local issues and have extensive knowledge and experience in working with

is

time foo of an issue (or more so), than it was 10 years ago,

h v

The informal, ad hoc food system that exists is mainlyshort-term grants from Non-Governmental Organizations. There is limited capacfor system-wide coordination, and a lack of solid comprehensive data upon which to plan or to find efficiencies.

The above report finishes off with recommendations, including investment in food programs should be based on a comprehensive assessment of the District-wide needs, services and gaps, and on an action plan that has been developed in consultation with community Stakeholders. Also, organize a meeting betDexisting gaps and the potential for increased cooperation to close them. The concern regarding food security was brought forward by the North Bay Social Planning Council in 1996 and a Hunger Task Force was created as a result of recommendations made to North Bay City Council. While the Hunger Task Force is no longer operbringing individuals, organizations and others together for improving food security w

local communities. This group is presently comprised of volunteer members who

the local food security systems. In moving forward, it makes sense to leverage thexpertise and commitment towards local food issues. Presently this group is short of

and money, and requires a dedicated staff to start working on solutions. Given thatd security appears to be as much

taking a coordinated and measured approach to ensuring that all Nipissing’s residents a e access to adequate food, is long overdue.

Fmove forward on many of these food issues and ultimately, work towards

tablishing a Food Charter for Nipissing District.

8.3 Nipissing Food Security Programs: Growth, Trends, Data

en the lack of available data, it is difficult to produce a current sociodemograpGiv hic

statistics, wqualitative information, combined with the income analysis, suggests heavy and /or

lear ood Bank larger, more entrenched organizations within Nipissing’s food security

ystem and thus can be considered general indicators for the food security system and

Theneeorgpeo

profile of the District’s emergency food users. For example, establishing the actual number of ODSP clients who use the food system (District-wide), or other related

ould require primary data and research. Having said that, the anecdotal and

frequent use. From this perspective, any analysis can be beneficial as a starting point for ning more for planning purposes. The Gathering Place and the North Bay F

as

re two of the

the level of demand.

Gathering Place is a community soup kitchen that offers daily lunches to those in d, while the North Bay Food Bank provides food supplies and groceries. These anizations operate steady programs and between them, serve an average of 3,100 ple /mo.



In terms of the number of people served daily, both have recently seen record numbers:e Gathering Place served 139 people on one day in May 2006 and the Food Bank ved 122 people just after the Easter weekend. Looking at service volume over time ever, gives a more accurate

thserhow picture of growth trends as revealed in the following hart: c

Figure 17: Trends, The Gathering Place & The North Bay Food Bank

Food Security Program Trends, 2004 & 2005: North Bay Food Bank and The Gathering Place

2500

0

500

1000

1500

2000

Jan 2

004

Feb Mar AprMay Ju

n Jul

Aug Sep OctNov Dec

Jan 2

005

Feb Mar AprMay Ju

n Jul

Aug Sep OctNov Dec

Tota

l Peo

ple

Serv

ed

North Bay Food Bank The Gathering Place ource: The Gathering Place and the North Bay Food Bank, June 2006.

T etween the two organizations and provides insight in s. Wfo may b thering Place has seen a 33% increase in the average number of clients served monthly since Jan. 2004, the Food

ank has seen a 17% decrease.

trict, ldren

ing

th the above income analysis and other research, infers that the ck of food security extends from the clients to their dependents.

901 /~17,791 (dependents /population 0-17); Ontario = 42,195 /~ 2,844,000

S

he chart shows very similar trends bto the seasonal food requirements by those in need, as well as overall growth patternhile the two organizations presumably share some of the same clients, their different od programs (lunch vs. groceries) would also result in different user-groups. This

e reflected in the overall growth rates: whereas The Ga

B 8.3 i) Food Concerns for Dependent Children There are 900 dependent children living as ODSP beneficiaries within Nipissing Diswhich is over three times the provincial rate per capita.25 The concern for these chiwas mentioned earlier in the report, in terms of general health, social and educational development. Given the nature of the low-income environments the children are growup in, food security is of paramount concern. As mentioned earlier, there is no specific data available on the direct prevalence of hunger for Nipissing ODSP clients or their dependents. The anecdotal information however, combined wila 25. Nipissing District =

Thus looking at local child hunger in general is a starting point in trying to understand the magnitude of the problem. As general indicators, The North Bay Food Bank served a monthly average of 437 children in 2005 and the Gathering Place served an average of 47 children (30% of

ese were pre-schoolers). Another indicator is the Canadian Community Health Survey a. The following chart

provides indication of children hunger in North Bay: Figure 18: Children Food Hunger, North Bay

thwhich contains general health information used by Statistics Canad

Households with children, which did not have enough food due to lack of money, 2000 /01

Ontario, 7.7%

NorthernOntario,

8.9%

North Bay, 13.5%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

Hou

seho

lds

(%)

2.0%

0.0%'

Source: Chart by D. Plumstead, data taken from report by: Northern Health Information Partnership; The Northern Ontario Child & Youth Health Report, June 2003. Primary source: The Canadian Community Health Survey, 2000 /01. Note: Children defined by those 25 yrs. and younger living in the household, or 19 yrs. and younger, if living alone. This is based on a self-administered questionnaire and should be interpreted accordingly. Regardless of the social status of the children, the above cannot be ignored. This

rces the need for immediate action at the local level - not just planning but also the ing local child hunger.

reinfoimplementation of fast-track strategies for reduc 8.4 Special Diet Allowance

Some clients should be on a special diet under the guidance of a Dietician but they need a Doctor’s referral to do so. The problem is, many do not have Doctors. The special diet allowance is covered under Directive 6.4 and provides up to a maxiof $250 /mo. for those who require a special diet due to a medical condition, which mbe listed in the special diet schedule. This condition must be confirmed by an approved health professional which includes a registered Physician, Nurse (in the extended class

N(EC) or Dietician (Midwives can also approve conditions pertain

mum ust

-ing to breastfeeding

nd /or pregnancy). The problem is, a Doctor’s referral is still required in many cases efore other health professionals can perform the assessment and many of the clients

Rabdo not have a Doctor.


10. Recommendation: MCSS The Ministry should have a meeting with representation from the above health

look at

DSP clients. Thus there is only one (1) out-patient Dietician cated in North Bay (at the hospital) and one (1) in West Nipissing, who can perform the

here is also community concern regarding the present special diet allowance, which vidual’s dietary requirements to that of

specific medical conditions. The concern is for those who did qualify for a special diet

In the case of Dieticians, the Public Health Unit Dieticians are not mandated to do nutritional assessments for Olonutritional assessments required, but both these Dieticians need a referral from a Doctor.26 Public Health Dieticians receive many calls from clients needing a special diet assessment but regrettably, have to turn them away (recently, the Health Unit had to issue inter-office correspondence to address this). Twas changed from being based upon an indi

allowance under the old program, but who will no longer qualify under the new one because they are unable to have an assessment done. Other issues came up with regards to the special diet, most of which revolved around not being able to receive it, or receiving it, but not knowing what is and is not covered. The MCSS policy directives are very specific and clear as to the criteria for eligibility and what is covered (these can be accessed on the MCSS website). As noticed in other areas of this service review, this indicates a need for improved communications between the MCSS, community service providers and clients (see “Special /Discretionary Benefits - communications” page 100). When one focus group was asked for which area would you like to see an income raise?, “special diets” was their first choice followed by housing.

professionals to discuss the extent of this issue, and if warranted, possible solutions that could be implemented.

8.5 Food supply

ood bank and church hours don’t always correspond to the needF s of clients. he above refers to the local food security network and the fact that opening hours don’t

ents needs. To better understand this, a list of the s.

ses.

Talways match up with the clicommunity food organizations was compiled, along with their operating days and timeThe list represents the majority of food organizations in the District, but is not necessarily

clusive of all District food programs. A glance at the days and times reveals a inhaphazard and somewhat confusing schedule: 26. There are other Dieticians in the District, but as they are not covered under OHIP, clients can not afford

their services in most ca


Table 19: Local Food Security Organizations & Schedules y Food Organization Operating Client Visits Operating Notes Communit

Days Allowed Times Bonfield Food Bank Catholic Charities Tuesday Monthly 0900 - 1200 Sandwich Lunches

Corpus Ch 1300 - 1500 ies (East of

O'Brien) risti Church Friday Phone request Within parish boundar

Emmanuel United Church Saturday 1st Saturday /mo. 0900 - 1030 West Ferris Community Brunch Mattawa F wa's churches ood Bank Collaboration by MattaMattawa R ate oman Catholic Church As required Based on need / Restaurant gift certificNorth Bay em Food Bank Mon, Wed, Fri Monthly 0900 - 1500 Operates on point systPro-Cathe PEP dral Mon. to Fri. Weekly -no limits 1200 - 1300 Provides lunches atRedeemer 30 First come, first serve Lutheran Church Tuesday Weekly 09Salvation Army M, W, F Monthly 0900 - 1300 Salvation A rmy Sunday Monthly 1800 Gospel Fellowship CaféSt John's Anglican Church Wednesday 0900 - 1000 St John's A unch nglican Church Saturday 3rd Saturday /mo. 0900 - 1030 West Ferris Community Br

St Peters Rest of

oman Catholic Church Tuesday Monthly Within parish boundaries (WO'Brien)

St. Andrew's United Church Thursday Every 2 weeks 0830 - 1030 Closed in July St. Brice's 0900 - 1130 Anglican Church Thursday St-Vincent de Paul Church Thursday Every 2 months 1200 - 1330 food bags The Gathering Place Mon to Fri. Weekly 1130 - 1330 Lunches served Trinity Unit Closed during August ed Church Monday Monthly 0930 - 1100West Nipissing Food Bank Wednesday Every 3 weeks Emergency arrangements can be made

S rmy and phone calls to above organizations. Tc ht and fo n’t necessarily be running towards the end of th West Nipissing: approximately 21% of the caseload lives there and yet, the West Nipissing Food Bank is

nly open every 3rd Wednesday. This was brought up as a major issue at the community onsultation in Sturgeon Falls (the food bank was invited to this consultation but

ld not attend). Clients usually need food towards the end of the month a o

.6 Transportation

ource: The Gathering Place, The Salvation A

he problem for clients is trying to follow what, where and when things are open. As lients are paid towards the end of the month, this is often when cash flow gets tigod demand is high. The food programs however, wo

e month. Perhaps the best example of this is in

ocunfortunately coubut the food bank is not open. As a result, many of the service organizations feel extrpressure as clients come to them in need of food and /or money for food. Again, not tdetract from the efforts of these volunteer food organizations but rather, to illustrate the mis-alignment between actual client needs and the services. It should be noted that The Gathering Place and the North Bay Food Bank stood out as offering reliant, consistent food services which most of the clients spoke highly of. 8

Increasing transportation costs will mean eating less Reduced public transportation in certain areas limits access to the food banks and kitchens.

- -

Note: Transportation is covered as a separate service area beginning on the next page, but will be covered here as it pertains to food security.


Increasing energy pric g in fares a l transportation cwas a concern voiced by many clients. Recently, base taxi fare has increased by $2.35

lic transit has sen by $0.25 While the average person wouldn’t even give f this, for ODS this can represent a sig e

public tran otdisability). S lients sa an fe t rs and less

ion are enti an issssue that cro o ther areas e

er “transportation” owin it oe area g th kit fo

comme nce ing transportatio es 2, 84 & 86.

es resultin higher cab nd genera osts,

and pubo

ri . 27

notice living expenses (some clients use ta

P clients nificant incrsit is n

ase in their daily xis because conducive to their

he groceparticular ome c id this will me wer trips tofood. Limited transportat in outlying as was also id fied as ue but this is more of a macro i sses over int many o – this is cov red in more detail und on the foll

sing page. Suffice

ry soupto say that f

and r those living in the

ry District’s remotult.

s, acces e prima chens od banks can be vediffic

For general re ndations co rn n, see pag 8

27. Not all ODSP clients receive bus discounts - this is covered in more detail under “transportation” , see

page 84, “bus discounts: North Bay”.


9.0 TRANSPORTATION

e

ding Greater Sudbury). In terms of Nipissing District’s ODSP clients and service

“The biggest barrier to service is transportation” – Community Service Organization.

In the big picture, transportation is one of Northern Ontario’s biggest barriers to servicdelivery and development in general, affecting key areas such as social and economic development, and health and education services. Northern Ontario covers 88% of Ontario’s landmass and yet has an average population density of just 2 people /sq. km.

xclu(eproviders, this directly translates into difficulty in providing and accessing, community services. The following table summarizes the key points regarding transportation that emerged from the focus groups (clients) and community consultations (service providers): Table 20: Key points from Focus Groups & Community Consultations: Transportation

ALIGNMENT /

BEST PRACTICES GAPS BARRIERS CAPACITY / SOLUTIONS

There is confusion

ound the guidelines d eligibility of North

ay bus discounts for DSP clients. There is perception that only ose with physical sabilities get bus scounts.

here is a lack of blic transportation in est Ferris, and on the

ki Club Rd. and hippewa St. routes.

miting bus schedules: ere is no bus service holidays or on

undays after 6PM.

HARA does not erate after 9PM

hich restricts evening tivities and social life specially for young

dults).

ransportation is very ited or non-existent

outlying areas such Redbridge,

emagami and parts of est Nipissing.

Confusion amongst clients and service organizations as to what transportation costs are and are not, covered by ODSP. For the costs that are covered, the tracking and reporting of expenses and the reimbursement process is cumbersome and hard for clients to keep up with. The taxi base-rate increase to $3.90 will mean many clients can no longer afford to take a taxi. Transportation is the biggest barrier to delivering services, for West Nipissing service organizations.

Rural areas within the District are underserviced due to the services being located in a central spot and no transportation available. Examples: legal services, counseling, addiction, CMHA.

