CCAC School Services*

* 9.1 Overview of Community Care Access Centre (CCAC) school services are provided to children/youths in publicly funded and private schools and to children/youths who are being home schooled to assist them in pursuing their education. The student must require the services in order to be able to attend school, participate in school routines and receive instruction, including receiving satisfactory instruction at home. In other words, in the absence of school services, the child s/youth s school attendance, instruction or participation would be significantly disrupted. CCAC school services include professional school services and personal support school services. Professional school services are provided to children/youths in publicly funded and private schools and to children/youths who are being home schooled. CCAC personal support school services are only provided to children/youths in private schools and to children/youths who are being home schooled 9.1.1 Children/Youths in Publicly Funded Schools Children/youths enrolled in publicly funded schools have access to a range of professional school services: nursing, physiotherapy, occupational therapy, speech-language pathology and dietetics. These services are provided through CCAC contracted service providers and include the training of school personnel and provision of necessary medical supplies, dressings and treatment equipment. The CCAC provides access to these professional school services for children/youths with medical and/or rehabilitation needs to enable them to attend school, participate in school routines and receive instruction. Personal support school services are not provided by the CCAC to students in publicly funded schools. School boards are responsible for accommodating the needs of public school students for assistance with routine personal activities of living. Social work services are not provided through the CCAC in publicly funded school settings. Public school resources deal with psycho-social needs of students that need to be addressed while attending public school. September 2006 1

CCAC professional school services are provided in publicly funded schools by the Ministry of Health and Long-Term Care (MOHLTC), the Ministry of Education and Training (EDU), and the Ministry of Community and Social Services (MCSS), pursuant to the following: 1. Policy/Program Memorandum No. 81 (PPM81), July 19, 1984, available at: [http://www.edu.gov.on.ca/extra/eng/ppm/81.html]. This policy memorandum sets out the responsibility of the MOHLTC for funding the provision of health services for children/youths with special needs who would have difficulty attending school, if at all, were they not to receive these services. The policy also addresses joint responsibilities of the MOHLTC and school boards for medications, lifting, positioning, general maintenance exercises, feeding and toileting. 2. Memorandum regarding Catheterization and Suctioning, August 14, 1989; Clarification of Policy/Program Memorandum No. 81. This memorandum was issued in response to questions raised about PPM81, in order to clarify the responsibilities for different types of catheterization and suctioning, as follows: Clean catheterization and shallow surface suctioning are recognized as part of a child s normal toileting and oral hygiene needs and can be administered by the child or school board staff. Training and direction for these procedures may be provided by the parent or the CCAC. Sterile intermittent catheterization and deep suctioning are administered by a health professional provided by the CCAC. 3. Interministerial Guidelines for the Provision of Speech and Language Services 1988 (MCYS, EDU, MOHLTC), available at: [http://www.edu.gov.on.ca/extra/eng/ppm/81.html]. This memorandum clarifies the shared responsibilities of CCACs and school boards relating to the provision of speech therapy, as follows: The school board is responsible for the initial assessment to determine if the primary concern is speech production or a language disorder. The CCAC is responsible for children/youths who have problems because speech production is difficult. The Interministerial Guidelines for the Provision of Speech and Language Services were developed in 1985 and revised in 1988 to provide direction to public schools and home care programs 1 about their responsibilities in the provision of speech and language services. This 1988 version also supercedes references to speech and speech pathology/therapy in PPM81. 1 Precursors to the CCAC. September 2006 2

Medical disorders that the CCAC manages fall primarily under the following diagnostic areas: articulation/speech sound production problems caused by motor speech disorders including dyspraxias and dysarthrias; non-speech communication (assessment for and prescription of and orientation to augmentative and alternative methods of communication); fluency disorders such as stuttering; voice disorders (e.g., hoarseness and/or nasal speech due to vocal nodules and cleft lip palate); and swallowing disorders. CCACs do not provide speech therapy for children/youths who primarily have a language disorder. School boards are responsible for providing these services to children/youths who have a language disorder (i.e., do not have the ability to translate thoughts into verbal expression and to understand others, and do not have reading and spelling skills that are prerequisite for acquiring literacy skills). CCACs must provide professional school services in accordance with PPM81 and all other relevant memoranda and guidelines. CCACs must not assume any of the responsibilities of school boards as outlined in PPM81 and all other relevant memoranda and guidelines. 9.1.2 Children/Youths in Private Schools and Home Schooling Situations Children/youths enrolled in private schools or receiving instruction at home have access to a range of professional school services and personal support school services: nursing, physiotherapy, occupational therapy, speech-language pathology, dietetics, and personal support services such as personal hygiene activities and routine activities of living. These school services can be purchased directly 2 or accessed through CCAC contracted service providers. Social work services are not provided through the CCAC in private schools and home schooling situations. The CCAC provides access to these professional school services and personal support school services to children/youths with medical and/or rehabilitation needs to enable them to attend school, participate in school routines and receive satisfactory instruction at home. In other 2 Purchased services means that the CCAC provides funding directly to a transfer payment agency. The agency in turn provides funding to the private school or the parent/guardian in home schooling situations, who is then responsible for locating and hiring the service provider. September 2006 3

