Introduction
In Ontario, ABA therapy is the leading therapy for children on the spectrum. This type of therapy uses the principles of learning and motivation to change behavior and is useful for children on the spectrum to grow. ABA therapy effectively improves social skills, communication skills, and behavior and provides support and training for parents to manage difficult behaviours that children on the spectrum display.
During the pandemic, healthcare services in Ontario were impacted in many ways including, instilling fear, grief, social isolation, and financial and occupational losses which had created a mental health crisis. Children with pre-existing mental health conditions/neurodevelopmental disorders were more vulnerable as province-wide lockdowns created closures of schools and access to ABA treatment. This resulted in many missed and delayed care as many in-person services were suspended. This created a need for more accessible services in healthcare, therapy, and services for developmental therapies.
If you are a parent or have a family member who has children with Autism spectrum Disorder (ASD) you are constantly looking for ways to get the help they deserve. Getting a diagnosis, being on the Ontario Autism Program (OAP) waitlist for funding, access to funding as well as prioritizing treatment for your child/family member.
Throughout the pandemic, there were many struggles with access to healthcare and treatment. ABA therapy had many restrictions in place for over a year, which impacted the way ABA services were provided. Parents, children, and families were extended on the waitlist. Telehealth was one of the only ways to access therapy, which created barriers for families without technology. It is important to explore how Ontario’s ABA therapy landscape is adapting to post-pandemic trends and what benefits and challenges came from this.
The Pre-Pandemic State of ABA Therapy in Ontario
Before the pandemic, the state of ABA Therapy was provided in person, but still had its challenges. Although there were The OAP funding options of Direct Funding Options (DFO) and Contracted service providers by the government, the challenges of accessibility to ABA therapy included long waitlists for services, particularly in areas that lacked finances such as rural or remote areas. Autism Ontario shares that parents and caregivers pre-pandemic had issues and financial pressure to sell their homes, spend their savings and work extra jobs to afford services to provide full-time care for their child. It is important to have access early which has been the challenge that persists even before the pandemic.
According to Kinark Family Services (2017), research before the pandemic showed the need for virtual services as telehealth as an alternative showed more access, and flexibility and is important in helping families overcome the barriers, challenges, and affordability of services.
Pandemic Disruptions and Immediate Response
With lockdowns and school closures, access to ABA therapy was not reachable. According to the Pandemic Canadian Autism Needs Assessment Survey, 82% of caregivers reported that social engagement was challenging, as resources such as recreation, financial means to take time off work, technology to work from home as well community support were not accessible. The beginning of the pandemic was the most challenging as no one was prepared for this.
The shift to remote services was essential to provide support to families at this time. Direct delivery service models were developed during the pandemic to support children’s consistency of service. The DFO for the OAP government funding allowed for tele-health services to be continued with this funding. There was also The childhood budget and Interim – One-time funding during the pandemic that allowed for services by the public health guidelines. This helped provide children with their services both independently or with family support to prompt, guide, and reinforce children’s positive behaviours and learning skills.
As this had created a means to give services to children in need there were significant challenges posited as well. The effectiveness of these sessions depended heavily on the age of the child, what symptoms the child displayed, as well as the involvement of the parents. It was a challenging time for parents to get that time off from work, and if they did not have access to technology those services would not be able to be implemented.
Post-Pandemic Healthcare Trends Influencing ABA Therapy
Technology advancements, changes in healthcare policy, and a growing recognition of accessibility and family-centered care have shaped the post-pandemic landscape for ABA therapy in Ontario. Virtual and tele-health practices as shared by The American Psychological Association look at these practices as affordable, efficient, and flexible services. A lot of people do not think that virtual services are as effective as in-person services, however, it allows those in remote areas, access to services through the internet.
3 areas of providing tele-health services include:
- Providing training to the caregiver
- Direct delivery models – to the child with ASD
- Direct delivery models – with parental involvement
Technological advances allow for the development of apps, mobile games, and access to virtual services and affect how data is collected and maintained in one service and space. Having this data-driven practice can help influence how ABA therapy is delivered, with a focus on holistic, long-term outcomes. As Direct delivery models started during the pandemic, it allowed for services to be directed to children as well as when parents are involved, allowing for them to reinforce the child and provide better prompting.
Meanwhile, challenges such as workforce shortages and the need for greater equity in service access continue to shape the field’s future. In Ontario (2022) there are a total of 1,272 BCBA’s or BCBA-Ds of which more than half reside in either the Greater Toronto Area or Ottawa, leaving a large rural area not served, which has shown the need for these virtual services.
ABA therapy is likely to develop through new technologies, having different models of care, and family needs, with an increasing focus on collaboration and individual therapy processes. Tele-health allows for more accessibility to services due to accessing these services online, through various methods and means. It also allows for consistency and reliability of the technology in these mobile apps and technology is more effective and less risky than human error in data collection, and analysis.
With more predicted baseline measures, the expected outcomes are more reliable for behavior analysts to assess the effectiveness of interventions and allow for data-driven decisions to modify treatment plans to suit these interventions and create more individualized approaches for ABA Therapy. This could include a hybridized online and in-person ABA therapy.