Transportation costs should be based on income. Issue bus passes to all

aranBO

ODSP clients who are eligible. Introduce a special transport system (taxis, etc.) for ODSP clients with special needs. Implement a system similar to that used for Sr. Citizens, for example, a bus that will go around once or twice a week to bring clients to the grocery store. Provide a transportation allowance or travel vouchers to those living in rural /outlying areas. Offer reduced bus fares based on income rather than disability. Provide resources to a lead agency, for the delivery of transportation services

network.

a thdidi TpuWSC LithonS Popwac(ea TliminasTW

through a volunteer


9.1 Lack of Transportation: Service Provider’s Perspective i) West Nipissing & Other Areas Service providers in West Nipissing stated that transportation is the biggest issue with regards to delivering their services to clients. In many cases, the organizations end up going to the client because there is no public transit within the municipality and clients can not afford to travel (example: a taxi from Field into Sturgeon Falls costs approx. $40 and a return trip to North Bay is $35). The map below helps to visually see where the clients live, with respect to West Nipissing and the rest of the District:

igure 19: F ODSP Caseload by Location within Nipissing District

Nipissing District ODSP Caseload (Stewart, 2005). Note

ODSP Caseload by Area

Data source: Data from : caseload is

1% o s live in West Nipissing and a) lls, there are 233 clients who live in the

el mainly involves bringing clients oth r meetings, outside the area. This is not only a very costly way to

services (transportation is the second highest budget item aftns), but it means that service delivery is highly re service organizations are under the impression there are no funds ortation costs (other than for medical reasons), MCSS Directive 9.12

Necessities) indicates that agencies may be reimon the circumstances. Again, this illustrates the need

ommunications around Directives, between MCSS and the commurganizations (see “communications” page 100). As with many of theansportation woes, solutions will not happen overnight. Having said

services have been identified and it is necessary to look at possible removing these.

for Feb.

lthough the

2005 and equals 3,481. Approximately 2majority (502 clientssurrounding areas. Tappointments and

eliver

f the District’s client lives in Sturgeon Fahe added trav to Doctor

er wages for some liant on energy

edof these organizatiocosts. Although theprovided for transp(Mandatory Special costs depending up

bursed for some for improved

c nity service District’s that, barriers to

solutions for

otr

30

2

3

2410

42502

37

9

2617

195

12

5752

16

10

61

2419 = North Ba

= West Ni

y

pissing

47

73

= No

5

rth

43 = South

237 = East

ODSP Caseload by Area

30

2

3

2410

42502

37

9

2617

195

12

5752

16

10

61

2419 = North Ba

ip

y

= West N issing

47

735

= North

43 = South

237 = East


11. Recommendation: Municipality of West Nipissing

orthern areas such as Temagami, as revealed by talks with the staff at the Temagami s may have gone to New

Liskeard looking for services). It should be noted that while West Nipissing organizations seemed to be the most affected by transportation costs, North Bay organizations also are affected. Some organizations reported that their transportation budgets are intended for staff travel only and yet they often have to bring rural clients to medical /specialty appointments (including outside the area), or even to the ODSP office. 9.2 Limited Bus Schedules: North Bay

Conduct a feasibility study on extending the Para-Bus into West Nipissing.

Presumably the other outlying areas in Southern and Eastern Nipissing District experience similar transportation issues, although not with the same magnitude due tothe smaller caseloads. Little is known about the transportation needs of clients in the NOW Resource Centre (it was heard that in the past, some client

The majority of the District’s clients live in North Bay, which has a public transit system. The problem noted by clients is that there are limited bus schedules in certain areas, particularly regarding Sunday services. Below is a map of North Bay showing where the clients live, as a percentage of the North Bay caseload: Figure 20: North Bay ODSP Caseload, Area of Residence

Central, 46%

Birch Haven 5%

Pinewood, 8%

Thibeault Terrace,

4.5%

Airport Hill, 0.5%

Graniteville, 9%

Source: Data from Nipissing District ODSP Caseload, MCSS /MCYS April 2005.

West Ferris, 23%


A little over two-thirds of the clients live in Central North Bay and West Ferris, with most o aven. Approximately 5.5% o H

uring the client focus groups and a meeting with the OW /ODSP Support Network, it or on

f the remainder living in Pinewood, Graniteville and Birch Hf the clients live in the outer city limits of Thibeault Terrace, Airport Hill and Hornelleights.

Dwas noted that there is no Sunday bus service in West Ferris (Lakeshore route) the Chippewa St. or Ski Club Rd. routes. The following maps show these routes: Figure 21: Lakeshore Bus Route Figure 22: Chippewa Bus Route

Source (all maps): copied from North Bay Transit, dules

: Ski Club Rd

Routes and Sche

Figure 23 . Route


12. Recommendations: MCSS for the de

ould utilize a staff and ated on its effectiveness in

ce measures; Expand an existing service such as to be more inclusive (i.e., move beyond just the phys aspect) and handle larger volumes of clients

ould also be extended into West Nipissing.

s, it s the concept of social inclusion. Unfortunately this problem is one of

conomics: the city has observed that of the 13 bus routes, it is not feasible to run

us routes that do offer Sunday services, but not past 6PM

Provide resources to a lead agency

As many of the clients live in the city centre and West Ferris, this essentially means they do not have a means of transportation on Sundays (there are three social housing projects located on the Lakeshore route). This not only restricts the activities of clientundermineeSunday services on these particular routes due to low ridership. So while the personal transportation needs of clients exist, the overall demand for transportation service apparently does not. The other problem noted with regards to public transportation pertains to the b

(including the Para-bus). The clients stated that this limits their weekend activities and social time. Additionally, the fact that there is no public transit on holidays

velopment and implementation of a Community Transportation Program. The program wvolunteer network of drivers, and would be evalumeeting client needs, as well as specific performan

OR Para-Taxi

ical disabilityduring the times of greatest need. This service w

leaves some clients stranded, especially for long weekends. For those who are disabled and living on low income without a means of transportation, the lack of transit on holidays can become a major issue. The above transportation problems are not easily resolved. While gaps have been identified, the cost of implementing solutions may be restrictive and would require further review including a cost-benefit analysis. Perhaps North Bay’s MAAC Committee could look at this issue further in its annual planning process (see next page). Some of the solutions offered by clients and service organizations may be quite obtainable and offer a starting point (see “Solutions /Best Practices, Table 20, page 80). Most of these ideas would require additional resources for a lead agency to develop some sort of community transportation program for clients. Such a program would likely utilize a staff position (Dispatcher, etc.) and a volunteer network of drivers. Alternatively, a program modeled on the Para-Taxi may be effective – this service utilizes existing taxis which are dispatched through the Para-Bus office (clients pay regular bus fare).

.3 Bus Discounts: North Bay

9

here is confusion around the guidelines and eligibility of North Bay bus iscounts for ODSP clients.

he fact that not all ODSP clients receive a discounted bus pass

Td T was a concern heard

roughout this review, from both clients and service providers. th


The perception amongst clients is that those with “noticeable” physical disabilities get discounts while those with “not noticeable” disabilities such as mental illness or developmental delay, don’t. Upon checking with the city Transit Department, it would appear that this is perception and not anything to do with policy. All ODSP clientseligible for a monthly bus discount of $25 provided they make an appointment to co

are me to

city hall in person, show their proof of ODSP assistance and fill out an application (which includes demonstrating they can’t walk a distance of 175 metres). Clients do have tshow up at their sched

o uled appointment if they are to receive the discount (missed

ppointments do occur).

ion

h

o while there is a set procedure in place, the interpretation of “disability” appears to be

a The disability discounts are grouped in with seniors and fall under the following definitof “reduced” fare: Available to Senior Citizens and Approved Disabled Applicants who have completed a form and been approved by the City Administrator or designate. Witthis ID Card, a person can purchase a monthly pass for $50.00 per calendar month. Sfairly open and subjective as indicated by the above definition. Also, as there are noODSP identification cards that specify the type of disability, this further lends itself to subjectivity. It should be noted that proof of ODSP assistance does not mean automaticapproval for a bus discount, by the City Transit Department. Depending on how this iscommunicated to clients by the ODSP Office or community service providers, this could lead to false client expectations or add to the confusion, if clients do not receive the discount for whatever reason. It can also be noted that the process of offering discounts to the disabled population appears to be more of an informal one, in that it is honored from the Mayors Office. While it would be beneficial to know the number of ODSP clientthat actually have bus discounts or the percentage of discounts that are given to with disabilities (vs. students and seniors), this data is presently unavai

s people

lable. 9.4 Municipal Accessibility Advisory Committee (MAAC)

unicipal Accessibility Advisory Committee’s (MAAC) were formed in 2003 under thntarians with Disabilities Act, and are mandated to prepare annual municipal ccessibility plans for city services

M e Oa , with the intention of improving opportunities for the d the identification, removal and prevention of barriers to at uE Interestingly above issues of limited bus schedules and bus discounts have not come up during the City of North Bay’s MAAC planning sessions. In reviewing

AAC’s Municipal Accessibility Plan 2003, and subsequent updates: 2004, 2005, ommunity stakeholders have not mentioned these as issues.

he need to expand Para-Bus services (longer hours, rvice),

s with conventional transit schedules or bus discounts r the disabled population. This may be in part, due to the way the MAAC has defined

rspective.

isabled population. This includes full participation in community living. The definition of Disability for this purpose is th

sed by the Ontarians with Disabilities Act 2001 and the Ontario Human Rights Code. ssentially, it is an all encompassing definition that would include those on ODSP.

enough, the

Mc While there was reference for tenhanced weekend /Sunday service, more vehicles and extended Para-Taxi sethere was no mention of problemfo“accessibility” or because the emphasis on accessibility of City services is more from a physical perspective rather than from an operating or delivery pe


13. Recommendation: City of North Bay That North Bay City Council reviews the following transportation issues througits Municipal Accessibility Advisory Committee, specifically: 9.2 (page 82):

h

Limited bus schedules (no Sunday service) in areas where there are relatively large numbers of ODSP clients living (particularly the Lakeshore, Chippewa and Ski Club Rd. routes) 9.3 (page 84): The issuing of bus discounts to people with disabilities: currentpolicy, procedure and eligibility criteria.

9.5 Transportation Expenses

re receive

em

Additionally, the people who have attended the MAAC public consultations may be morepresentative of the physically disabled population, most of which, presumably bus discounts. Since 2003, the City of North Bay’s MAAC has made recommendations to Council which has resulted in notable improvements for the local disabled population. Given the mandate of this committee and its present structure and planning process, it would seappropriate for the North Bay MACC to further review issues 9.2 and 9.3 above.

The ODSP Policy Directives are quite explicit in explaining the ODSP Program and policies, and can be found on the MCSS website: www.cfcs.gov.on.ca/MCSS. Transportation costs are covered under ODSP Income Support Directives, No. 9: Benefits. Under the Benefits Directive, item 9.12, Mandatory Special Necessities

cludes the legislation & directives covering transportation. in

There is uncertainty amongst clients and service providers as to what transportation rlier, West Nipissing’s service

ties nd recently the MCSS has started a Community Agency Network to enhance

00)

m, they in turn will need transfer this knowledge to their clients.

costs are, or are not, covered by ODSP. As mentioned eaorganizations are racking up travel expenses that many of them are not recovering. Clients also reported that for the costs that are covered, the tracking and reporting of expenses and the reimbursement process is cumbersome and hard for clients to understand and keep up with.

As with other areas of this report that involve MCSS Directives or policies, the above indicates the need for improved communications within the community regarding the ODSP program in general. Improving communications will require effort from all paracommunications within the communities. Other information-sharing sessions such as community forums (see “Special /Discretionary Benefits – communications” page 1could also be implemented in an effort to make further improvements. As service providers become more knowledgeable about the ODSP prograto

Regarding the improving of communications with clients, the MCSS’s return to a Case Manager assigned to individual clients should improve things considerably as clients will now have one ODSP Worker to work with. The ministry is also changing its forms, correspondence, etc. in an effort to become more client-friendly.


10.0 GENERAL SERVICES, CHILD & FAMILY SUPPORTS “Clients get bounced around between various community organizations, in search of

services – they feel frustrated and defeated.” – Community Service Provider. The following table summarizes the key points regarding child & family supports and general community services that emerged from the focus groups (clients), community consultations (service providers) and various meetings and interviews:

Table 21: Key points from Focus Groups & Community Consultations: Child & Family SGAP

upports, General Community Services S BARRIERS CAPACITY /


OLIPI and PEP are ecw

ot provide ongoing pport and services

d addictions, support

collaboration is lacking amongst service

aperwork.

such as OW & ODSP do not work in partnership

There is a lack of service

children programs, etc.) and a duplication of service in others (child screening, referrals.

A central point of

A current Directory of Services that is maintained annually

LIPI and PEP are ecw

ot provide ongoing pport and services

d addictions, support

collaboration is lacking amongst service

aperwork.

such as OW & ODSP do not work in partnership

There is a lack of service

children programs, etc.) and a duplication of service in others (child screening, referrals.

A central point of

A current Directory of Services that is maintained annually

rganizations such as Service organizations in

ations such as

Service organizations in

ffective in dealing with risis and in identifying hat is needed. They

North Bay are not integrated and many work in silos. Communications, coordination and

in some areas (mental health, addictions,

access for services and information. ffective in dealing with

risis and in identifying hat is needed. They

North Bay are not integrated and many work in silos. Communications, coordination and

in some areas (mental health, addictions,

access for services and information.

cannsucannsu

and readily distributed.

re-onthly heon the

past.

nd ell

coordinated.

ice l

r. There

services. End the Child Tax Benefit clawback.

however due to a lack providers. however due to a lack providers. More agency networking;introduce the mnetworking luncthat was held in

of resources. Many clients are unaware of what services or support systems are available in the community.

Many service organizations are tapped out and are “referring & deferring”. Clients are “bounced

West Nipissing service organizations are not sure what services are offered in North Bay; the service system seems complicated.

of resources. Many clients are unaware of what services or support systems are available in the community.