words, in the absence of school services, the child s/youth s school attendance, instruction or participation would be significantly disrupted. CCACs are required to provide the initial assessment for speech-language pathology for children/youths in private schools or receiving home schooling. The CCAC funds private schools and parents/guardians providing home schooling (through an agency) for the treatment of speech disorders primarily in the diagnostic areas listed above in subsection #9.1.1, point 3 in this manual. September 2006 4

9.2 Eligibility for Community Care Access Centre (CCAC) school services are governed by the Long-Term Care Act, 1994 (LTCA). The regulations under the LTCA refer to the terms school and private school as they are defined under the Education Act (EA). The following are the definitions of these terms under the EA: s. 1(1) school means, (a) the body of elementary school pupils or secondary school pupils that is organized as a unit for educational purposes under the jurisdiction of the appropriate board, or (b) the body of pupils enrolled in any of the elementary or secondary school courses of study in an educational institution operated by the Government of Ontario, and includes the teachers and other staff members associated with the unit or institution and the lands and premises used in connection with the unit or institution; private school means an institution at which instruction is provided at any time between the hours of 9 a.m. and 4 p.m. on any school day for five or more pupils who are of or over compulsory school age in any of the subjects of the elementary or secondary school courses of study and that is not a school as defined in this section; In addition, the regulations under the LTCA refer to subsection 21(1)(a) of the EA relating to home schooling. Subsection 21(1)(a) of the EA states: s. 2(2) A child is excused from attendance at school if, (a) the child is receiving satisfactory instruction at home or elsewhere; 9.2.1 Eligibility for Professional School Services Section 5 of regulation 386/99 of the LTCA states: s. 5(1) school means a school as defined in subsection 1 (1) of the Education Act and includes a private school as defined in subsection 1 (1) of that Act. school services means the following professional services that are provided to a person who is enrolled as a pupil at a school on the school premises or while the pupil is being transported to or from the school on a school bus or other school vehicle or participating in a school trip or activity outside the school premises or that are provided to a person who is receiving satisfactory instruction at home in accordance with clause 21 (2) (a) of the Education Act and are necessary in order for the person to be able to receive instruction: September 2006 5

1. Nursing services. 2. Occupational therapy services. 3. Physiotherapy services. 4. Speech-language pathology services. 5. Dietetics services. 6. Training of school personnel to provide the services referred to in paragraphs 1 to 5 to persons enrolled as a pupil at the school. 7. The provision of medical supplies, dressings and treatment equipment necessary to the provision of the services referred to in paragraphs 1 to 5. Clarification: Professional school services are defined in regulation 386/99 of the LTCA as nursing services, occupational therapy services, physiotherapy services, speech-language services and dietetics services. These services include the training of school personnel and provision of necessary medical supplies, dressings and treatment equipment. s. 5(2) A community care access centre shall not provide school services to a person unless the person meets the following eligibility criteria: Clarification: A CCAC does not have the authority to provide professional school services to a person unless the person meets the following eligibility criteria: s. 5(2)1. The person must be enrolled as a pupil at a school or be receiving satisfactory instruction at home in accordance with clause 21 (2) (a) of the Education Act. Clarification: A child/youth up to the age of 21 must be either enrolled in a publicly funded school or private school or receiving satisfactory instruction at home in order to be eligible for these professional school services. More information is available on the Ministry of Education and Training (EDU) website at: [http://www.edu.gov.on.ca/eng/funding/]. s. 5(2)2 The person must require the services, i. in order to be able to attend school, participate in school routines and receive instruction, or ii. in order to be able to receive satisfactory instruction at home in accordance with clause 21 (2) (a) of the Education Act. Clarifications: The CCAC may provide professional school services at the school or while the pupil is being transported to or from publicly funded school or private school or participating in publicly funded school or private school related activities (see subsection #9.5 in this manual for additional information) in other locations 3. The professional school services 3 For example, early screening may be done in a clinic setting. September 2006 6

