Abuse and urgent access to residential resources
1. The Ministry of Community and Social Services should regularly monitor and audit agencies serving adults with developmental disabilities to ensure they are meeting their regulatory responsibilities to report abuse to police.
2. The Ministry of Community and Social Services should engage in education and outreach efforts with agencies serving adults with developmental disabilities concerning their legal obligation to report incidents of abuse to police, and include examples such as Adam’s story to emphasize the importance of early reporting.
3. The Ministry of Community and Social Services should direct Developmental Services Ontario offices, as well as service agencies responsible for placing and/or housing adults with developmental disabilities, that victims of abuse should be placed in safe and secure housing and not returned to the care of their abusers.
4. The Ministry of Community and Social Services should regularly gather statistical information from agencies, as well as police services across Ontario, to identify the number of situations in which adults with developmental disabilities have been the victims of abuse by caregivers.
5. The Ministry of Community and Social Services should make specific resources available to be used in urgent situations to provide safe housing and services where an adult with developmental disabilities is the victim of abuse and requires removal from their home for their protection.
6. The Ministry of Community and Social Services should consult with the Ministry of Community Safety and Correctional Services, as well as police services throughout the province, to promote the establishment of specialty police units able to address situations involving abuse of adults with developmental disabilities.
7. The Ministry of Community and Social Services should regularly collect statistical information about the use of community shelters by adults with developmental disabilities, which can be used for planning for crisis supports and services.
8. The Ministry of Community and Social Services should ensure that there are adequate crisis beds throughout the province to serve the urgent needs of adults with developmental disabilities.
9. The Ministry of Community and Social Services should create an online provincial inventory of crisis beds easily accessible to developmental services and police officials.
10. The Ministry of Community and Social Services should provide direction to service agencies that homeless shelters and similar temporary options are unsuitable for those with developmental disabilities and dual diagnosis.
11. The Ministry of Community and Social Services should develop an urgent response mechanism that is available and accessible province-wide on a 24-hour, seven-day-a-week basis.
12. The Ministry of Community and Social Services should ensure that crisis workers are available to assist adults with developmental disabilities who require urgent assistance to access temporary residential placements.
13. The Ministry of Community and Social Services should develop an expanded reporting system so that service agencies, Developmental Services Ontario offices, police or other officials can identify situations where there is potential for an abuse to develop, if adequate developmental services and supports are not provided on an urgent basis.
14. The Ministry of Community and Social Services should expand the definition of urgent circumstances in the Urgent Response Guidelines to address situations where a risk of abuse has been identified.
Inappropriate hospitalization
15. The Ministry of Community and Social Services should obtain regular information from hospitals across the province concerning emergency visits and admissions of adults with developmental disabilities, including details about hospital stays, their length, and their outcomes, in order to plan for appropriate developmental supports and services.
16. The Ministry of Community and Social Services should send a direct message to Developmental Services Ontario and community service agencies that adults with developmental disabilities should not be left in hospitals where there is no medical need.
17. The Ministry of Community and Social Services should require service agencies, Developmental Services Ontario offices and hospitals to provide regular reports about adults with developmental disabilities who are hospitalized but no longer require hospital care, and maintain an active record of such cases.
18. The Ministry of Community and Social Services and Developmental Services Ontario offices should ensure that individuals identified on its record of alternative level of care hospital patients are prioritized as urgent for community placements.
19. The Ministry of Community and Social Services should report publicly on a regular basis about the work of the various inter-ministerial committees relating to developmental services and the health care system, as well as on the status of initiatives under discussion.
Inappropriate admission to long-term care homes
20. The Ministry of Community and Social Services should take steps to ensure that it is notified when it is proposed that an adult with a developmental disability be placed in a long-term care home.
21. The Ministry of Community and Social Services should actively work with local agencies to ensure that placement of young adults with developmental disabilities in long-term care homes is considered a last resort and that alternative solutions are vigorously pursued.