Many service organizations are tapped out and are “referring & deferring”. Clients are “bounced


More resources ($) for community organizations. A type of WrapArouService that is w

There are waiting lists for children-support services. There is a lack of children programs in general –the children in

around” between community agencies, in search of services. Every organization has different forms to fill out, and this is on top of all the ODSP p

There are waiting lists for children-support services. There is a lack of children programs in general –the children in

around” between community agencies, in search of services. Every organization has different forms to fill out, and this is on top of all the ODSP p

low income families need more activities. There is a lack of day supports for the high-need, DD population –after finishing school at age 21, they have no programs or activities to turn to. A lack of mental health

One Kids Place is hard to get to for people with disabilities and their children. Child Tax Credit benefits are deducted dollar-for-dollar from ODSP benefits (clawback). Social service agencies

low income families need more activities. There is a lack of day supports for the high-need, DD population –after finishing school at age 21, they have no programs or activities to turn to. A lack of mental health

One Kids Place is hard to get to for people with disabilities and their children. Child Tax Credit benefits are deducted dollar-for-dollar from ODSP benefits (clawback). Social service agencies

ananservices. services.

when serving clients (regarding benefits & referrals).

when serving clients (regarding benefits & referrals).

Educate the clients more on services and what is available. West Nipissing servorganizations are welintegrated and work closely togetheis no duplication of


The organizations listed on page 2 are representative of the Districts service community, nd they all perform services in some form or other to ODSP beneficiaries. These

satellite ge

Assistance to people in crisis

Clinical support services Counselling for abused men and woman

faos io

en

nl supports

treatmees

pme s

cial s budgeting, emotional, parene:

cou es (children & adults) ing

al therice , bathing, dressing, etc.

l rdi using, long-term care fa

Public education, evention leer and information

ho

tance abuse counselling ein

sportation Treatment service Trusteeship progr Youth transition programs Vocational /employment services

aorganizations also serve other community groups such as people on OW, low-income families not on social assistance, Seniors, or general families and children in need. Many

f these organizations are located in North Bay and some have offices orooperations in Sturgeon Falls and Mattawa. Between them, they offer the following ranof programs and services: Adult & children protection services ••• Case management for the developmentally delayed population • Child development: speech /language, intellectual, psychological, behavioural,

dren & family• Chil•

supports

•• Counselling for • Community supp• Developmental a• Discretionary b• Family, adult and• Food security &• Financia

milies and children rt teams sessment & consultatefits child intervention utrition

n

• Gambling • Group hom• Infant develo• Legal services Life skills: so

nt

nt program

• kills development, daily living aids nselling & servic

ting • Loan-out servic• Mental health• Nurs• Occupation• Outreach serv• Peer support, se• Placement coo

apy, physiotherapy s: personal groomingf-help and advocacynation services (into ho awareness and prisure programs services

cilities, etc.) •• Recreation and• Referrals to oth• Respite services• Shelter for the • Social housing Subs

meless

/addictions• • Supported Indep• Supportive hous Tran

ndent Living g

s ams

•••••


There are additional community organizations that serve ODSP clients, but in keeping within the scope of this review, not all of them could be included. These include thepublic agencies which deliver health and education services and also those which provide mental health services. Additionally, there are specialty organizations which cater to a specific type of disability, such as the Canadian National Institute for the the Canadian Diabetes Association, the Alzheimer Society, etc.

Blind,

efore going into some of the issues listed in the above table, kudos should be given d their staff who have participated in this study,

mmunity citizens in need. Essentially this means that le and people with

ome ople in need, while others represent a person’s very last community organizations operate on a referral basis

me are funded by ministries and operate s, while others are funded through grants

ittle more informally. However, all these n: they work with a complex, vulnerable

Bwhere due. The service organizations anwork on the front-lines to serve coon a daily basis, they deal with crisis situations, hard-to-serve clientemultiple barriers to daily living. There are differences amongst these organizations: sare a first-line-of defense for pehope or chance. Some of these

iwh le others accept walk-ins off the street. Soliciewithin defined operating guidelines and po

erate a land fundraising initiatives, and oporganizations share at least one thing in commosegment of the population and are doing what they can with the resources they have. 10.1 General Services i) Client Awareness: Many clients are unaware of what services or support

able in the community. nd service organizations alike, and it basically

applies not know what

t Nipissing where the nd who offers them).

e detailed community services directories rvices directory which

ith services literally being “all over the place”

lf is part of the at are in the community, it can actually look like a

systems are availThe above was echoamounts to clients no

ed by clients at being sure where to find the services they need. This also

to North Bay’s service network in general, in that, many organizations do services the others are offering (this is not applicable to Wesservice providers are well aware of all community services a This is a little perplexing given some of thpresently in circulation. The ODSP Office itself has an extensive sestaff make clients aware of. Additionally, whow could someone not know where to go? The service list on the previous page indicates that services are numerous and readily available. That in itseproblem: with the myriad of services thcomplex maze to someone who is less informed or intuitive. There are multiple access

e community service system, which can be a good thing, or a are. For someone with a cognitive challenge or a physical obility, multiple access points can be a hindrance and

re current

and exit points within thbad thing, depending who you

limits mdisability that severelybarrier.

tories that aCommunity services direc are always a good place to start. g and distributing them throughout the community is another.

some good ones, continuity seems to be an issue, with directories over the years. One that

o the disabled community is Starting Point, A Resource s in Nipissing, produced by the North Bay & District

DACL - undated).

Producing them is onWhile North Bay has

e thinhad

different organizations having produced differentstands out as being specific tBook for People with DisabilitieAssociation for Community Living (NB


14. Recommendation: DNSSAB or MCSS Identify an organization that will take the lead in producing an annual CommunityServices Directory for People with Disabilities in Nipissing District, and fund thi

To be done effectively, this type of resource manual needs to be performed by the same agency, year after year. This lead agency needs to have an annual budget

s

organization annually. The annual budget for this directory should be based distribution (to community

s and clients throughout the District, and which may involve multiple mediums such as print, web based, and alternative formats for the

y, bi-

h Bay

such as business, overnment and social services.

This was a comprehensive service directory but for whatever reason, there has only been one copy produced (apparently another edition will be out soon). In terms of general directories, the Ontario Early Years Centre (which operates under the Nort& District Association for Community Living) currently has an extensive community services directory on-line, for families and their children. The Blue Sky Region Portal also has detailed on-line community directories for different areasG

upon production (overheads and direct costs), service organization

disabled population) and maintenance (updates & improvements: quarterlannual, etc.).

for producingand distributing the directory and not be reliant on fundraising initiatives, one-time grants& funding, or in-kind services. And it needs to be undertaken as a communications /marketing initiative: produce a detailed, updated, directory of community services for people with disabilities and ensure it is distributed throughout the community, in varioumediums, on a regular basis.

s

Note: 1. The Ontario Early Years Centre is presently re-developing and updating their community services inventory. Given the existing systems and database of the OEYC and their parent organization (NBDACL), it may make sense for them to champion the above (www.ontarioearlyyears.ca. Nipissing; Community Services Inventory). A dir

roduced through the Blue Sky Region Portal may be another option ectory

p(www.blueskyregion.ca: social services). 2. Conducting an inventory of current serviis included in the scope of this review, however, given the magnitude of this task it would be more effective to transfer it to the above recommendation. The above is just a starting point for what ideally amounts to, fully integrated communi

ces

ty services (see below). While the development of a community services directory is much needed, the needs of clients go much further to include; the minimizing of the number of service access & exit points, streamlining the referral /qualifying process and generally providing client assistance in securing services (and for some of these clients, this may involve assisting them throughout the entire process). While the ODSP Office is a central access point which has an extensive community services directory, it is not mandated

ct as a r to

eferral service or see that clients receive the community services they may

r

arequire. ii) General services, key points. The following are the key points regarding general services, taken from the focus groups, consultations, meetings and interviews. Basically these all point to the need fo some type of integrated service network, i.e., a central access point or community gateway to services:


Clients may have to go from organization to organization in search of servicor before they can be helped.

Service organizations in North Bay are not integrated and many work in silCommunication, coordination and collaboration is lacking amongst service providers.

There is a lack of service in s

es

os.

ome areas (mental health, addictions, children

DSP paperwork. It refer to North Bay services in general – thoa om c work

programs, etc.) and a duplication of service in others (applications, child screening, referrals).


Paper maze for clients: every organization has different forms to fill out, and this is on top of all the O

should be noted that the above bullet points e service organizations in Sturgeon Falls appear to be much more integrated in terms

f working together and coordinating services. It can also be noted that many of the bove points came from the service organizations themselves, or are observations frlients. In fairness and regarding the second point, many of these organizations do

together at some level, whether it’s on a case management or referral basis, or where e best interest of the client is concerned. Often the needs of a client span across

ifferent service areas and disciplines, and these organizations communicate with one nother in the bes

thda t interest of the client.

ver, is that this local

The above points seem to apply more from an integration perspective, as it pertains to information sharing and planning. Additionally, while organizations will work with each other on behalf of the client, there is limited service coordination in the long term. The community service fragmentation and independence that does exist, likely results from the competing mandates amongst some of these organizations, combined with their competition for limited funding when serving the same population (according to West Nipissing’s service providers, the main reason they work together so well is they don’t compete for funding). Perhaps the most significant factor howe service network is a microcosm of a much larger system at work: Ontario’s mental health system. Close to half the District’s ODSP caseload suffers from mental illness as their primary disability (this does not include dual diagnosis) and most of the service organizations in this review are in some way or other, connected to or affected by, Ontario’s mental health system. When viewed from this perspective, the bullet points above are just the tip of the iceberg. Ontario’s mental health system is presently undergoing major reform as the Government divests its psychiatric hospital governance, operations and beds, and shifts from hospto commu

ital nity-based services. While going into this in detail is beyond the scope of this

services’ and publicly delivered mental ce the outset (and keeping the two separate has

d in

ty ry health care system is at some point, inevitable.

study, the linkage between ‘ODSP community health services has been evident sinbeen challenging). Furthermore, when reviewing the list of service areas addressethis study and the services offered by the community organizations represented (page 88), the common denominator is health. Thus the cross-over from ‘ODSP communiservices’ into the prima


As it relates to the delivery of community services then, it is appropriate to look at some f he findings of the recent Mental Ho t ealth Implementation Task Force. To assist with

) Regional Task Forces to

(theDis ition, a Provincial Forum was created to provide a means by which the

• h system is diverse and fragmented with many services and

mental health reform, in 2001 the province appointed nine (9make recommendations for regional and local improvements to mental health services

Northeast Task Force covered Northeastern Ontario which includes Nipissing trict).28 In add

Task Force members could communicate. Regarding the delivery of services, the following issues and concerns were noted by the Provincial Forum: 29

“Ontario’s mental healtsupports operating independently of each other” (there are 355 separate mental health programs funded by the MOHLTC)

• “In many regions, services and supports operate independently of each other, with no coordination or integration”

“It is difficult to determine whether people living with mental illness are getting the

nal Teams in all regions. These teams will

te

of e

members and this government, to the creation of comprehensive mental health system that delivers real results”.

ntario. Final . 2002.

•most appropriate kinds of care when they need it, from the service providers best able to provide them”

• “The Task Forces have identified a need for streamlined access to services, better linkages among first-line, intensive and specialized services, and a continuum of care at the community level”

And Recommendations from the Provincial Forum included the following: “The appointment of Regional Transitio

serve as Change Agents and steer implementation of reforms after the mandate of the Task Forces has ended”

“Local service and support functions must be aligned so that the mental health system can respond directly to client needs. Formal arrangements are needed at thelocal and regional levels to plan, develop, finance, coordinate, monitor and evaluathese supports”

The final reports by the Provincial Forum and the Regional Task Forces were submitted to the MOHLTC in 2003 and are considered by many, to be the most comprehensive proposal for mental health reform in Ontario’s’ history. As the Canadian Mental Health Association notes however, “planning for reform began in 1988 with the publicationthe Graham Report”. In the Canadian Mental Health Association’s report The FuturBegins Now, it emphasizes three (3) priorities for mental health reform, which would “bridge the hard work of the task forcea 28. The need for mental health care reform emerged from the Ontario Health Services Restructuring

Commission which was established in 1996. This commission had a 4-yr. mandate to make decisionsregarding the restructuring of Ontario public hospitals, as well as advising the MOHLTC on other changes to Ontario’s health services system. The Commission advocated for the establishment of regional Mental Health Agencies which subsequently were formed, but as the Mental Health Implementation Task Forces.

29. Ref: The Time is Now, Themes and Recommendations for Mental Health Reform in O

Report of the Provincial Forum of Mental Health Implementation Task Force Chairs, Dec


The report provides current examples of provincial investments that are being made in community service integration, with very successful results. 30

15. Recommendation: North East LHIN (Local Health Integration Network) Under the LHIN’s mandate to plan, integrate and fund local health services: i) That the LHIN identifies the resources necessary to implement a comm

service integration model in Nipissing District, when devunity

eloping its

ii)Integrated Health Service Plan with input from the community.

That within the above plan, LHIN develops and implements a fast-track strategy for Nipissing District which would accelerate the implementation of this service integration model (i.e., action items are being completed within 6-9 months.)

above recommendations will result in a process which takes time. In the meantimThe e, there are immediate things that can be done to encourage better communications and

comives that need to occur on a

to occur ularly and be sustainable, an organization needs to be responsible for resourcing and

networking amongst service providers, in anticipation of working closer together. In recent years, MCSS has hosted two regional forums which have brought together

munity service organizations in an effort to increase awareness and build partnerships. These are important communications initiatcontinual basis. Another valuable communications and networking event would be similar to the one held in the past. For these “Meet & Greet” type of eventsreg organizing them on a regular basis.

16. Recommendation: DNSSAB

orluncheon held everyorganization for these events, on a regular basis.

That DNSSAB reintroduce and sponsor the type of networking event for service ganizations and ministries that occurred in the past. Example: a breakfast or

4 months. This includes providing the resources and

lth

- rmal of

- I together to develop and implement an electronic, shared-client record ar

In terms of networking, the above could be expanded upon to introduce a more formal type of planning committee. Using children services as an example, the Nipissing Best Start Network has recently formed as a result of the provinces Best Start strategy. Eventhough the Best Start program has significantly changed direction with the change in Federal Government, local community organizations have seen the value in staying together as a committee. 30. Ref: Canadian Mental Health Association, The Future Begins Now: Three Priorities for Mental Hea

Reform, 2002. Examples include:

In Grey Bruce, all mental health service providers, including the local hospital, have entered into folegal agreements to create a highly accessible system for the consumer, based upon the strengths each of the partner organizations. n London, agencies have comethat has facilitated access and timely service for clients in case management and crisis services (similwork has been done in Timmins through the Adaptable Management Information System (AMIS).