must be necessary in order for the child/youth to be able to attend publicly funded school or private school, participate in publicly funded school or private school routines and receive instruction. In other words, in the absence of professional school services, the child s/youth s publicly funded school or private school attendance, instruction or participation would be significantly disrupted. The CCAC must not assume responsibility for determining what constitutes satisfactory instruction at home. In order for a child/youth who is receiving home schooling to be eligible for professional school services, the parent/guardian must provide the CCAC with a letter from the relevant school board indicating that the child/youth is excused from attendance at school because he or she is receiving satisfactory instruction at home. Policy/Program Memorandum No. 131 (PPM131), dated June 17, 2002, addresses the services offered by the MOHTLC and sets out the process a parent/guardian should follow in order to obtain the appropriate documentation, including a sample letter. PPM131 and the sample letter are available on the EDU website at: [http://www.edu.gov.on.ca/extra/eng/ppm/131.html]. s. 5(2)3 The person must be an insured person under the Health Insurance Act. (See chapter #3 in this manual for Ontario Health Insurance Program (OHIP) eligibility criteria.) s. 5(2)4 The school or home in which the service is to be provided must have the physical features necessary to enable the service to be provided. Clarifications: The setting in which the professional school services are to be provided must be conducive to providing the service such as having enough space to allow the use of necessary equipment and supplies, and privacy to allow appropriate treatment to be given. The CCAC must use their best efforts to adapt their service provision to the available surroundings. However, when such adaptations cannot be made, the CCAC must discuss alternative courses of action with the child/youth/parent/guardian and/or publicly funded or private school in order to avoid declaring a child/youth ineligible for professional school services on this basis. s. 5(2)5 The risk that a service provider who provides the school service to the person who requires the service will suffer serious physical harm while providing the service, i. must not be significant, or ii. if it is significant, the service provider must be able to take reasonable steps to reduce the risk so that it is no longer significant. September 2006 7

Clarification: The CCAC must use their best efforts to mitigate any risk to the point where it is no longer a serious risk to the contracted service provider in order to avoid declaring a child/youth ineligible for professional school services on this basis. 9.2.2 Eligibility for Personal Support School Services Section 7 of regulation 386/99 of the LTCA states: s. 7(1) school means a private school as defined in subsection 1 (1) of the Education Act; s. 7(1) personal support school services means the following personal support services that are provided to a person who is enrolled as a pupil at a school on the school premises or during a school trip or activity outside the school premises or that are provided to a person who is receiving satisfactory instruction at home in accordance with clause 21 (2) (a) of the Education Act and are necessary in order for the person to be able to receive instruction: 1. Personal hygiene activities. 2. Routine personal activities of living. 3. Training of school personnel to provide the services referred to in paragraphs 1 and 2 to persons enrolled as pupils at the school and assisting the personnel in providing them. 4. The provision of medical and personal equipment necessary to the provision of the services referred to in paragraphs 1 and 2. Clarification: Personal support school services are defined in regulation 386/99 as personal hygiene activities and routine personal activities of living. These services include the training of school personnel and provision of treatment equipment necessary to the provision of the services. Personal hygiene activities and routine personal activities of living in the context of private and home schools include assistance with eating, dressing and toileting (including clean catheterization), personal hygiene (including shallow suctioning), mobility, transferring, positioning, and routine exercises taught by a therapist (physiotherapist, occupational therapist, speech-language pathologist). 4 s. 7(2) A community care access centre shall not provide personal support school services to a person unless the person meets the following eligibility criteria: Clarification: A CCAC does not have the authority to provide personal support school services to a person unless the person meets the following eligibility criteria: s. 7(2)1 The person must be enrolled as a pupil at a school or be receiving satisfactory instruction at home in accordance with clause 21 (2) (a) of the Education Act. 4 MOHLTC Memorandum regarding Personal Support Services and Equipment in Private and Home Schools, January 8, 2001. September 2006 8

Clarification: A child/youth up to the age of 21 must be either enrolled in a private school or receiving satisfactory instruction at home in order to be eligible for these personal support school services. More information is available on the EDU website at: [http://www.edu.gov.on.ca/eng/funding/]. s. 7(2)2 The person must require the services, i. in order to be able to attend school, participate in school routines and receive instruction, or ii. in order to be able to receive satisfactory instruction at home in accordance with clause 21 (2) (a) of the Education Act. Clarifications: The CCAC may provide personal support school services at the private school or while the pupil is being transported to or from private school or participating in private school related activities (see subsection #9.5 in this manual for additional information) in other locations 5. The personal support school services must be necessary in order for the child/youth to be able to attend private school, participate in private school routines and receive instruction. In other words, in the absence of personal support school services, the child s/youth s private school attendance, instruction or participation would be significantly disrupted. The CCAC must not assume responsibility for determining what constitutes satisfactory instruction at home. In order for a child/youth who is receiving home schooling to be eligible for personal support school services, the parent/guardian must provide the CCAC with a letter from the relevant school board indicating that the child/youth is excused from attendance at school because he or she is receiving satisfactory instruction at home. Policy/Program Memorandum No. 131 (PPM131), dated June 17, 2002, addresses the services offered by the MOHTLC and sets out the process a parent/guardian should follow in order to obtain the appropriate documentation, including a sample letter. PPM131 and the sample letter are available on the EDU website at: [http://www.edu.gov.on.ca/extra/eng/ppm/131.html]. s. 7(2)3 The person must be an insured person under the Health Insurance Act. (See chapter #3 in this manual for Ontario Health Insurance Program (OHIP) eligibility criteria.) s. 7(2)4 The school or home in which the service is to be provided must have the physical features necessary to enable the service to be provided. 5 For example, early screening may be done in a clinic setting. September 2006 9