Increased Demand for Mental Health Services:
During the pandemic, there was a major need for counselling and psychotherapy services, which is why in 2020, Ontario released new OHIP billing codes that enable physicians to provide crisis counselling to patients over the phone. This overburdened primary healthcare systems and did not allow for psychotherapist or psychologist referrals. The government provided a Roadmap to Wellness, which was shared to deliver structured psychotherapy services “funded like OHIP” However, there are barriers to this as well, such as doctor referrals, with the main focus of psychotherapy being Cognitive Behavioural Therapy (CBT).
As children were isolated from school, peers extended family, and other resources, their mental health was detrimentally affected as those on the Autism Spectrum were the most at-risk. According to certain studies, there was evidence of autistic children experiencing mental health deterioration during the pandemic. This creates more attention and focus on ABA practices, for the diminished care during the pandemic. It shows implications for children on the spectrum who lost therapy access during key developmental periods requiring their provided ABA therapy for more improvement for the lost time.
Shift Toward Personalized, Client-Centered Care
There is growing evidence that data-driven, client-centric ABA approaches impact the treatment & relationship of children with ASD. The functional gains in the first year of care are clinically important, so ensuring an individualized therapy plan is important to drive success and great outcomes for a child with ASD. Each child is acknowledged for their uniqueness, families are encouraged to collaborate, and the autonomy of those receiving care is respected. A focus on functional outcomes, cultural relevance, and the preferences of families ensures that ABA therapy remains effective, meaningful, and respectful.
Ontario’s Healthcare System Adapting to ABA Therapy Needs
In Ontario, as children with ASD, are shown to be more prevalent the need for the healthcare system to adapt is important. According to the Ontario government, they are investing $97 million over three years to launch a pilot program at three major hospitals in Toronto, Hamilton, and Ottawa to help children and youth with complex special needs such as developmental and intellectual disabilities, mental health concerns, chronic conditions, and physical disabilities, connect to the highly individualized and specialized care they need.
The new funding for ABA therapy depicts the severity of the spectrum as well as the age of the child.
Post-Pandemic Funding Help:
- Direct Funding Options (DFO): This was provided prior to the pandemic however there is more availability through the OAP.
- Child and Family Support Program: This program allows families to use the funds from OAP for ABA therapy and other services based on their individual needs. This creates more space for individual support including in-home services, tele-health, or other behavioural programs.
- The Waitlist Support Program: This program provides families on the OAP waitlist with accessibility to some funding for some therapy, to help with delays in service provision to address the long waitlists.
- More Eligibility for ABA Services: The expanded coverage helps with the costs of service providers such as community-based ABA therapy programs, private clinics, Speech and Language, Occupational therapy, and more.
Challenges Ahead
Although there are great improvements in ABA services there are still challenges. In the areas of access, shortages in the field, funding, and variable services are still tricky areas. The challenges ahead include the bottleneck of waitlist services. It may have great promise with some of these great government funding options, however, the growing need for autism services is important to take into account. Access to these services may be affordable to those with higher income, but not too much with low-income families.
The shortages of BCBA as shared above go to show less professionals in the field and more need for evidence-based practices. Various services need to be approved under the funding limits, but may not provide everything required for your individual treatment plan for your child. It is important to advocate for the means of treating your child and improving your self-care as burnout is hard to recover from with the stressors of having a child on the spectrum and balancing home, work, and social life.
Conclusion
As we look at the changes from the Pandemic to now, we have more access to ABA services for our Children on the spectrum There have been many struggles with access to healthcare and treatment. ABA therapy throughout the pandemic had many restrictions in place for over a year, which impacted the way ABA services were provided. Parents, children, and families were extended on the waitlists, and tele-health was one of the only ways to access therapy, which created barriers for families without technology.
In exploring the impact of ABA therapy today, there is more access to ABA therapy, with more individualized treatment plans given the options of in-person, virtual, or hybrid services. There is a promise to look at how the government is creating more funding options for children with ASD. One thing to look for in the future is more options for adults with autism and providing more funding and services for them.
Call to Action:
With the impact of the pandemic, mental health is the main concern. At The Insight Clinic, we have many therapists who can help you manage burnout, depression, anxiety, and financial burdens as well as provide resources for Autism & ABA therapy. If you are a parent struggling with managing the behaviours of a child with autism, are anxious, or are struggling with finding options, The Insight Clinic can provide you with a therapist to cope with the anxieties and struggles. You can reach out today to book an appointment with our skilled and trained therapists to help you gain understanding and develop healthier coping strategies when you are feeling anxious, or developing these maladaptive thought patterns.
In collaboration with The Insight Clinic, ABA Academy leads with a focus on excellence and focuses on providing individual ABA Interventions for your child’s growth in social, cognitive, emotional, and physical developmental growth and milestones. ABA Academy provides high-quality, individualized, and effective services to help your child grow and learn from a fully licensed and qualified BCBA. Reach out today to see if ABA Academy is the right fit for your child’s ABA services.