17. ecommendation: DNSSAB R DNSSAB facilitates an initial forum with community service providers to k on the interest in, and viability of, forming a type of network /planning

That checcommittee. The objective of this committee would be to move forward on integrative community services for the disabled population (see also Recomm. #15).

network (not surprisingly, some of the community organizations that are represented by th e wefo ardp nin

and

tivities (DNSSAB has just completed a pilot, ubsidized summer recreation program which hopefully will continue on a permanent

b ivCp ce. However, longer term support is unavailable due to the limited resources these organizations have. The ODSP

0.2 Child & Family Supports

Incidentally, this Best Start network is faced with a similar scenario of the need to integrate community children services and this is one of the primary objectives of the

e Best Start committee also provide services to ODSP beneficiaries). The culturithin the service organizations and community must be supportive of this type of ndeavor however, and this may take time to nurture and develop. As the next step rw , an initial meeting could be held to “test the waters” and discuss the idea of a

lan g committee:

iii) Lack of Programs. Services lacking in the community include general mental health services (see counseling page 103) and addictions (service organizations report waiting lists and state that clients are traveling outside the District for addictions service). Regarding the developmentally delayed population, youth (ages 21 yrs. +) who are finished school living at home do not have any programs or activities to turn to. Similarly, for children-at-risk such as ODSP and other low-income dependents, there are no subsidized ecreational programs or learning acr

sasis).

) Resources. lients noted that organizations such as LIPI and PEP are very effective in identifying roblems and helping them to receive one-time assistan

& OW Support Network currently has approximately 60 members but faces resource issues at the most basic level, including difficulty in finding office space and paying for office supplies, printing, etc. Many of the recommendations in this report are indicative ofthe additional resources that are necessary for making improvements to ODSP community services. 1

organizationtimAddth

Obtaining community service data specific to ODSP clients and their dependents, has been somewhat difficult as mentioned previously in this report. In many cases

s may have this data, but it is buried within the system and would require e and manpower to extract – both of which, many of these organizations are short of. itionally, the internal polices or regulations of some community organizations limits

e sharing of client information, including aggregate data.

While there are no specific numbers on how many ODSP dependent children are uthe community services, the organizations who have participated in this study and whooffer children services, all state that they have children from ODSP families amongst their clientele. Are ODSP children in need of special support services? One revealinindicator is the utilization of services at the Nipissing & Parry Sound Children’s Aid Society – they estimate that 30% of their Nipissing child welfare clients who receive

sing

g

ongoing protection services are ODSP dependents. This statistic points to the high-neby these families for p

ed revention, intervention and support.

i) (ACFS) DBc ts aa health counselling (based on regular referrals) to 3 months for the Family Milieu Program. The T.I.P.S program (home-based treatment and intervention for ages 0-6)

th. Historically, the ACFS has had a waiting list of approximately mental health services – currently there are approximately 100

powers

e are

ally, there are 150 dependent children ages 16 & 17 (24%) who are right behind ese children will require transitional support in order to successfully

Algonquin Child & Family Services uring the focus groups, it was also noted that families had to wait to get into North ay’s Algonquin Child and Family Services (ACFS), the main service organization for hildren & families with developmental challenges. The actual number of ODSP cliennd dependent children who are using the services of ACFS however, is presently not vailable. The waiting list at ACFS presently ranges from 8 months for children’s mental

has a wait time of 1 mon12 months for children’schildren on this list. In 2004, ACFC also started a Wraparound process which ema family to grow towards a better quality of life, by “wrapping them” with friends, family and professionals. Recently Wraparound graduated its first families! However, therpresently 10 families on the waiting list and the sustainability of Wraparound is threatened by the present difficulty in recruiting volunteer facilitators and staff only working part-time. From the chart on page 57, some of these 88 dependent adults (ages 18 yrs. +) will bethinking about leaving their homes to move into the community on their own.

dditionAthem. Some of thleave their family home and integrate into the community on their own. Unfortunately however, there is a lack of youth transition programs in the District. There is also a gap between youth justice programs and hard-to-serve youth programs (i.e., programs for those whose actions do not land them in jail, but which are deemed inappropriate within the community). ii) North Bay Crisis Centre An example of the above is the North Bay Crisis Centres’ Future Residential Pro

his program providesgram.

a supportive living and learning environment to youth ages 16-4.31 The program has 10 single beds (accommodating 10 youths) and presently runs at

e reason for this under-utilization however is not a lack of sources and staffing. On the contrary, the Crisis Centre

T2about 70%-80% occupancy. Thdemand but rather, a lack of rehas to turn away hard-to-serve youth because it does not have the resources or staff to manage this group. The hard-to-serve youth require more specialized and strucmeasures, which in turn requires more staff, different programming, etc. The crisis centre estimates that with the proper funding, it could easily double its capacity to 20

tured

beds and accommodate these additional youth. 31. This environment includes: goal setting, independent life skills training, one-on-one counseling,

interpersonal education, co-operative living skills, nutrition education, meal planning & preparation, community awareness, 24 hour staff support & encouragement and structured Room & Board.


18. Recommendation: DNSSAB In keeping with the new direction taken by the MCSS with regards to research and the development of its new Municipal-Provincial Research Network, that DNSSAB work with the Research Network towards developing and enhancing, community-based service data. This data would be used by Ministries, Municipalities, public agencies and community service organizations for evidence-based,

outcomes. Integrated information and analysis across the various service areas and disciplines will go a long way towards assisting and improving planning, and ensuring that programs and policies are both pragmatic and effective. This ties in with the concepof service integration mentioned earlier, and the sharing of data and information. DNSSAB and MCSS can start by working together with the core agencies through the research network:

policy & planning purposes.

s

ere

t

s mentioned earlier, there is a lack of community data to accompany the anecdotal community services utilization and

t

North Bay Crisis Centre staff note that, “many of the children we see that are ages 16-18are living in terrible room & board situations”. Staff also acknowledges that the Children’Aid Society (Nipissing /Parry Sound) is frequently asking them to take more youth. This also an acknowledged gap within the mental health system for housing (especially transitional) for this age group. Without the daily living skills needed for independenliving, this population is much less likely to succeed in supported housing units, evenwith community supports. Ainformation regarding ODSP families and their



11.0 SPECIAL & DISCRETIONARY BENEFITS “We are dealing with people who don’t want to leave their home because they are too embarrassed about their teeth.” – West Nipissing, Community Service Provider For the purpose of this report, “special benefits” refer to the benefits of ODSP and “discretionary benefits” refer to those of OW. Although these benefit programs have

dependent legislation, an ODSP client may need to access either, depending upon the

ealth

nlike OW’s discretionary benefits which provide some flexibility and daptation to client needs, the ODSP benefits are firmly set and do not allow any

variations (i.e., no discretionary benefits). Within the community, other types of benefits a ch as DNSSAB (OW discretionary benefits) and L e s T fr various m

intype of benefit required. Special benefits refer to both health and non-health related benefits that are not mandatory but rather, are issued at the discretion of the ODSP Program Director on anindividual basis. These benefits fall under ODSP Directive #9: “Benefits” and some of the more common ones include drug and dental care, vision, hearing, and extended hcare. Non-health related benefits include moving expenses, vocational training and transportation’s.32 Ua

re also provided by organizations suIPI. Community service clubs such as the Rotary and Kinsmen Clubs may also providome assistance for special benefits, on an individual basis.

he following table summarizes the key points regarding special benefits that emergedom the focus groups (clients), community consultations (service providers) and eetings and interviews:

Table 22: Key points from Focus Groups & Community Consultations: Special Benefits APS BARRIERS CAPACITY /


G

A lack of coverage for

e following was ted:

l (specifically dentures). Special footwear and orthotics.

etic supplies. ations

(inadequate drug card coverage).

dical expenses e health

measures.

The process for obtaining dentures is ineffective and can act as a barrier for some clients. There is a misunderstanding amongst clients and service providers as to what benefits are covered by ODSP.

In some cases, fulfilling client’s special needs is far from seamless – the process is cumbersome, time consuming and frustrating for the clients.

More education for clients and service organizations, as to what benefits are covered and the processes involved.

thno

• Denta

•

• Diab• Medic

• Me• Preventativ

32. There are sixteen (16) benefits: Employment start-up, community start-up, heating costs, home repairs,

utilities, assistive devices, dental benefits, drug benefits, guide dog, extended health, hearing aids, mandatory special necessities, mobility devices, vision care, back-to-school & winter clothing and low-cost energy conservation measures.

11.1 Alignment & Barriers

The process of obtaining special benefits can be very difficult for the client to go through and in some cases, it is far from seamless. Adding to the confusion is a misunderstanding amongst clients and service providers as to what benefits are or are

ration and middlemen within the benefits supply chain. Different

e directives, “Assistive Devices” (Directive 9.6) can be used s an example. This directive covers those benefits for assistive aids and devices used

ludes orthotics which was an issue br th client

Ministry of Health and Long T LTC) arogram:

an as a llyctor (which ma , se m

W t fee P r it is no other source of funding avail

s m more than one assessor, if p ssible).

l fil e form and then will refer the client to an r”, who care professional registered with ADP. The authorizer

ethe the client meets ADP funding criteria or not - if they do, the fill in the form for the correct type of equipment required by the client device required is somewhat complex to design such as a

device, the client will be referred to “a team of skilled specialists” at pproved by ADP).

. The authorizer will then give the client the form to take to the supplier to get the equipment (in some cases however, the form is first sent to ADP for approval, before

not, covered by ODSP. i) Process One of the reasons for the above lies in the complexity of Special Benefits in general

nd the maze of administaMinistries and agencies actually administer and fund these various benefits and depending upon the type of discretionary benefit, there are different funding models used which affect the amount of ODSP coverage. Furthermore, there are various professionals involved (Physicians, Dentists, etc.) as well as equipment suppliers, vendors and in some cases, community organizations. Thus fulfilling one (1) discretionary need for one (1) client may actually involve up to 4-5 parties in the transaction. This might not be so bad if the process was seamless for the client but unfortunately this is not the case. In many instances, the client is exposed to the delays and inefficiencies which such a system presents. There are currently 16 ODSP “Benefit” Directives and if these were process-mapped, the result would likely be a maze containing many non value-adding activities. The following are two examples of the lient process for obtaining benefits: c

Assistive Devices Program (ADP) The process for one of thesato replace, compensate for, or improve the functional abilities of people with disabilities(this incproviders). The

ought up by boerm Care (MOH

s and service dministers this

p 1. To apply for

Dosistive device, a medicny clients don’t haveile the assessmen

l assessment is usuae page 108) or a “tea is not covered by ADable (if the assessmen

required by a of health care , MCSS will covet is over $500,

professionals”. if there

h

MCSS will reque t an estimate fro

l out a diagnosis-releasis a health

o

2. The Doctor wil“authorizewill asses whauthorizer w

r ill

(If the assistivecommunicationsa clinic a

3

the client can purchase the equipment). The supplier must be a registered vendor with the ADP. If the device has to be custom made, the client will be referred to a professional “who is trained to make the device” (and who is also registered with ADP).


4. The client must pay the vendor directly and the vendor will bill ADP for the approved

ple the client is not approved for funding, he /she can apply to B for discretionary benefits (If the needs are for diabetic or surgical supplies,

io which

he

nd. for

ive. The ing:

r, ng

e Rotary Club, the Kinsman Club, etc.)

. According to LIPI, only about half of the successful applicants will actually proceed

It sh

cost of the equipment. The amount paid by ADP varies according to the type of benefit: it may cover up to 75% of the cost, or a fixed amount up to a maximum contribution. Alternatively, it may be an annual grant.

. If in the above exam5

DNSSAan application can be made for Mandatory Special Necessities Benefit).

From the above it can be seen that a client could experience a long and drawn out process. Dentures Dental Benefits are covered under Directive 9.7 and are administered by the OntarDental Association. Under this directive, there is also a Dental Special Care Planclients can access if their oral health is directly affected by their disability (including tuse of prescribed medications or medical treatment). Dentures however are not coveredunder this directive, but rather are funded through OW’s (DNSSAB) discretionary benefits program. Low Income People Involvement (LIPI) administers the dentures program on behalf of DNSSAB and co-funds the dentures through its Community FuWhile there is a lack of coverage for dentures in general (see page 101), the processlients trying to get dentures under the coverage that does exist, is ineffectc

current process resembles the follow

1. A client in need of dentures will make a request to the MCSS ODSP Office where they likely will receive a “no provision letter” and instructions to go to the DNSSAB OW Office, where assistance might be available under OW’s Discretionary Benefits.

2. At the OW Office, clients are told that OW policy is to not fund dentures. Howevethey are given a list of community organizations that may be able to help (includiLIPI, th

3. As LIPI is well known, many clients will likely go there. At LIPI, a needs test is performed and if LIPI has sufficient funds, they will pay a maximum of 25% of thedenture costs – the client is required to pay the other 75%. Quite often, LIPI has to turn clients away because they do not have enough money in their Community Fund,which is used to pay for the dentures.