Clarifications: The setting in which the personal support school services are to be provided must be conducive to providing the service such as having enough space to allow the use of necessary equipment and supplies, and privacy to allow appropriate treatment to be given. The CCAC must use their best efforts to adapt their service provision to the available surroundings. However, when such adaptations cannot be made, the CCAC must discuss alternative courses of action with the child/youth/parent/guardian and/or private school in order to avoid declaring a child/youth ineligible for personal support school services on this basis. s. 7(2)5 The risk that a service provider who provides the service to the person who requires it will suffer serious physical harm while providing the service, i. must not be significant, or ii. if it is significant, the service provider must be able to take reasonable steps to reduce the risk so that it is no longer significant. Clarification: The CCAC must use their best efforts to mitigate any risk to the point where it is no longer a serious risk to the contracted service provider in order to avoid declaring a child/youth ineligible for personal support school services on this basis. 9.2.3 Overview of Services Offered by CCAC Publicly Funded Schools Private Schools Home Schooling Situations Nursing, physiotherapy, occupational therapy, specified speech-language pathology after school board provides initial assessment, dietetics Nursing, physiotherapy, occupational therapy, specified speech-language pathology (including initial assessment), dietetics Personal support services Nursing, physiotherapy, occupational therapy, specified speech-language pathology (including initial assessment), dietetics Personal support services Training of school personnel Training of school personnel Training of parent/guardian The provision of medical supplies, dressings and treatment equipment relating to professional school services The provision of medical supplies, dressings and treatment equipment relating to professional school services as well as the provision of medical and personal The provision of medical supplies, dressings and treatment equipment relating to professional school services as well as the provision of medical September 2006 10

Publicly Funded Schools Private Schools Home Schooling Situations equipment relating to personal support school services and personal equipment relating to personal support school services September 2006 11

9.3 Service Maximums Service maximums for CCAC school services are regulated under the Long-Term Care Act, 1994 (LTCA). 9.3.1 Private and Publicly Funded Schools No Service Maximums There are no service maximums for Community Care Access Centre (CCAC) school services provided in public and private schools. However, subsection 4(3) of regulation 386/99 of the LTCA states: s. 4(3) In determining the maximum amount of nursing services that may be provided to a person under this section, a community care access centre shall not include any nursing services that are provided as school services under sections 5 and 6. Clarification: Subsection 4(3) of regulation 386/99 provides that the CCAC must not include the hours of nursing services provided to a child/youth in a publicly funded school, private school or in a home schooling situation through CCAC school services when determining the maximum amount of nursing services that can be provided to a child/youth as part of in-home nursing services. Children/youths who receive CCAC school services may also receive professional services at home. 9.3.2 Home Schooling Situations Service Maximums There are service maximums for children/youths receiving professional school services and personal support school services while being home schooled. regulation 386/99 of the LTCA states: s. 6 A community care access centre that provides school services to a person who is receiving satisfactory instruction at home in accordance with clause 21 (2) (a) of the Education Act shall not provide more than six hours of school services a day to that person, five days a week. s. 7(3) A community care access centre that provides personal support school services under this section to a person who is receiving satisfactory instruction at home in accordance with clause 21 (2) (a) of the Education Act shall not provide more than six hours of those services a day to that person, five days a week. Clarification: The CCAC must not provide more than six hours of professional school services or personal support school services a day, five days a week to a child/youth who receives home schooling. However, regulation 386/99 of the LTCA states: September 2006 12

s. 3(4) In determining the maximum amount of personal support services that may be provided to a person under this section, a community care access centre shall not include any personal support school services provided under section 7. Clarification: Subsection 3(4) of regulation 386/99 provides that the CCAC must not include the hours of personal support school services provided to a child/youth in a private school or in a home schooling situation through CCAC school services when determining the maximum amount of personal support services that can be provided to a child/youth as part of in-home personal support services. September 2006 13

