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IL Guest Blog: Deinstitutionalizing Ontario

Chrystal Jansz Rieken, M.A., BCBA
Clinical Services Supervisor
Burkhart Center for Autism Research and Education

August 15, 2014

In 2010 the Chairman of the National Association for the Dually Diagnosed United States Policy Committee reported that in the United States there was a “significant slowing of the trend of movement of people out of state facilities.” In fact, the Chairman reported that although 2,637 individuals were discharged from facilities since 2007, an additional 2,128 were admitted to such a facility. Policy and practice are moving towards community living and equality for people with disabilities. However, we still do not see a reverse from the reliance on institutional settings as a response to meeting the needs of individuals who present challenges to community placement.

This does not mean such transitions aren't happening elsewhere. For example, in Ontario, Canada the deinstitutionalization process, known as the Facility Initiative led by the Ontario Provincial Government, saw the return of over 7,000 people to the community and closure of sixteen facilities by its completion in 2009.

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The Facility Initiative would not have been successful without considerable financial dedication from various related governmental agencies. In the end, the Government of Ontario committed $276 million to strengthen community supports, with $70 million dedicated to creating new residential options for people leaving the facilities. This is a considerable amount of funding, but it is cheaper in the long run. Multiple sources¹ report the societal cost of keeping facilities open and supporting a person throughout their lifetime involve much higher investment and societal financial burden than funding deinstitutionalization. Not only does the closure of facilities and relocation of individuals to community placements reduce the societal cost, it also places people where they deserve to live: in their communities.

The Provincial Government of Ontario commissioned a series of studies to monitor and evaluate the Facility Initiative process. They showed that:

• individuals with varying levels of medical and behavioral needs were successfully transitioned into the community
• many residents moved back to communities where their families lived, even though their facilities were in distant and rural communities.

The Facility Initiative process was guided by the Person-Centered Planning (PCP) approach. This differs from traditional transition or service planning approaches, which try to relocate the person into an existing group home where they will most likely ‘fit.’ Rather, PCP refers specifically to planning that focuses on the goals and wishes of the individual. Planning, as well as the written transition plan, does not follow a one-size-fits-all format, with a professional controlling the direction of the plan. Rather, PCP emphasizes the principles of self-advocacy and attention to strengths and capabilities, not deficits. In PCP there is no professional authority or deficit orientation in the planning process. Instead, a professional facilitator guides meetings, maintains records, co-ordinates services and helps shape the plan to meet the needs and goals of the individual. This includes identifying where services need to be created, not making the person’s goals fit within the existing system.

¹  See John Davidson's A Time for Reform: Close and Consolidate Texas’ State Supported Living Centers (Aug. 2014) pp. 3 - 4 and the National Council on Disabilities' Deinstitutionalization Toolkit: Costs, in Detail (2012).

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Learn more about Ontario's deinstitutionalization process.

Stay tuned next week for Jansz Rieken's follow up piece on one of the individuals who transitioned into the community during the Facility Initiative.

About Chrystal

Chrystal is the Clinical Services Supervisor at the Burkhart Center for Autism Education and Research at Texas Tech University. She holds a Masters Degree in Applied Disability Studies with a specialization in Applied Behaviour Analysis, is a Board Certified Behaviour Analyst, and is currently a doctoral candidate at the Burkhart Center in her last semester of studies. Since joining the Burkhart Center in 2011, she has lead the development of outpatient services including the Behaviour Support Clinic and Intensive Behavioural Intervention clinic. Chrystal has research and clinical experience within institutional settings as well as evaluating the process of their closure. Her other areas of research and practice include training teachers and therapists in behavior analysis, program evaluation, early intervention, behaviour assessments, and the use of psychotropic medication in ASD.