4with getting dentures, the others can not pay their 75% share.

ould be noted that the above is not meant to detract from the quality of LIPI servicethe contrary, LIPI is a good example of a community service organization partnering DNSSAB to provide front-line crisis services to people in need. Rather, the above ilustrate a process that is not effective and has many uncertainties for the client me of the clients who are in need of dentures but heard about this process through ds, said they will not bother to apply). Unfortunately, DNSSAB

s. On with s to il(so

ien Managers, LIPI and

eregobli

frthe MCSS have been down this road before and have already made attempts at str amlining the process. Whereas OW has the authority to make policy changes

arding the delivery of discretionary benefits, ODSP does not. Thus the ODSP office is gated to inform clients of their right to apply for benefits through OW.


ii) Communications

ed to the extensive benefit process is the general lack of knowledge about benein the community. As indicated above, the process for some of these benefits mctive communications difficult, between the ODSP Offi

Add fits with akes

ffe ce and the community.

os “be all, end

ons in particular need to recognize that ODSP is a program of last resort and is supplement any other available sources of income and /or benefits

eAdditionally, this is compounded by the fact that MCSS programs have constantly beenin flux during the past couple of years, which adds to the confusion.

ing sight of the fact that ODSP is a social assistance program and not theLall”, may create false expectations within the community and further erode communications regarding which benefits should be provided. Community service

rganizatiointended to . The fact that ODSP’s policy intent varies depending upon the type of benefit may also confuse things as this determines to what extent coverage is (or is not) provided. Clients, community service organizations and all other ODSP stakeholders need to be aware of these varying policy intents as they explain the MCSS’s position for a given benefit. For example, whereas the drug coverage is meant to be all encompassing, the coverage for benefits such as diabetic supplies or medical transportation is only meant as a last resort. In terms of assistive devices, the MCSS’s role is predominantly that of a co-funder, i.e., it funds assessments and the client’s contribution (often 25%), while the MOHLTC actually administers the program. The following table summarizes these examples: Table 23: Intent of Policy by Benefit Type Benefit Type Dir. # Intent of Policy Ass

Ministry of Health and Long-Term ogram

istive Devices (orthotics, wheelchairs, 9.6 To provide coverage to ODSP ventilators, respiratory equipment, communication / visual / hearing aids, etc.)

benefit unit members for assessment fees and the consumer co-payment for the

Care's Assistive Devices PrDrug 9.8 s To ensure that eligible member

of the benefit unit are provided with drug coverage.

Ma 9.12 To ensure that ODSP recipients l

n reasonably

ndatory Special Necessities (diabetic supplies, surgical supplies & dressings and transportation for medical treatment)

receive diabetic supplies, surgicasupplies and dressings, and transportatiorequired for medical treatment, where they are not available from any other source.

Source: ODSP Income Support Directives; www.mcss.gov.on.ca This has implications from a service providers perspective – for example, it would be beneficial to know that someone other than MCSS is (or needs to be) responsible fdiabetic and medical supplies, as well as medical transportation. If the provider thinks this is going to come from the Ministry, there is bound to be disappointment. Community ervice organizations should be familiar with these Directives which can b

or

e found on the CSS website: www.mcss.gov.on.ca

sM .


19. Recommendation: MCSS That within its communication strategy, the Ministry considers holding regular community forums that will provide information about core servicand Directives (such as Benefits). This could be in conjunction with its new Community Agency Network (below) or with the networking g

es

roup in Recommendation #16 (page 93).

As of June 2006, the MCSS (Northeast Region) has started a Community Agency Network where information and updates are shared with Ministry contacts via email. This will complement the MCSS’s regular information sessions that are held within the community and across the region. As MCSS takes every opportunity to participate in community forums, sessions, etc., this new network should further enhance community communications.

11.2 Gaps: Lack of coverage

i) Dentures As mentioned earlier, dentures are not covered under ODSP’s Dental Benefits. They are primarily funded through LIPI’s Community Fund which is dependent on ommunity c donations (individual & corporate), fundraising and discretionary benefits

or denturesthrough DNSSAB. The lack of coverage f was by far the dominant issue ser vi in time, this is

hi af p e req

pproximatce rate for

unknown, it can be assumed to be higher than averagemedications and poor nutrition have on teeth. While it i

ed dentures through other sources such servi

when discussing benefits with clients and vice pro qu

ders. At this pointlargely anecdotal as there is no data with wOffices do not manually track the number oactually receive them. In 2005, LIPI funded acaseload) for dentures.

ch toeopl

ntify it – the ODSP and OW uesting dentures or those that ely 17 clients (0.5% of the dentures by clients is presently due to the effect that s also unknown how many clients

33 While the prevalen

receiv as ce clubs, LIPI’s caseload utilization rate of 0.5% suggests a large gap b en tetwe hose who need dentures and those who actually get them. As self esteem is compro

es u inee t if

ii) Orthotics The need for more adequate coverage of orthotics (spemany times during the focus groups and community co is is anecdotal as there is little data available). Similar to dentures, orthotics are not covered

nefit covers only orthotic devices

mised by having poor teeth, the concept of social inclusion quickly becominclusive” programs in the world will have littlthemselves heading out the door.

nderm effec

d - even the best “socially people can’t feel good about

cial shoes and inserts) came up nsultations (again th

under ODSP’s Benefits (the Assisted Devices be ). Clients obtain an estimate of the orthotics they need and are then directed to OW to apply for discretionary benefits. Unlike dentures however (where they are referred directly to LIPI), here the clients are needs tested and if they qualify, a portion of their costs will be covered - they are then referred to LIPI. In 2004 /05, LIPI funded approximately 10 ODSP clients for orthotics, through the Community Fund. 33. Ref: LIPI Community Fund Report, 2004-05.


20. Recommendation: MCSS T B

hat OW start manually tracking ODSP clients who apply for Discretionaryenefits (particularly dentures & orthotics), and the outcome.

21. Recommendation: DNSSAB & MCSS overage for dentures and orthotics, a review should be

and

ill also

SS may want to check if this is a problem elsewhere

of Policy Directive 9.7 would ppropriate (i.e., consider including dentures under the dental benefits

iew efits.

and

ill also

SS may want to check if this is a problem elsewhere

of Policy Directive 9.7 would ppropriate (i.e., consider including dentures under the dental benefits

iew efits.

i) As there is a gap in cundertaken by DNSSAB & MCSS regarding their respective Discretionaryg their respective DiscretionarySpecial Benefits. As LIPI’s present Community Fund is insufficient for meeting the needs of clients, the review should include an estimate of the present shortfall and how it will be made up. Invariably this review winvolve reviewing the present Municipal contributions, and cost-sharing arrangements with the province.

Special Benefits. As LIPI’s present Community Fund is insufficient for meeting the needs of clients, the review should include an estimate of the present shortfall and how it will be made up. Invariably this review winvolve reviewing the present Municipal contributions, and cost-sharing arrangements with the province.

ii) Regarding dentures, MCin the province - if it is, then an internal review

ii) Regarding dentures, MCin the province - if it is, then an internal reviewseem aseem aadministered by the Ontario Dental Association). Additionally, this revadministered by the Ontario Dental Association). Additionally, this revshould re-visit the exclusion of ODSP Dependent Adults from dental benshould re-visit the exclusion of ODSP Dependent Adults from dental ben


1 2.0 COUNSELING

Table 24: Key points from Focus Groups & Community Consultations: Therapeutic CGAPS BARRIERS CAPACITY /


ounseling

There is a lack of stherprogFalls &ThesePost TDisordDiagnConcuand MiMental Illness (MMI).

lients with mental nesses have to travel

complex cases.

OW or MCSS could have a Psychiatrist or

ing and

ty

Implement a central point of access for

pecific types of The average waiting time for community

Cill

apeutic counseling rams in Sturgeon

North Bay. include: raumatic Stress er (PTSD), Dual

osis & rrent Disorders, ld to Moderate

Therapeutic counseling services is 6 mos. There is a lack of access to Therapeutic counseling services for many ODSP clients.

outside the District to get therapeutic counseling. Different types of therapeutic counseling and programs are needed to match the changing trend of more

Psychologist on retainer. Additional staffnew programs are required by communiagencies.

information, referrals, treatment and prevention.

*Note: The word “counseling” is very broad as there are many different types of counseling which can mean many different things. For the purpose of this report, “counseling” refers to therapeutic counseling which focuses more on therapies and

cludes many various methods and techniques for helping people with mental illness s. psychiatry which focuses more on the medical model and the use of medication). sychiatric services are mainly delivered through the public mental health system which beyond the scope of this review and thus the term therapeutic counseling is used roughout this section. Also, the following is only a snapshot of therapeutic counseling

s it relates to the overall mental health picture, but nonetheless serves to highlight ome of the important issues presently within the local communities.

is estimated that approximately 1,600 ODSP clients in Nipissing District have been iagnosed serious mental illness (SMI) 34, which is a prevalence rate 7% higher than ntario’s average (the fact that North Bay has one (1) of Ontario’s four (4) Psychiatric ospitals is considered to be the main reason for this greater prevalence). Given this igher prevalence and the greater need per capita for community mental health services general 35, one might expect to find a broader scope of services or even innovative

ervice delivery models between provincial Ministries and the District’s community ervice organizations. When it comes to therapeutic counseling services however, what ppears to be in place for some clients are barriers to access and gaps in services.

4. Ref: Nipissing District ODSP Caseload: An Analysis by Area of Residence, Age, Family Status and Primary Disability, MCSS /MCYS April 2005. In this report, primary disability is estimated from a 20% sample of Nipissing District’s overall caseload. 43.5% of the caseload was found to have psychosis or neurosis as the primary disability. Ontario’s rate is approximately 36%.

. The report Nipissing District ODSP Caseload (Stewart, Apr. 2005) refers to the “sediment effect” whereby people discharged from the Psychiatric Hospital will remain close to it, in order to access the hospital’s (or other) community supports and services.

in(vPisthas ItdOHhinssa 3

35


12.1 Barriers: clients not being able to access the existing therapeutic counseling services.

ere ents with s presently utic cou uld

hear consiste at include of orgaure for obtaining services for thos mental i

n’t kn n e com y roblem sing as the tha

em en

Perhaps the best way to find out about accessibility is to start with the question: whP clido ODS

hope to mental illnesnt answers th

go for therapespecific names

who have a

nseling? One wonizations or at least llness. But in fact, a set proced e

wthe answer “I do(this is not a parea and most of th

ow” comes up too ofte in West Nipis

go to the Alliance C

ithin the servicre are fewer clients tre. Waiting lists

munity in North Ban in the North Bay

are thlients come in throug

e main problem specific s

in e c h treamsWest Nipissing). Th problem is that unless

the ou patient services, or thtc l peu

(such as through Psychiatric Hospital’s.), they will have difficu

t rough violence / tic counseling abuse, addictions, e ty in receiving thera

because these servic n .es are only available o a pay-per-use basis Me services average $70 - $1 ill n ss them.

n hy the average Case M u a c s eam (vs. the opposite program

he primary funders of therapeutic counseling services are the MCS C and e way in which they fund therapeutic counseling service organizations contributes to

g ose for

h

el e short-term,

sychology is delivered under the therapeutic model and involves more one-on-one ,

ts

ost clients cannot ever acceafford thes

This helps to explaiclient into a specifi

(which 00 /hr.) and thus wanager spends so m

of matching a w ch time trying to fit

to meet the client’s

S & MOHLT

trneeds). Tththis barrier to access – the policy intent of their programs results in strict programmincriteria for specific client segments (streams) such as psychiatric outpatients or threquiring crisis interventions. This results in a “you don’t fit the program” messagemany people suffering mental illness. These funding silos also contribute to a lack of therapies and other therapeutic counseling services (covered under ‘gaps’ below”) whicare needed within the community, but not delivered because they fall outside of the traditional funding envelopes. Additionally, Government Ministries need to acknowledge the distinction between psychological and psychiatric services. Whereas psychiatry follows the medical modand deals more with medication prescriptions and group therapy for thpsessions and a focus on the longer-term. Depending on the type of mental illness thenone may be more effective than the other for a particular client. Presently ODSP clienand others have to go through the same streams in order to access therapeutic counseling services, regardless of whether they require psychiatric or psychological therapeutic counseling.

22. Recommendation: MCSS i) For new ODSP clients who have been diagnosed with SMI, provide them with

access to therapeutic counseling services – these sessions can go a long ity

ii)

way towards helping the clients, who otherwise may not have the opportunfor professional therapy.

Consider adding therapeutic counseling services to the Special Benefits program –this would provide access to services for clients who have a mental illness, but who do not fit one of the existing streams and cannot afford pay-per-use therapeutic counseling services.


22. Recommendation: MCSS (continued) iii) Communicate more effectively with the MOHLTC regarding funding for

people with mental illness. This includes consolidating resources so there are no program duplications and ensuring that all those with a mental illness can receive effective therapeutic counseling. This also entails recognizing that clients will cross-over between separately funded (i.e., different ministry) programs. By making these funding and program changes, the Ministry can start to change the present service delivery culture of “who are you funded by and what’s your mandate” to “it’s o.k. to step outside the boundaries to serve the client”.

iv) Recognize the difference between the psychological and psychiatric

ferent ministry) programs. By making these funding and program changes, the Ministry can start to change the present service delivery culture of “who are you funded by and what’s your mandate” to “it’s o.k. to step outside the boundaries to serve the client”.

iv) Recognize the difference between the psychological and psychiatric needs of clients and design policies and programs accordingly. Central to the development of these programs would be the notion of access to effective therapeutic counseling for all clients with mental illness.

12.2 Gaps: a lack of specific therapeutic counseling programs

While accessing existing therapeutic counseling programs is a problem noted above, theopposite also holds true: there is a lack of specific types of therapeutic counseling programs that are needed within the community. The following are areas where therapeutic counseling capacity needs to be expanded in order to effectively serve Nipissing District’s ODSP clients and others with mental illness: i) Post Traumatic Stress Disorder (PTSD)

Post Traumatic Stress Disorder

is a negative psychological outcome that has resulted om an exposure to, or confrontation with, a highly traumatic event. As with other

D can

those who have both a mental illness and a developmental elay while concurrent disorders are the combination of mental illness and substance

a quantifying the number of ODSP clients who are d is currently not possible due to the absence of data (tdemo

36. Tm

frcomorbidities (the presence of other disorders in addition to the primary one), PTSbe complex in that, it may be masked by a primary disability of mental illness and hencegoes undiagnosed or is not treated for specifically. With regards to ODSP, there is currently no data available or numbers with which to quantify how many clients are inneed of this service. Anecdotally within the community however, the need for this specific type of therapeutic counseling is evident. ii) Dual Diagnosis & Concurrent Disorders

ual Diagnosis refers to Dd

buse /addiction.36 As with PTSD,iagnosed with either of the abovehis should be an area of interest for the MCSS and MOHLTC as it would better

nstrate the need).

his is not to be confused with the American definition of dual diagnosis which is a combination of ental illness and substance abuse /addiction (concurrent disorder in Canadian terms).