9.4 Equipment Relating to School Services 9.4.1 Medical Supplies, Dressings and Treatment Equipment Relating to Professional School Services Professional school services include the provision of medical supplies, dressings and treatment equipment necessary to the provision of nursing services, occupational therapy services, physiotherapy services, speech-language pathology services, and dietetics services to eligible children/youths. Subsection 5(1)7 of regulation 386/99 of the Long-Term Care Act, 1994 (LTCA) states that school services include the provision of medical supplies, dressings and treatment equipment necessary to the provision of the services referred to in paragraphs 1 to 5. The eligibility criteria and case management functions set out in subsection #9.2.1 in this manual apply to these medical supplies, dressings and treatment equipment. Clarification: The child/youth or his or her parent/guardian is responsible for the provision and transportation of any specialized long-term treatment equipment required for the child/youth to participate in school which is not related to the provision of school services, for example, a wheelchair. 6 The Community Care Access Centre (CCAC) case manager may authorize the provision of treatment equipment to an eligible child/youth through the CCAC school services when one of the following conditions applies: the treatment equipment is required for a trial period prior to purchase and requires monitoring and evaluation by an Assistive Devices Program (ADP) authorizing professional; the treatment equipment is not available through ADP and is essential to support the child s/youth s medical treatment/rehabilitation needs (as opposed to education related needs, such as a communication device or customized desk, which is the responsibility of the school board); or the child/youth has a short-term need for the treatment equipment. Note: The CCAC does not provide Ontario Drug Benefits (ODBs) to children who are only receiving school services. Treatment Equipment Selection To facilitate the provision of treatment equipment, the CCAC case manager must: 6 A child/youth may be eligible to receive assistance to obtain equipment for long-term use from the Ministry of Health and Long-Term Care (MOHLTC) as per Assistive Devices Program (ADP) requirements. September 2006 14

assess a child s/youth s need for equipment or request a therapist to do the assessment for this equipment; select the most cost effective equipment; authorize the price of equipment which may include applicable taxes and delivery charges or monthly rental charges; and reassess the child/youth if different equipment is subsequently required. Purchase, Maintenance and Disposal of Treatment Equipment The purchase, disposal and maintenance of treatment equipment are the responsibility of the school or the home schooling parent. When the child/youth no longer requires the treatment equipment, it is the responsibility of the school or parent to determine the best use of the equipment (e.g., donate to charity). 9.4.2 Medical and Personal Equipment Relating to Personal Support School Services Personal support school services include the provision of medical and personal equipment necessary to the provision of routine hygiene activities and routine personal activities of daily living. Subsection 7(1)4 of regulation 386/99 of the LTCA states that personal support school services include the provision of medical and personal equipment necessary to the provision of the services referred to in paragraphs 1 and 2. The eligibility criteria and case management functions set out in subsections #9.2.1 and #9.2.2 in this manual, respectively apply to these medical supplies, dressings and treatment equipment. The medical and personal equipment required must be necessary to the provision of personal support school services. Examples include standers, grab bars, lifts, adaptive seating equipment (e.g., wedges, wrist weights and weighted vests), commode chairs, change tables, suction machines, adaptive feeding equipment, lifts and wheelchair tables. The CCAC case manager must authorize the purchase of the following medical and personal equipment: equipment that is covered by the Ministry of Health and Long-Term Care (MOHLTC) ADP required for the home and the school setting and problematic to transport, (e.g., suction machine) 7 ; and 7 In this case, a second piece of equipment may be necessary. The second piece of equipment does not have to be identical to the original piece but must be functionally appropriate for the purpose for which it is required, e.g., more conducive to travel or accommodated to functioning in a smaller space. September 2006 15

equipment that is not covered by the ADP but is needed to support the provision of personal support school services as determined by a professional assessment (e.g., transfer boards). Medical and Personal Equipment Not Provided The CCAC does not provide the following medical and personal equipment: educational equipment that allows the child/youth to access the curriculum (e.g., frequency modulation (FM) systems for children/youths who are hard of hearing, Braille printers and custom designed desks); and equipment associated with modifying the school or home infrastructure. This may include, elevators, stair glides, special toilets, handrails for stairs, ramps, locked medication cupboard and cardio-pulmonary equipment. Medical and Personal Equipment Selection To facilitate the provision of medical and personal equipment, the case manager must: assess a child s need for equipment or request a therapist to do the assessment for equipment; select the most cost effective equipment; authorize the price of equipment which may include applicable taxes and delivery charges or monthly rental charges; and reassess the child/youth if different equipment is subsequently required. Purchase, Disposal and Maintenance of Medical and Personal Equipment The purchase, disposal and maintenance of medical and personal equipment are the responsibility of the school or the home schooling parent/guardian. When the child/youth no longer requires the equipment, it is the responsibility of the school or parent/guardian to determine the best use of the equipment (e.g., donate to charity). September 2006 16