22. The Ministry of Community and Social Services should engage in ongoing research on how many adults with developmental disabilities are housed within the long-term care system and compile statistics, including age and nature of condition, for use in system planning.
23. The Ministry of Community and Social Services should launch an immediate review of all placements of individuals with developmental disabilities in the long-term care sector, and ensure that any individuals who have been inappropriately placed are appropriately prioritized for transitioning to the developmental services sector.
24. The Ministry of Community and Social Services should review all placements of individuals with developmental disabilities in the long-term care sector on an ongoing basis to ensure that such placements meet individual needs.
25. The Ministry of Community and Social Services should enter into a protocol with the Ministry of Health and Long-Term Care to ensure that it is notified and provided with relevant information about complaints and investigations relating to serious occurrences involving adults with developmental disabilities within the long-term care system.
26. The Ministry of Community and Social Services should educate Developmental Services Ontario officials and other stakeholders about options for placements within the long-term care sector to encourage greater cross-sector collaboration and the potential for placements to be exchanged to accommodate the needs of adults with developmental disabilities.
Criminalization and incarceration
27. The Ministry of Community and Social Services should ensure that there are specialized case management and court support services available for all individuals with developmental disabilities involved with the criminal justice and correctional system.
28. The Ministry of Community and Social Services should create positions or retain service providers to be responsible for co-ordinating an urgent response in cases where adults with developmental disabilities are or are at risk of being charged with criminal offences, arrested and/or incarcerated, including liaising with families and relevant officials and securing supportive resources and services, such as residential placements.
29. The Ministry of Community and Social Services should undertake research and conduct consultation with subject specialists concerning the creation of specialized court diversion programs addressed specifically to the needs of adults with developmental disabilities.
30. The Ministry of Community and Social Services should work with the Ministry of the Attorney General and the Ministry of Community Safety and Correctional Services to support specialized diversion programs for individuals with developmental disabilities who are charged with criminal offences.
31. The Ministry of Community and Social Services should take the lead and work with other ministry partners to develop a responsive and proactive system of residential supports to divert adults with developmental disabilities away from the criminal justice and correctional systems.
32. The Ministry of Community and Social Services should ensure that senior officials take a proactive and robust approach to inter-ministerial initiatives aimed at reducing potential for the criminalization of individuals with developmental disabilities and dual diagnosis.
33. The Ministry of Community and Social Services should publicly post progress updates on initiatives and collaborative efforts relating to diverting adults with developmental disabilities from – and protecting them within – the justice system.
34. The Ministry of Community and Social Services should engage in targeted outreach and education of officials in the justice and correctional systems to improve understanding of the nature of developmental disabilities and the developmental services system, and to encourage implementation of best practices for responding to individuals with developmental disabilities, based on the advice of subject experts.
35. The Ministry of Community and Social Services should work with the Ministry of Children and Youth Services to ensure that it provides detailed case information about youths with developmental disabilities and dual diagnosis transitioning to the adult system, who have been involved with the youth justice system.
36. The Ministry of Community and Social Services should gather statistical information on the number of adults with developmental disabilities who enter the criminal justice and correctional systems, to help with planning to ensure there are adequate resources including supervised residential placements within the community as an alternative to incarceration.
37. The Ministry of Community and Social Services should consult with service providers, community groups and other relevant ministries – such as the Ministries of the Attorney General, Children and Youth Services, Community Safety and Correctional Services, Education, and Health and Long-Term Care – with a view to developing a co-ordinated system for gathering statistical and qualitative information to identify the number of individuals and types of situations that may require exceptional supports to minimize the risk of individuals who require developmental services defaulting to the criminal justice system.
38. The Ministry of Community and Social Services should work with the Ministries of the Attorney General and Community Safety and Correctional Services to develop an effective process for sharing information and facilitating resolutions of cases involving adults with developmental disabilities within the criminal justice and correctional systems.
39. The Ministry of Community and Social Services should work with other relevant ministries on a process for identifying and providing preventative supports for individuals at risk of becoming involved in the criminal justice system.