R approximately 10% of the District’s ODSP caselre D popu ts are r

egarding dual diagnosis, it is estimated thatoad has developmental delay (DD) as their primary disability. Other

search and reports estimate that the prevalence of dual diagnosis amongst the Dlation ranges from 30 – 60%.37 The question arises as to how many of these clieneceiving effective treatment for their dual diagnosis? According to community peutic counseling providers, gaps start to appear with this type of therapeutic seling. For example, the main treatment stream for clients with dual diagnosis is ntly through the North Bay & District Association for Community Living (NBDACL)

h is the main provider of services for the DD population. The medical option is the one available for clients and this involves an out-of-town Psychiatrist (via rence calls or bi-mon

theracounpresewhiconly confe thly drop-ins) who works through the NBDACL and performs mfoqualicoun

edication checks. Additionally, as an IQ level of 70 or below is the admittance standard r the NBDACL, those with slightly greater intelligence fall into a grey area and may not

fy for services. Regarding concurrent disorders, it is important that therapeutic seling occurs simultaneously for both the mental illness and the addictions.

programs for mental health and addictions are often running in parallelCommunity ther than in an integrative fashion that treats both at the same timera . This can be

he other which further re of Nipissing offers

to be nd

Mild-Moderate Mental Illness (MMI)

ay have a primary disability (other than e

compounded by the difficulties in identifying one disorder over tleads to separate treatment. The Community Counseling Centsome therapeutic counseling for concurrent disorders but more capacity is needed. Although integrative models are costly and complicated to design, they are proven effective and more of this type of therapeutic counseling is needed in North Bay aWest Nipissing. iii)

Unlike those with SMI, some ODSP clients mmental illness) for which they have been “adjudicated disabled’. However, some of thesclients also have mental health issues which are not as extensive as SMI, but still require additional therapeutic counseling support. However, as there are currently no community programs for MMI nor any Ministry funding for such programs, these clients are going undiagnosed and untreated. North Bay’s therapeutic counseling providersseeing a growing trend with people with MMI and are concerned about this lack of therapeutic counseling programming.

are

he lack of therapeutic counseling services in the above areas continues to be of major providers - perhaps even more so as the

place

Tconcern for the District’s community service restructuring of the North East Mental Health Centre’s North Bay Campus has now commenced. As clients /patients are being transferred from the hospital into the community, the need for increased support services and mental health therapeutic counseling is evident. However, although these concerns have been documented in thepast through numerous community consultations, focus groups, restructuring commissions and reports, some of the critical supports and services are still not inwithin the community. With the District’s high prevalence of mental illness and the lack of

erapeutic counseling access and programs identified above, it is evident that further overnment investment is still required.

37. Canadian Mental Health Association (Ontario Division), Position Paper: Respecting Dual Diagnosis;

Dual Diagnosis Task Force of the Public Policy Committee, June 1998.

thG


23. Recommendation: MCSS & MOHLTC / North East LHIN As the primary funders of therapeutic counseling services, the Ministries should meet with Nipissing District’s mental health community services to discuss the above issues, and identify solutions and resources.

24. Recommendation: MOHLTC /North East LHIN: (see also Recom. #15, #17) service community, create a Gateway to n Nipissing District. This would provide a

o

As noted by the Northeast Mental Health Implementation Task Force (see page 92), the fragmented nature of Ontario’s mental health system calls for a streamlining of access tservices and a continuum of care at the community level. The effects of this fragmentation spill over into many program areas including therapeutic counseling and further compound the problems identified above. Given that mental health therapeutic counseling is a critical determinant of not only the clients’ well being but also to the success (or failure) of many other programs, the need to de-fragment or streamline community therapeutic counseling services is evident. One way in achieving this is through a central access point for clients that would coordinate all therapeutic counseling information, referral, treatment and prevention programs. This ties in with the concept of integrative services (see recommendations #15 & #17), and could be considered withinthose general community integration initiatives or separately amongst the therapeuticcounseling service providers (public and community).

In partnership with the mental healthServices for mental health services icentral point of access for information, referrals, treatment and prevention.


13.0 ASSESSMENT & REFERRAL “

It took over three years the first time I applied for ODSP” – Nipissing District ODSP client.

Table 25: Key points from Focus Groups & Community Consultations: Assessment and R

APS BARRIERS CAPACITY / SOLUTIONS / eferral

GALIGNMENT BEST PRACTICES

Many clients do not have a Doctor which makes it difficult to apply for ODSP, and to get referrals for community services (not to mention their health needs going un-answered). During the application process, clients were frustrated in not knowing where they

New Doctors are screening new clients making it difficult for people with disabilities to obtain a Doctor. The waiting time for getting onto ODSP is extensive – clients reported wait times of 1-2 years on average. Formal assessments (paid for by the clients) appear

The Claude Ranger Clinic (one of the main assessment services used by Ontario Works), is no longer taking clients due to backlog. There appears to be a high rate of application failures, appeals and re-applications. There is a disconnect occurring so

OW or MCSS should have a Physician and /or Psychologist on retainer.

stco

ood (lack of mmunications from

O

to get fast-tracked, but times can still vary from 2-

mewhere between the initial

DSP Office). weeks to 1-year, under the same circumstances.

application (input), and the final DAU decision

(output).

lthough the area of assessment and referral was the primary focus of this study, the kage to the ODSP application process quickly became evident from the first focus

roup held. Two main issues surfaced regarding assessment and referral, namely a lack f Doctors and an inefficient ODSP application process (lengthy and a high rate of fusals).

3.1 Lack of Doctors for ODSP Clients

Alingore 1

imply put, there is a lack of Doctors for ODSP clients. Anecdotally, this was echoed roughout this study by clients and the service community alike. While this is a icrocosm of the much larger problem of a Physician shortage throughout rural Canada,

still needs to be considered in context and at the local level. Many clients have ultiple, complex health issues and not having a family Doctor further compounds their ifficulties in life. Taken in the local context, Nipissing’s higher prevalence of ODSP anslates into a relatively greater need for medical services and community programs nd services. As many of these require some sort of assessment or Doctor’s referral owever, the client’s options become very limited, very quickly. Some of the focus group articipants also stated that not having a Doctor made it very difficult for them to get on ODSP.

Sthmitmdtrahpto


(Note: there is also concern that the time for rapid reinstatement is too short because nce a client is off ODSP they will have a very difficult time getting back on without a

). While health issues can

an assessment or referral without a family Doctor becomes much more This also lim s for peop lying for

transferring from OW to ODSP as the Health n the ODackage requires completion by a Family Doctor, Psychologist, Ophthalmologist or

(ex

fo gnumber ts without r sently unknown.

ger icture however, can he starting point in an rs d and ontext. The following map shows is ans:

hic ysicia

oDoctor’s assessment or referral. As the rapid reinstatement guidelines are being hanged however, this concern should disappear- see page 53c

be addressed through walk-in clinics or as a last-resort the Hospital Emergency Room,obtainingdifficult. its the chance le who are app

Status Report iODSP or are SP application

pRegistered Nurse While quantitative daproblem, the nLooking at the bigeffort to better undeCanada’s present d

tended class).

ta would be beneficial of ODSP clien

r determining the ma family Physicians is plp in establishing a

itude of the e

ptand the local neetribution of Physici

Distribution of Ph

c

Figure 24: Geograp ns in Canada.

Source (by permission): Geographic Distribution of Physicians in Canada: Beyond How Many and Where, 2005. Canadian Institute for Health Information (CIHI). At the national level, Canada’s rural areas account for approximately 21% of the population, but have just 9.5 % of the country’s Physicians. Ontario has an average of 86 Physicians /100,000 of population, which is 12 lower than the average and the lowesin Canada (excluding territories). According to Dr. David Bach who is the president of the Ontario Medical Association (OMA), Ontario is short 2,300 Doctors.

oving furt

t

her down towards the local level, a glance at the map reveals the shortage of hysicians in Northern Ontario relative to the rest of the province.

MP


25. Recommendation: MOHLTC That the Ministry of Health further research this issue –good questions to start with are: how many of the 217,000 + Ontarians presently on ODSP, have Doctors? How many in the North have Doctors, compared to other Ontario regions? If the disabled population is disproportionately represented in Ontario’s Physician caseload, then Ontario’s health care system has one more important aspect to consider…..

That the Ministry of Health meet with representatives of Family Physicians, service providers and other key stakeholders, to discuss the implications of, and possible solutions for, ODSP clients who do not have family Doctors.

y n

ted on

d

nd in this case, also to good humanitarian practice. dditionally, describing the physician shortage in terms of what it means for different

It would appear that this problem has been around for quite some time, as evidenced bthe Ministry of Health’s Underserviced Area Program which was established in 1969, irecognition of the need for more health professionals in Northern Ontario. Providing a recommendation that is logical and makes sense is difficult given the magnitude of the problem and the high-profiled reports that have already commenthis. These include Looking Back, Looking Forward (Ontario Health Services Restructuring Commission, 1996-2000) and the Romanow Report (2002). Having saithat, to not take any action because the problem appears to large or insurmountableruns contradictory to good planning aApopulation segments (such as the disabled) is beneficial as the impacts can vary considerably. As stated by OMA’s president “improvements to the health-care system are possible, however we need to be diligent in confronting the aspects of our systemthat are under strain - we need to hear the concerns of patients, doctors, and communities to help all levels of government take appropriate action.”

re qualitative and quantitative information would help to define this issue further. Perhaps representatives from the Ministry of health could also meet with Physician and service-provider representatives to discuss the shortage-of-care problem, solely as it relates to the disabled population.

13.2 ODSP Application Process

From a Ministry of Health interest-perspective, gathering mo

ught with rate of application failures:

Clients and service providers indicate that the ODSP application process is fraproblems that include delays and a high 13.2 i) Lengthy Application Process Many of the clients in the focus groups talked about their frustrations with applying for ODSP and the extended length of time it took to get onto ODSP. Stories of application times that extended past 1-year seemed common (it was interesting to note that clients

ho went on to disability in the early 90’s only waited 2-4 months). w



This issue recently came to light when the Ontario Ombudsman investigated the MCSS DAU unit, based upon client complaints of extended waiting times and a loss of benefits due to this wait (only 4 months of retroactive benefits are paid to the applicant,

gardless of how long the application takes). The following are key points from the

ime, and

e

an effort

d

• Currently the average processing time for applications not triaged is 8 months and as U backlog of 13-14,000 cases.

• / week.

• rder

• The 4-month retroactive rule is more of a regulation to provide a performance

ODSP payments dating back to the application date).

mendations that emerged from this report:

he optimal the intent and purpose of the program, and are required to process ODSP applications

io Disability upport Program, including keeping in regular contact with applicants to advise em of the status of their applications on a regular basis, and providing useful formation by telephone where possible.

reOmbudsman’s report, Losing the Waiting Game (May 2006): • The Ministry has known about application delay problems for quite some t

has been working on making improvements to the system.

• Some of these improvements involve fast-tracking certain applications. As an example, a “triage” process was implemented which expedites applications that clearly demonstrate “disability” through medical evidence.

• The ministry only began keeping detailed statistics on the length of time taken by thDAU to make decisions on ODSP applications, in 2005.

• Prior to this current review, the Ombudsman’s Office had been investigating delays relating to the completion of internal reviews – the DAU was receiving 40% more internal review applications than what the system had been designed for. Into solve this problem, staffing resources were reallocated within the DAU to help withthis backlog. Unfortunately this led to staffing shortages in other areas, particularly the initial application /adjudication area. So in effect, the backlog was transferrefrom the DAU’s internal review area, to its adjudication area.

of February 2006, there was a DA

The current problem is largely due to staffing: The DAU was set up to handle 400 applications /week, but is presently receiving approximately 700 applications

The 2006 provincial budget is committing resources to expand the DAU unit in oto address these application processing delays – by the end of 2006, the MCSS is committing to reducing application process times to less than 4 months.

measurement & standard for the MCSS. As a performance indicator meant to improve service standards for the ministry, it is actually penalizing ODSP applicants (Note: since the Ombudsman’s report, applicants will now receive retroactive

Below are some of the key recom That the Ministry of Community and Social Services review the service standards for the adjudication of ODSP applications and determine what tprocessing time should be, given determine what staffing strategiesexpeditiously. That the Ministry of Community and Social Services establish appropriate service goals for the treatment of pending application sunder the OntarSthin

That the Ministry of Community and Social Services pay retroactive benefits to all applicants to the Ontario Disability Support Program who were disentitled to benefits as a result of Ministry delays and the impact of section 17 of Ontaregulation 222 /98 under the Ontario Disability Support Program Act, 1997limitiretroactive benefits to four months.

rio ng

x mo commendations are

ill be

Given the Ombudsman’s report and the fact that the MCSS is presently conducting a si

nth review on the DAU and the application process, further reunnecessary at this time. As with any policy or program changes however, what wimportant is the monitoring of key indicators to ensure that the changes are effective.

The ot “adjudicated disabled” (or

proretuappthe l. As 200 as disabled, meaning

pre e as an indicator.

13.2 ii) /Appeals re appears to be a high number of applications that are n

in layman terms, are turned down) and consequently a high number of appeals. Under the ODSP Act, if an individual is denied benefits they can request an internal review,

vided they do so within 10 days of receiving their notice of decision. The DAU in rn, must complete its review of the case and return a written-decision to the licant, also within 10 days. If the applicant is again turned down at this review stage,

y may appeal to an independent adjudicative body called the Social Benefits Tribunaa final matter of recourse, tribunal decisions can be appealed to the courts. Since 3, approximately 55% of the DAU applications are adjudicated

45% of the applications are not granted ODSP.38 While DAU data for Nipissing District is sently not available, the number of OW referrals to ODSP can serv

The following chart shows the cases that OW has referred to ODSP in the past three years:

Figure 25: OW Referrals, Nipissing District

OW Referrals to ODSP: Nipissing District, 2003-2005

293272250

300

350

1760

1780

1800

OWRefferals

Granted220200

ferr

als

1740 oad

133

168

137

0

50

100

150

OW

Re

1680

1700

1720

OW

1660

Cas

el

ODSP

OWCaseload

2003 2004 2005

Source: SDMT Intake Performance Report (referrals) and Termination Details Report (ODSP granted). Caseload data from DNSSAB OW. 38. ODSP Caseload, Factors Behind Recent Growth, Jan. 2005. Statistics and Analysis Unit, ODSP Branch,

Social Policy Development Division, MCSS.