9.5 Transportation Relating to School Services It is the not the responsibility of the Community Care Access Centre (CCAC) to transport children/youths to publicly funded or private school. The CCAC provides school services to eligible children/youths while they are being transported to or from school on a school bus or other school vehicle or are participating in a school trip or activity outside the school premises. The CCAC may only provide school services when the child/youth being transported: is at risk of significant physical injury during transportation; and the skills of a nursing professional are required within scope of practice. A child/youth who is home schooled is also eligible for nursing services while being transported in a private vehicle to attend an organized activity directly related to the education of the child/youth as long as the child/youth meets the above criteria. The CCAC does not provide school services in relation to casual activities that are not related to the child s/youth s education. September 2006 17

9.6 Case Management Function Relating to the Provision of The Community Care Access Centre (CCAC) case manager must assess the child s/youth s requirements, determine eligibility for school services and for each eligible child/youth, develop and authorize a plan of service that sets out the amount of service to be provided in accordance with the Long-Term Care Act, 1994 (LTCA). When required by the school board, the CCAC is responsible to ensure that case managers have police clearance/criminal checks in order to be able to access schools/school property. The CCAC case manager must manage the plan of service between the child/youth, the parent/guardian, the school and the contracted service provider as well as: interpret CCAC school service policies and guidelines; collaborate in planning for the integration of school services to complement existing school programs; make recommendations about specific supplies and dressings and facilitate access to certain specialized equipment to meet the program goals; track units of service for these services, as required by the Management Information System (MIS); and facilitate harmonious relationships among the parties. The CCAC case manager must review the child s/youth s requirements when appropriate. Depending on the child s condition and circumstances, the review can be in consultation with the contracted service provider, parent/guardian and school personnel as appropriate. It is recommended that the CCAC conduct a review at least once a year. During the course of the review, the CCAC must evaluate the child s/youth s plan of service (outcomes, goals and timeframes) and revise the plan of service as necessary when the child s/youth s requirements change. 9.6.1 Specific Processes Relating to Provision of CCAC Professional School Services to Children/Youths Enrolled in Publicly Funded Schools For a child/youth enrolled in a publicly funded school, the child s/youth s parent and/or an outside health care professional, if one is involved, should first discuss any need for professional school services with the principal of the school. If it is agreed that CCAC professional school services would be appropriate in the situation, the parties should designate one person to contact the CCAC. September 2006 18

The CCAC case manager must contact the school for an appointment to see and assess the child, with the parent s consent. The CCAC must then assess the child s/youth s needs, determine whether the child/youth is eligible for professional school services and if so, develop and authorize a plan of service. The CCAC provides the professional school services to children/youths in publicly funded schools through their service providers. 9.6.2 Specific Processes Relating to the Provision of CCAC Professional School Services and Personal Support School Services to Children/Youths Enrolled in Private Schools For a child/youth enrolled in a private school, the parent/guardian should first discuss with the principal of the school: the need for professional school services or personal support school services; and the request for a referral. If it is agreed that CCAC professional school services or personal support school services would be appropriate in the situation, the principal or parent should then contact the CCAC. The principal must provide express permission to the CCAC to provide service on school property. The CCAC case manager must contact the school for an appointment to see and assess the child, with the parent s consent. The CCAC must then assess the child s/youth s needs, determine whether the child/youth is eligible for either professional school services or personal support school services, or both, and if so, develop and authorize a plan of service. The private school may: receive funding directly from the CCAC and hire the service provider itself; or request in writing that the CCAC arrange the professional school services or personal support school services on the school s behalf. The CCAC then refers the matter to the appropriate contracted service provider. Where the private school receives funding directly from the CCAC, the following responsibilities arise: The CCAC case manager must: enter into a memorandum of understanding with the principal/chief administrator of the private school; receive quarterly reports from the private schools and include this information in the quarterly reports submitted to the Ministry of Health and Long-Term Care (MOHLTC); September 2006 19