40. The Ministry of Community and Social Services should consult relevant stakeholders with a view to encouraging Developmental Services Ontario offices, service agencies and police services to work together to develop a provincewide vulnerable person registry to assist police and justice officials in responding to crisis involving adults with developmental disabilities.
41. The Ministry of Community and Social Services should continue to support the development, based on best practices, of guidelines and protocols for responding to physical aggression by adults with developmental disabilities, balancing the need to protect clients and staff with the goal of avoiding criminalization of those with developmental disabilities.
42. The Ministry of Community and Social Services should engage in consultation and outreach with justice officials, including police services, correctional officials, Crown prosecutors and the judiciary, relating to best practices for addressing the needs of individuals with challenging behaviours.
Medically complex cases
43. The Ministry of Community and Social Services should engage the Ministry of Health and Long-Term Care in the multi-ministry planning process in medically complex cases to ensure appropriate specialized medical and community resources are available as they transition into the adult system.
44. The Ministry of Community and Social Services should ensure that Developmental Services Ontario offices actively pursue opportunities for sharing of resources across geographical boundaries to ensure that the urgent needs of individuals in underserviced areas are adequately met.
Abandonment and homelessness
45. The Ministry of Community and Social Services should analyze cases of abandonment to identify root causes and develop ameliorative measures to reduce the risk of abandonment in future.
46. The Ministry of Community and Social Services should add a requirement to its occurrence reporting system so that cases in which there is a substantial risk of abandonment or homelessness are reported to the Ministry and appropriately addressed.
47. The Ministry of Community and Social Services should ensure that sufficient resources are available to address situations or significant risks of abandonment or homelessness.
48. The Ministry of Community and Social Services should provide clear direction to its regional offices and Developmental Services Ontario officials about co-ordinating services to meet the needs of clients who reside in and/or receive services from more than one jurisdiction.
49. The Ministry of Community and Social Services should work closely with the Ministry of Children and Youth Services, Ministry of Education, Ministry of Health and Long-Term Care, Developmental Services Ontario offices and service agencies to track individual cases and crisis events in the developmental services sector.
50. The Ministry of Community and Social Services should engage subject experts to advise on the likelihood and rate of life crises in the developmental services sector and use these projections in system planning.
51. The Ministry of Community and Social Services should direct Developmental Services Ontario, service co-ordination offices and agencies providing developmental services to adopt record-keeping practices requiring that contacts with families, the Ministry and other agencies be properly documented.
Vacancy management
52. The Ministry of Community and Social Services should provide direction to Developmental Services Ontario offices to ensure that individuals are matched to vacancies only where there is a realistic prospect of an appropriate fit.
53. The Ministry of Community and Social Services should ensure that service agencies provide detailed explanations for rejecting applicants for residential vacancies who are in crisis situations and/or have complex needs.
54. The Ministry of Community and Social Services should conduct research and consultation aimed at developing an inventory of residential placements for adults with developmental disabilities whose extreme behavioural or medical needs are not currently adequately accommodated.
55. The Ministry of Community and Social Services should ensure that there are consistent time requirements for notifying Developmental Services Ontario offices of residential vacancies.
56. The Ministry of Community and Social Services should review regional practices for using unfilled permanent residential vacancies with a view to encouraging temporary use of such vacancies for urgent cases.
Information and case management resources
57. The Ministry of Community and Social Services should take steps to ensure that adults with developmental disabilities have access to case management services throughout Ontario.
58. The Ministry of Community and Social Services should consult relevant ministries and stakeholder groups with a view to developing an online resource to help caregivers connect and share their knowledge and experiences.
59. The Ministry of Community and Social Services should formally recognize that it has an important role to play in facilitating the resolution of individual crisis cases.
Progress reporting
60. The Ministry of Community and Social Services should report back to my Office in six months’ time on the progress in implementing my recommendations, and at six-month intervals thereafter until such time as I am satisfied that adequate steps have been taken to address them.
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