Note: “ODSP Granted” does not necessarily indicate the number of applicants granted the first time but rather, the number granted in total. This may include applicants whwere not successful in their first application attempt but were successful after subsequent internal reviews or appeals.

o

s expected, the chart indicates that as the OW caseload grows, the number of ODSP

ch

lso costs to the system. The resources expended by DNSSAB (OW) and the MCSS AU) in application processing and internal reviews and the subsequent appeal

the Social Benefits Tribunal, the Nipissing Legal Aid Clinic and the

nts

likely forthcoming with the DAU application process, this would be an effective

Areferrals does as well, although not necessarily in direct proportion. It also indicates that on average, the number of cases not granted ODSP has been a minimum of 45% whibasically corresponds to the provincial average. This seems to be a very high number ofapplication failures, affecting not only the client through prolonged periods of stress buta(Dprocess involving courts, must be considerable (incidentally, Legal Aid Ontario indicates that 80% of the clients who appeal with the help of a legal clinic, are granted ODSP). From the perspective of OW, this also poses another concern about the 45% (approximately 115 people) who are not granted ODSP…where to from here? The fact that these OW clieapplied to ODSP indicates that they have multiple barriers to employment and to succeeding in the OW program. As the Permanently Unemployable (PUE) category no longer exists, there now is a very hard-to-serve segment remaining in a program that wasn’t necessarily designed for them. While DNSSAB has an Intensive Case Management system in place for these particular clients, the debate continues as to the most effective way to work with the clients. As a final note, DNSSAB presently does not track OW referrals to ODSP in terms of the length of time taken for a decision, those granted the first time, etc. Given the changes

at arethindicator to measure as it will provide local feedback to the Ministry regarding the

effectiveness of their program changes.


14.0 LEGAL /ADVOCACY Table 26: Key points from Focus Groups & Community Consultations: Legal /AdGAPS BARRIERS

vocacy CAPACITY / SOLUTIONS / ALIGNMENT BEST PRACTICES

Many Lawyers will not represent ODSP clients –they don’t respond to client queries or claim “not to know anything about ODSP”.

The Legal Aid Clinic is hard to get to (Shirreff Ave.).

Clients report that the Nipissing Legal Aid Clinic is a good resource and works well.

The cost of a psycho vocational assessment through the legal clinic is $500 compared to$1500 regular. This should be made moraccessible.

e

Advocating for people with disabilities is an ongoing activity, driven by the need for continual improvement of social inclusion. Promoting community education and awareness on a consistent basis is paramount to making advancements in the lives of people with disabilities. Many of the organizations involved in this review are involved in both service and advocacy for the disabled population. Throughout the focus grouclients seemed generally pleased with community service and advocacy. Apart from theODSP program itself, client frustrations stemmed more from supply issues (a lack of aprogram or service) rather than from a delivery perspective (what or how somedelivered). Advocacy groups such as PEP (People for Equal Partnership), LIPI (Low Income People Involvement), Nipissing CMH

ps,

thing is

A (Canadian Mental Health Association) nd the Nipissing Legal Clinic were frequently mentioned as being good advocates and

gal Clinic’s caseload (10% higher than Legal id Ontario). The chart below indicates that the majority of time spent working with DSP clients is on DAU appeals:

aoffering good services. Regarding legal services, the Nipissing Legal Aid Clinic is the primary service provider and clients seem pleased with their overall service. As mentioned earlier, ODSP accounts for approximately 45% of the LeAO

Nipissing Community Legal Clinic: ODSP Case Type, 2005

2.9%

71.4%

11.4%11.4%

2.9%

FB: PUE / Disabled DAU Appeal Child Benefits Overpayment Other Source: Nipissing Legal Aid Clinic.


One issue facing the legal clinic involves ODSP Canadian Pension Plan (CPP) pplications. As this is a contributory plan, many clients do not qualify for CPP. However,

legal aid clini pursue CPP denial appeals on behalf of the clients. According to the Clinic, this is somewhat of a ise that

ing th issing Legal Clinicntario egal Aid system in general. These include increasing demand (the

il ess is on the rise) and costs (ODSP procedury reports), with little change to base funding. Curre

tem is under review and it is hoped that some of these conce

aunder the ODSP Act, it is a statutory obligation to pursue all revenue sources possible and the c is obliged to

pointless exerc should be eliminated. Other issues facfaced by the Oincidence of mental frequent and costl

id sys

e Nip concerning ODSP are similar to those

es require more ntly Ontario’s legal

s will be

Lln

a rnaddressed.


15.0 CONCLUSION Establishing the needs of the community’s most vulnerable citizens and the service capacity to meet these needs has been a difficult exercise. The very nature of disability and its complex surrounding environment make it challenging for research and aNipissing Di

nalysis. strict’s service system is equally complex, with a relatively large number of

ervice organizations providing a wide range of services to the client population.

rovides a greater understanding of Nipissing District’s ODSP population nd their needs, as well as the community service system that has developed in sponse to these needs. The review has also produced 25 recommendations in direct sponse to identified shortcomings, and these vary in magnitude of client impact and sources for implementation. Finally and as indicated by the literature review, this study the first of its kind at the District level and hence provides a community baseline easurement and a starting point for moving forward.

performing the community services review based on the Nipissing District ODSP opulation, shortcomings have been identified and highlighted in the report. Generally ese shortcomings can be categorized as either “gaps or barriers”, or they have sulted from insufficient service capacity or alignment. In keeping with the report’s commendations, these shortcomings can be viewed as opportunities for improvement

nd they fall into the following common themes: financial hardship, unmet needs, ansportation, children at risk, service integration and communications.

inancial hardship is encountered by many of Nipissing’s ODSP clients and this has any negative ramifications in other areas of their lives. The clients also have unmet eeds and these appear to be most prevalent in the areas of housing, food, benefits and ounseling. Further challenges relate to the District’s geography which results in ansportation difficulties for both the clients and service organizations. The delivery of, nd access to community services is restricted which affects operating efficiencies and

its the client’s program participation. Nipissing’s relatively high share of ODSP ependent children creates concern around children at risk and this has been an nderlying theme in both ODSP reports. As pointed out in this report however, more ommunity information, data and research is needed in order to quantify the concern nd analyze children outcomes. Where general community services are concerned, the eed for gateway to services and integration is evident. The present community service ystem offers numerous types of services through multiple access and exit points, and resents a complex maze for clients to navigate. Finally, communications emerged as a ey area for improvement between the community’s main ODSP stakeholders, i.e., the lients, the service organizations and the Ministry of Community and Social Services

CSS).

should be noted that the ODSP program itself was not the subject of review and the roject scope excluded publicly delivered health and education services and also mployment supports.

sCollectively, the community services are not mapped or measured and data in key service areas is lacking. To determine service alignment and capacity in view of such a system is challenging, and in hindsight the project has had ambitious objectives and scope. This review parerereism Inpthrereatr Fmnctralimducanspkc(M Itpe


As the review progressed however, it became evident that the delivery of “community ervices” to ODSP clients was entwined with the administration of the ODSP program.

inally as a side note, this review was specific to Nipissing District’s ODSP population

ts and

sHence many of the recommendations that have emerged from the review are gearedtowards the program administrators: MCSS. The Ministry has made notable improvements to the ODSP program over the past two years and most recently (during the time this report was being written), it has been working on enhancing the area of employment supports to further improve the ODSP program. As outlined in their Thriving Communities framework, the Ministry’s commitment to people and communities is evident, and it is hoped that MCSS will view this report within that context, i.e., in terms of enhancing the lives of the clients and the delivery of community services. Fand the community services for these clients. These community services also serve other low-income segments of the population including Ontario Works (OW) cliennon social-assistance recipients. Therefore, some of the report findings and recommendations likely have implications and validity for these other groups as well.



O D S P R A T E C H A R T – February 2005 Board & Lodging - Regulation 33(1)1 Basic Needs (Renters & Owners) – Regulation 30(1)1

+ Special Boarder Allowance – Regulation 33(1)5 Capped Amount – Regulation 30(2) Additional Amounts for B&L with Dependants other than Spouse – Regulation 33(1)2 Shelter Maximums – Reg. 31 4 (Renters and Owners) PNA – Regulation 32(2)(a) Flat Rate Earnings Exemptions – Reg 38(1)ii Asset Limit – Reg. 27(1) et 30 (3) Special Benefit – Reg. 45.1(1) ACSD Amounts Pregnancy Nutritional Allowance Regulation 30(1)5 and 33(1)6

(2)2

Special Di

Regulation

Benefits – Regulation 4

Allowance (1)4, 33(1)4, 33(2) &

Single persoApplicant/Recipient + Spouse $ 1029 Applicant/Recipient + Disabled Spouse $ 1,356

n or Sole Support Parent $ 678

$52.00 per case added to above B&L Table

Age of Dependant(s)

+ Northern Allowance

Reg.33(1)3

13+ years

0-12 years

Single Couple

A. Single - First dependant Each additional dependant, add

$396 $192

$342 $143

$140 $219 $222 $252

Double Disabled Rate: $1607.00

Persons in institutions receive $116.00

# of Dependants other than

Spouse and over years

thern ance 0(1)2 Couple

13 years 0-12 Single Couple Couple (both

disabled)

+ NorAllowReg 3

Single 0 0 0 $ 232 $532 788 $1063 140 1 0

1 1 0

$$

272 $796 $848

902 949

$1177 $1224

231

2 0 1 2

2 1 0

111

311 tional add $39

$909 $961

$1009

$$$

033 080 128

$1308 $1355 $1403

269 each addidependant

For each additional dependant, add: (a) 13 years and ov 18er………………………..$ 0 (b) 0-12 years ……………………………$ 131

Benefit Unit Size

Maximum Monthly Shelter Allowance*

1 $427 2 $672 3 $729 4 $792 5 $853 6+ $885

Winte

Back t

CSUM

Guide

Emplo

2

r 105.00

o 69.00 128.00

B 799.00

1,500.00

D 64.00

y 253.00

si 455.00

Clothing $

School Allowance: 4-12 years $ 13-17 years $

(once/24 mo) (Single) $

(Family) $

og Allowance $

ment Start Up (once/12 mo) $

dence Max. $nd Re

Single $5,000 Couple $7,500 Each dependant add $500 Dependent Adult $536 eff. Mar 2005 Reg. 2(2)(d)(i)

Minimum $25 Maximum $400 effective July 1, 2004

Max. $250/month per member f the beo nefit unit

Single $ 160 Couple/Family $ 235

Milk-Based (Lactose Tolerant) = $40.00/month Non-Dairy (Lactose Intolerant) =$50.00/month Note: In addition to Special Diet Allowance

$110 Single $200 Couple/Family issued September and November 2004

* Reg. 31(2)5 – add $57 for “doubled disabled”

DNSSA om 119

Wo

eekrth

ly B

C ofN ay ry

2005

B: C munity Services Review, Based on the ODSP Client Population; Oct. 2006

o P

st ar

F S

ooo

d un

ind

thAr

e ea

Age Cost/Week ($)

1 $14.49

2 to 3 $15.25

Child 4 to 6 $20.12

7 to 9 $24.12

10 to 12 $30.04

13 to 15 $35.27

Boy

16 to 18 $40.97

7 to 9 $23.28

10 to 12 $27.71

13 to 15 $29.67

Girl

16 to 18 $28.21

Pregnant Woman

Age Cost/ ek We ($) 1 Trimester $32.90 st

to 113 5 2nd & 3rd Trimester

$34.73

1st Trimester $32.82 to 116 8

2nd 3rd

ri te$35.24 &

mesT r 1st T s $rime ter 32.01

to 219 4 nd 3r

ri te

2T

& mes

d r

$34.09

1st T srime ter $30.74 to 425 nd 3r

ri te

9 2T

& mes

d r

$32.56

Lactation

Age Cost/Week ($) 13 to 15 $35.70

16 to 18 $36.15

19 to 24 $34.88

25 to 49 $33.22

.ca www.nbdhu.on

North B681NortTel:Fax:1-80

a Commh Bay (705) (7050-563

y Officercial

, ON P474-14 474-2-2808

e St10

) 80

Burk’s Falls Office 17 Copeland Street, BoBurk’s Falls, ON P0A 1Tel: (705) 382-2018 Fax: (705) 382-2931

cuS

7 11

reet B 4E7 0 9

x 484 C0

Parry74 ChParry Tel: (7Fax: (

Sounrch Sound,

05) 7405) 7

d Offitreet ON P26-5801

46-27

e

A 1Z

1

Age Cost/Week ($) 19 to 24 3 $ 8.77

25 to 49 3 $ 7.64

50 to 74 3 $ 4.16

75+ 3$ 1.08

19 to 2 24 $ 8.85

25 to $2 49 7.64

50 to 2 74 $ 7.16

75+ $26.41


iii) Terms of Re w, Based on ference: DNSSAB: Community Services Reviethe ODSP Population

Background A recent report, Nip SP Caseload (MCSS / MCYS April 2005), has identified a high inciden ability (relative to the population) within istrict. present caseload is app ly 3500 people (5.5% of the populati 8 and over) which is more than twice the provincial rate and the highest in O

In o gain further u nding by the District of Nipissing Soc s Administration Board (DNSSAB) and other agencies who deliver the o this cas review of th of this caseload will be conducted. 1. Objective

• he needs o SP caseload, for community social s thin the pissing.

• Review the capacity of t liver services, in response tts.