ensure the private school s quarterly reports identify all expenditures related to the provision of professional school services and personal support school services (Private schools may charge the CCAC up to 3% as an administration fee.); receive annual reconciliation reports from the private schools and provide this information in the annual reconciliation reports (ARRs) submitted to the MOHLTC (When the amount of funding is limited, the CCAC may use its discretion regarding the requirement for an ARR. In these cases, the submission of invoices with the quarterly report may be a less expensive and a more reasonable accountability mechanism.); and monitor and be satisfied based on the claims and reports submitted by the CCAC that the private school has spent the funding provided by the CCAC for approved services, including the purchase of services and equipment in accordance with the plans of service for the children/youths enrolled in the private school. The private school must: enter into a memorandum of understanding with the CCAC; use the funding provided by CCAC only for approved services, including the purchase of services and equipment in accordance with the plans of service for the children/youths enrolled in the private school; assume all liability related to the provision of services; hire service providers (When the private school hires staff to provide the approved services, the private school must use a standard job description and have policies for screening and supervision of staff. Any staff hired must comply with the requirements set in the Regulated Health Professions Act, 1991 (RHPA).); provide a quarterly report to the CCAC; provide an annual audited reconciliation report at year-end that indicates how their funding was spent for the provision of approved services in accordance with the plans of service for the eligible children/youths; and return any unspent funds to the CCAC. 9.6.3 Specific Processes Relating to the Provision of CCAC Professional School Services and Personal Support School Services to Children/Youths in Home Schooling Situations For a child/youth in home schooling, the parent/guardian should contact the CCAC directly. Once the CCAC has assessed a child s/youth s needs, determined his or her eligibility and developed and authorized a plan of service, the CCAC must flow funds for children/youths schooled at home through a local community agency that is a transfer payment agency of either the MOHLTC or Ministry of Community and Social Services (MCSS). The CCAC must flow funding directly to the agency and the agency must agree to act as a banker and September 2006 20

flow funds to the parent/guardian who will then purchase the approved services. The CCAC is responsible for the reconciliation process. Where the parent/guardian receives funding from the agency, the following responsibilities arise: The CCAC case manager must: enter into a memorandum of understanding with the parent/guardian; enter into a memorandum of understanding with the agency; receive quarterly receipts from the parent/guardian and include this information in the quarterly reports submitted to the MOHLTC; ensure the quarterly reports identify all expenditures related to the provision of professional school services and personal support school services approved by the CCAC (Parents/guardians are not permitted to charge an administration fee.); and monitor and be satisfied based on the claims and reports submitted by the parent/guardian that the parent/guardian has spent the funding provided by the agency for professional school services or personal support school services approved by the CCAC, including the purchase of services and equipment in accordance with the plan of service for the children/youths being home schooled. The parent/guardian must: enter into a memorandum of understanding with the CCAC; use the funding provided by the agency only for professional school services and personal support school services approved by the CCAC, including the purchase of services and equipment in accordance with the plan of service for the child/youth being home schooled; assume all liability related to the provision of services; directly hire appropriate and competent service providers (non-family members only) or contract with an appropriate service provider; provide quarterly reports identifying all expenditures related to the provision of professional school services and personal support school services approved by the CCAC for the child/youth being home schooled; and return any unspent funds to the CCAC. The agency must: flow the funds provided to the agency by the CCAC to the parent/guardian. September 2006 21

9.7 CCAC Approaches to Service Delivery for School Services Since the introduction of Community Care Access Centre (CCAC) school services, there has been a dramatic increase in the demand for these services. School children/youths are a unique client group because of the settings in which they receive school services and the need for their treatment and care to be integrated into their academic program. These factors have prompted each CCAC to pursue different approaches to service delivery in order to efficiently serve as many children/youths as possible. Regardless of the method of intervention or the type of therapist employed, the CCAC must ensure that: all procedures are within the scope of practice outlined under the Regulated Health Professions Act, 1991 (RHPA); all contracted service providers are trained and competent in the procedures used; and the procedures offered are in keeping with any site restrictions. 9.7.1 Acceptable Approaches to Service Delivery The following approaches are acceptable only when deemed to be appropriate by the CCAC and the school principal (where applicable): 1. Mediator Training: involves demonstrating and teaching tasks to school staff and volunteers (including the home schooling instructor). Teachers can assist in the supervision of students in regards to tasks that support the learning process. 8 (The role or involvement of school staff may depend on school policies.) 2. Group Treatment: involves treating children/youths with similar therapy needs in a group. For example, children/youths requiring life skills teaching can be taught in a group setting by therapists. Children/youths with similar difficulties may benefit from intensive treatment programs such as a writing program held in the summer months or a dysfluency treatment group. 3. Block Treatment/Cycling Model: involves use of a scheduling model based on a cycle of time when therapy is provided and not provided. Lengths of the interval can also be varied by cycling the variations (staggering cycle blocks, or staggering the length of blocks or intervals). After the initial block of treatments, teachers and parents/guardians are trained on a remedial program for the child/youth. The model can be used for individual or group treatments. 8 For example, the CCAC may agree to provide some training to teachers so that they would become more adept in recognizing the level of handwriting/printing difficulties which would benefit from a therapist s assessment. September 2006 22