• urrent syst ment within the Di rict of Nipissing. 2. Scope The Needs Analysis will:

he relevant socio-economic characte unique to the District differentiate it from Ontario in gene

• Define the services2 ort the ODSP population based upon client and service p vider inp es will include:

eling sing & s (including independent livinal /advoc

sment & referral al /disc y benefits

ild & fami rts securitportatiocial su

Cond entory o ent services ( ganization, description, geographic distr

• Ide in the service system

1. A cas individua family unit, receiving social assistance. The total number of cases aseload. Some cases support dependants who have disabilities, such as children, spouses or adults. The total number of people receiving ODSP support are the beneficiaries. In February 2005, Nipissing District’s ODSP caseload was ,481 and the total beneficiaries were approximately 5,300 (this includes 922 children under the age of 17). The age requirement for ODSP income eligibility is 18 years and over.

2. The study will not rvices delivere t, Public HealtEducation or Em nd assistance

issing District ODce of disroximate

the D The on, age 1ntario1.

rder to ndersta ial Serviceservices t

eload, a e needs

Review t f the OD ervices wiDistrict of Ni

he system to de o the needs of the clienIdentify c em align st

• Indicate tand which,

ristics that areal. r

needed to supput. These servicro

- Couns- Hou- Leg- Asse

upports acy

g)

s- Speci retionar- Ch ly suppo

y - Food- Trans- Finan

n pports

• uct an invibution).

f the curr or

ntify any gaps present .

e refers to an equals the c

l or single

3

measure health se d under the Health Ac h Services, ployment supports a .

• Identify further areas of review for improving or enhancing services, for the clients. • Identify Best practices within the present service delivery system.

nity Services eview, and will be responsible for delivering the final report. During the project, Dave ill report to a Steering Committee comprised of the following:

Chief Administrative Officer – DNSSAB

• ger of Community Housing Services, DNSSAB

e

Providing primary guidance and direction to the Researcher; ng resources necessary to complete the review;

he review process;

• xternal stakeholders. 5. Method5.1 Analyti l t

3. Deliverable A report that produces qualitative & quantitative analysis of the need for ODSP services, and the present system capacity and alignment, within the District. 4. Project Structure, Membership and Roles & Responsibilities

The DNSSAB Researcher, Dave Plumstead, will conduct the CommuRw• Bill White, • Bob Barraclough, Director of Operations and Client Services, DNSSAB

Tom Belanger, Mana Th Steering Committee will guide the project and provide resources and feedback for the Researcher. The duties of the Committee include: Approving the Terms of Reference; ••• Allocati• Providing input, feedback and recommendations throughout t• Liaising as necessary with respective community partners to ensure accurate and

timely data and information gathering; Meeting as necessary to complete the project requ• irements;

• Reviewing the final draft reports with the Researcher; Developing a communication plan for internal and e

ology ca ools used

• Existing D nal research and data. • External information and data: service system stakeholders and partners. • Commu tions, focus-group sessions and roundtable

discussiS

• ic research on District (census, current reports & studies, etc.).

.2 The Process

O SP caseload data and reports; inter

nity /Stakeholder consultaons.

• urveys and interviews. Socio-econom

5

a) Develop project Terms of Reference (TOR) first step is to form a project Steering Committee, and obtain input and approva the Committee, on the TOR (3

The l fromSep

rd, 4th draft). The final TOR should be completed by t. 15 (see Timelines, pg. 5).

b) Formation of the Reference Committee


A Reference Committee will then be formed, comprised of representation from organizations who deliver the services identified above (see “scope” on

embers of these organizations will be contacted and informed of the stu page 1).

dy, and invited participate in the services review process.

ill perform the following roles:

Identify service or resource issues.

as required.

P

Mto

This committee w

• Assist the Researcher in identifying relevant sources of data /information. • Assist the Researcher in the collection of data. •• Review & confirm the information gathered (where required). It is intended that committee representation will be formed from the following organizations: - Algonquin Child and Family Services - Canadian Mental Health Association - Disabled Adult & Youth Centre (DAAY) - DNSSAB: OW Team Coordinator

eople Involvement (LIPI) - Low Income P- Nipissing / Parry Sound Children’s Aid Society - Nipissing / Parry Sound District Health Unit - North Bay Crisis Centre - North Bay and District Association for Community Living - North Bay Community Housing Initiatives - PHARA - The Gathering Place

* ODSP Representatives from the Ministry of Community and Social Services (MCSS) iw ll provide input to the Reference Committee and Researcher,

erform Socio-economic Research on the District of Nipc) issing

This research will be a parallel process being conducted throughout the Needs Analysis. hile this information (or part of it) will be used in the analysis, it will also be required to

b-report that will indicate how the District differs from Ontario.

and summarizing the District’s socio-economic variables such

sed on the

The way in which this research is framed will be determined further into the process. It ial Determinants of Health model, or another, such as social

s

Wstand-alone, i.e., be a su This will involve analyzing as population, employment, income, housing and education. It should also includeMunicipal and DNSSAB funding sources, expenditures and resource gaps (basocioeconomics above).

may be based upon the Socand /or economic investment or societal indicators. d) Conduct Community Consultation

ll include a presentation and workshop

ns Review process that is underway.

Community consultations will be held, which wicomponent. The presentation will report the findi gs of the Nipissing District ODSP Caseload report,

nd will explain the current Community Servicea


The community Partners and Stakeholders attending the consultation will be ento participate fully in the process. The workshop component will be used to gatheinformation for the study, as identified in the scope above (page 1). This includes perceived services needed, service gaps & ar

couraged r key

eas for improvement, and identifying what

tively.3

ittee will be invited to participate, as ations. These sessions will bring together a

rnment Ministries to rass root-level, front-line service providers. This presents an excellent opportunity for

while tive input into the Community Services Review study.

invited to the community consultation in

ogram Services

ipissing Social Services Administration Board (DNSSAB): Ontario Works volvement (LIPI)

he following are organizations that will be invited to the community consultation in

iance District of Nipissing Social Services Administration Board (DNSSAB):

3. Approximately 83% of the ODSP caseload is in North Bay and Sturgeon Falls (69% and 14% respectively).

is currently working well. These public consultations will be held in North Bay and Sturgeon Falls respecOrganizations represented by the Reference Commwill other community groups and associdiverse group of Social Services Stakeholders, ranging from Govegthe District’s Partners and Stakeholders to get together and exchange views, providing collec

eThe following are organizations that will bNorth Bay (this is not an exhaustive list):

- Adult Community Mental Health Pr- Algonquin Child & Family Mental Health- Canadian Mental Health Association - Children’s Aid Society - Children’s Rehabilitation Service - Community Counseling Center - Disabled Adult & Youth Centre (DAAY) - District of N- Low Income People In- Mattawa Food Bank - Ministry of Children and Youth Services (MCYS)

Ministry of Community and Social Services (MCSS) - - Native People of Nipissing Housing - Near North Community Care Access Centre - Nipissing District Housing Registry - Nipissing District Social Services Board (Mattawa) North Bay Community Housing Initiative -

- North Bay Crisis Centre - North Bay and District Association for Community Living - North Bay /Parry Sound District Health Unit - North Bay Psychiatric Hospital /Northeast Mental Health Centre (NEMHC) North Bay Food Bank-

- North Bay Indian Friendship Centre - PHARA - The Gathering Place TSturgeon Falls: - Centre All-


- Family Resource Center - Ministry of Community and Social Services (MCSS) - Near North Community Care Access Centre (Sturgeon Falls) - North Bay and District Association for Community Living (Sturgeon Falls) - Sturgeon Falls Family Resource Centre

West Nipissing Child Care Corporation - - West Nipissing Food Bank - West Nipissing Housing Registry

* Note If the Reference Committee is too small or does not have the desired representation onit (see ‘b’ above), participants from the above consultations will be invited to join thecommittee.

f) Send out Surveys Surveys will be designed by the Researcher, with input from the Steering Committee and

ys will be sent to selected participant

Conduct Interviews & Collect Data

/or Reference Committee members. The surveorganizations (above) as required. g) Interviews will be held with key people such as ODSP Program Manager and Municipal

participants from the public consultations (above), tatistics and information will also be

O

Services Program Manager, selected and others where required. Relevant data, scollected where possible, from the organizations participating in the services review process or others as required. h) rganize Focus Groups Focus groups or roundtable discussions can be effective

rs. Focus group for soliciting information and will be held with clients in order

come of the groups may also be conducted with

etc.)

ction methods will be analyzed, they are

o eer review on the final draft.

. Meetings sis.

r project, much of the work can be exchanged and reviewed il).

feedback from system users or consumeto hear first hand, about their needs and issues. Depending upon the out

ier, focuspublic consultation workshops held earltargeted service providers (ex: housing, transportation, 6. Data Analysis All the information and data from the above colleorganized and compiled. Draft reports will be sent to the Steering Committee aspr duced, with a possible p 7The Steering Committee and Reference Committee will meet on an “as required” ba

or this particulaFelectronically (i.e., ema


8. Resources

Budget:

Direct costs: Travel: $150 Venue rentals: $ 350 Postage: $350 Printing /copying: $750

00 (Stats. Can. CANSIMS, etc.)

s

ort

Data $3

Total: $1900

. Timeline9

Final ODSP Rep Data Analysis Differentiation Summary Data Collection Terms of Reference Project Assimilation Aug. Sept. Oct. Nov. Dec. Jan 2005 2006 10. Project Contact David Plumstead, DNSSAB Researcher Tel: 705-474-2151, ext. 353 Email: [email protected]


iv) ODSP Client Focus Group Guide Questions: Counseling Are you able to obtain the counseling or personal support you need, when you need it?

……….

ports

If not, please explain………

ousing & SupH resent housing arrangements (rent, own, live with family, supportive housing

waiting ist for affordable, accessible, etc. housing? How long?

hat is needed to improve your housing /accommodations?

What are your petc.)?

Are they adequate?

If not adequate: are you on a l

W Assessment & Referral Do you presently have a family Doctor?

r serv s within the community?

nter in is area?

eneral Services /Child & a u p

Are you able to get referrals fo ice

What difficulties do you encou th G F mily S p orts Are you able to access the community services you need?

hat types of child or family supports do you receive? W

Are these adequate? Food Security Are you eating the way you want to, and when you need to?

If not, what can be done to help you?

ransportation

T

an you get around sufficiently to do all the things you need and want to do?

not, in which areas do you encounter difficulty?

an you suggest improvements?

C

If

C


Financial Supports What are your sources of income?

not, what additional /type of financial support do you need?

things you need additional income for?

Can you live sufficiently on your present income?

If

What are the

pecial / Discretionary BenefitsS Do you require any benefits in addition to your income, or..? What are these?

ental needs being met?

think should be added?

Are your medical & d

If you have encountered difficulties in obtaining benefits, what are these?

What benefits do you Legal /Advocacy Do you have any legal needs that are not being met?

what did you need help with?

bility is adequate?

ones?

pen Discussion

(For those that have used services of Legal Aid Clinic):

Do you feel community advocacy for disa

Do you use the services of any “advocacy” organizations? Which O

mment on? Is there anything you would like to add, or co


v) Reference Committee Survey

, etc..?

. Where are each of the above located?

scription of services offered to ODSP clients, for

SP clients that are under-served in any

services to the ODSP clients?

t ODSP system?

0. If yes to the above, what / where are these gaps?

1. Please provide any suggestions on how these gaps can be closed (eliminated).

2. Is there anything your organization does well that may be transferable to other ODSP service providers in the District? Please explain:

3: Please state any other comments you may have, regarding servicing ODSP clients in Nipissing District:

1. Name of Organization 2. How many locations, satellite operations, affiliates 3 4. Please list a complete de

each of the locations above

Do you know of an area that has OD5.way?

6. Do you face any barriers in delivering your 7. If yes to the above, what are these barriers? 8. How do you think these barriers can be removed? . Do you think there are any gaps in the presen9

1 1

1

1


vi) Community Consultation, Community Service Inventory

District of Nipissing – Review of Community Services lients for Ontario Disability Support Program (ODSP) C

d be

e of Organization ___________________________________________________________________

_______________________________________

rations, etc. does your

________________________ 3. Where are each of the above located?

_______________________

________

___________________________________________________________________

__________________________________________________

clients, for each of the locations above:

___________________________________________________________________

___________________________________________________________________

___________________________________________________________________

The following information will help in establishing an ODSP inventory of community services. If you could hand this in to one of the DNSSAB Staff before you leave, it woul

greatly appreciated!

1. Nam

2. How many locations, offices, satellite opeorganization have?

___________________________________________________________________

____________________________________________

___________________________________________________________

4. Please give a complete description of services offered to ODSP

___________________________________________________________________


___________________________________________________________________

___________________________________________________________________

___________________________________________________________________

___________________________________________________________________

___

________________

. Do you know of a geographical area that has ODSP clients that are under-

___________________________

__________________________________________________________________

________

__________________________________________________________________

__________________________________________________________________

_______________________________

________________________________________________________________

_________________

5served in any way?

________________________________________

_

___________________________________________________________

_

_

____________________________________

Thank you


vii) Community Consultation Break-out Sessions

District of Nipissing – Review of Community Services for Ontario Disability Support Program (ODSP) Clients

In Bdiscussions, brainstorming or a technique of your choice! Please have a recorder take notfindings, back to the main group. Thank you! Barriers 1. D 2. If yes to the above, what are these barriers? 3. H Gap4. D 5. I 6. P Best Practices 7. Is there anything your organization does well that may be transferable to other ODSP

service providers in the District? Please explain: General Comments 8. Please state any other comments you may have, regarding servicing ODSP clients in

Nipissing District:

reak-out Groups, please respond to the following questions using roundtable

es on the flipchart provided, and designate a spokesperson to present your group’s

o you face any barriers in delivering your services to the ODSP clients?

ow do you think these barriers can be removed?

s o you think there are any gaps in the present ODSP system?

f yes to the above, what / where are these gaps?

lease provide any suggestions on how these gaps can be closed (eliminated).


archive.dnssab.on.caarchive.dnssab.on.ca/Files/DNSSABCommunityServicesReview_final.pdfPurpose This study was undertaken by the District of Nipissing Social Services Administration

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