4. Periodic Sessions: involve scheduling of individual treatments at appropriate intervals (e.g., monthly, every three months). Treatment programs are designed for use at school and home. 5. Direct Service: involves treatment on a one-to-one basis. 6. Consultation: to exchange knowledge or information in a general, informative way between the CCAC and the school staff/instructor, as appropriate, i.e., a service care plan cannot be developed solely based on consultations. 7. Sharing Resources/Cost Sharing Staffing: where the health professional and educational assistant are working with the same child/youth and it is possible for one person to provide all the assistance, in cases where appropriate. This promotes continuity of care for the child/youth. Once the CCAC and the school principal have agreed on the split responsibilities, the cost of providing both services by one staff person must be shared between the CCAC and the public or private school. For example, a medically fragile child/youth with gastric tube feeds who has an educational assistant for educational needs and a nurse for tube feeds could have one dually-trained professional to provide both services. 8. Conferences: where case managers and/or contracted service providers may be required to attend case conferences or meetings to develop or explain plans of service. This is a normal expectation for the effective delivery of service. The case manager authorizes who attends case conferences, especially if the CCAC is paying for a contracted service provider to attend these meetings. Attendance at case conferences may be a service provider contractual obligation. 9. Service Sites: where the primary service site for the child/youth attending a public or private school is the school, the child/youth receiving instruction at home has home visits. Occasionally, a contracted service provider may need to visit a child/youth in locations other than the school setting. For example, a contracted service provider may be required to: participate in school day trips; attend case conferences and meetings not on school property; attend a specialized assessment requiring the presence of the student s CCAC therapist or other contracted service provider; access specialized equipment not available in the school; September 2006 23

provide specialized support during the student s transportation to and from school or a school-related activity; attend co-op placement sites; and/or conduct assessments in the child s/youth s home. Off-site service would be provided in accordance with the goals of CCAC professional school services and personal support school services. 10. General Training: while not a primary function of CCAC school services, the CCAC may authorize training and consultation to parents/guardians, and groups of school staff regarding provision of school services for eligible children/youths. Examples are training sessions on proper body mechanics for lifting, positioning and transferring. Many children have fine motor difficulties that affect their printing skills. CCACs could provide information to teachers on their professional development days or CCACs could approach school boards to ask whether they would like information sessions on professional activity days. While school services may include training on some occasions, schools have the primary responsibility to teach printing/handwriting skills to their students. The CCAC may agree to provide some training to teachers so that they would become more adept in recognizing the level of handwriting/printing difficulties which would benefit from a therapist s assessment. September 2006 24

9.8 Service Termination in Public, Private and Home Schools The Community Care Access Centre (CCAC) may terminate a child s professional school services or personal support school services if: the child/youth and/or parent/guardian are repeatedly not available for scheduled appointments; or the provision of continued therapy will not further clinical progress. The CCAC must terminate professional school services and personal support school services if: the child/youth moves from Ontario; any of the eligibility criteria cease to be met (for example, if the child/youth receiving services is no longer an insured person under the Health Insurance Act (HIA); the child is not enrolled in a publicly funded school or private school or is not being home schooled; or the child/youth has reached the age of 21. September 2006 25

9.9 CCAC Liaison Activities The Community Care Access Centre (CCAC) must liaise with publicly funded schools, private schools and community service agencies to ensure that these groups are fully informed about the professional school services and personal support school services provided by the CCAC. During the course of these liaison activities, the CCAC must ensure that they comply with the laws governing the confidentiality of personal health information. 9.9.1 Publicly Funded Schools and Private Schools The CCAC, schools and contracted service providers should have regular meetings to discuss the roles of CCAC staff, school staff and contracted service providers relating to the provision of services to pupils in schools (e.g., private treatment space, record keeping and information sharing) and other issues of mutual concern. Note: Every publicly funded school board must establish a Special Education Advisory Committee (SEAC) that advises the school board on special education issues. It is important for the CCAC case manager to liaise with this Committee for information sharing and planning purposes. School principals should be aware of service issues and the needs of children/youths in order to be partners in the provision of CCAC school services and personal support school services. Parents/guardians and teachers must be aware of these issues as there may be times when they are directly/indirectly involved with service provision or act as mediators on behalf of the pupil. 9.9.2 Agencies Providing Service to Preschoolers Preschool-aged children with special needs may be clients of early intervention programs, Easter Seal Society, day care centres, public health units, specialty clinics, hospitals or others. The CCAC and their contracted service providers must liaise with these organizations in order to ensure a smooth transition from the pre-school agency to CCAC school services when the child becomes school-aged and to avoid duplication of services. Note: Children attending day care or nursery schools are not eligible for the provision of CCAC school services in the day care or nursery school settings as these are not schools as defined under the Education Act (EA). September 2006 26