From the L’Image, Spring 2011
You have by now certainly heard of the provincial government’s objective of merging the 5 CRDITED on the island of Montreal. This objective is not new and has from time to time resurfaced since the 1980’s. Through the mergers, the government’s aim was to decrease the administrative cost of running the fi ve CRDITED, with their fi ve boards of administration, and their five director generals, and so on and so on, all racking up enormous expenses. The government also aimed to ensure that services bemore equitable across the island.
Last summer, the Agence de la santé et des services sociaux of Montreal, met with the 5 CRDITED and their partners in order to develop a proposal which would bring all organisations to a consensus. ATEDM is one of those partners.
The provincial government initially proposed to limit the number of CRDITED to 1 or 2 for the entire island of Montreal. The Agence of Montreal however finally opted for having three readaptation centres. This meant 1) to merge Gabrielle-Major with l’Intégrale, 2) to merge Lisette-Dupras with CROM and 3) that Miriam, who has historically never wanted to be merged with any other organisation, and wishes to keep its specific mandate for individuals of Jewish heritage, remain on its own. The provincial government however refused this proposal and requested that there only be 2 CRDITED in total. This implied merging Gabrielle-Major, l’Intégrale and Lisette-Dupras together, and merging CROM with Miriam.
The provincial government also requested that there be only one system or site of entry (guichet unique) permitting access to services of CRDITED. This single system would enable to better organise services for the island of Montreal as well as let parents determine which CRDITED they chose to go to. Under the current practice, it is an individual’s postal code that determines which CRDITED they can go to. However this practice is not legal. According to the law, an individual has the right to choose the organisation of his or her choice. This is however nor respected.
CROM’s and Miriam’s reaction to the government’s request that they merge was precisely the same as the one they had throughout 1980s-1990s, etc. These organisations do not want to merge and also refuse the creation of a single system of entry for obtaining services from CRDITED. They have each undertaken various actions to contest such a merger.
ATEDM and most of the other partners were invited to comment the government’s last proposal. The board of administration of the Agence of Montreal has since put this matter on hold due to the intensity of reactions from CROM and Miriam. Below you will find the commentary submitted by ATEDM on this matter.
L’Intégrale, Lisette-Dupras and Gabrielle-Major have for their part begun their process of merging and wish to reorganise their services with the perspective of improving the quality of the services they render. This matter is to be continued…
Comments Regarding the Scenario for the Merger of the CRDITEDs of Montreal.
“December 2, 2010 Proposal”
Before issuing our comments regarding the proposed merger of the CRDITEDs, it is important to understand the current situation of individuals with autism or autism spectrum disorder (ASD) and their families. They are exhausted, they do not receive enough services or none at all, they are dissatisfied with the health system and particularly disappointed by the services offered by the CSSSs and CRDITEDs. Clearly, the lack of expertise and vision is subject to disapproval everywhere and so is the scarcity of services. Nowadays, when we talk about individuals with ASD, we often refer to children aged 5 years old and less who should receive the 20 hours of intensive behavioral intervention (IBI) services they are supposed to have. There are still waiting lists, but the government has recognized the urgency to act with regards to children. The lack of money, resources and experience are part of the observations made. All individuals with ASD who are more than 5 years old are put on waiting lists since 2003. Not enough budgets, no development, nothing planned!
Therefore, when we talk about the merger of the CRDITEDs to ATEDM’s parents, their comments are: “What can be worst than what we have presently?” “We have nothing to lose, as we have nothing!” “This might change things for us.” Although parents are skeptical, they still want change.
The 2011 context, for individuals with ASD
¨ Individuals with ASD still form a complex and demanding clientele. Individuals with ASD without ID represent another challenge and the development of specialized services for them, quite different than those offered to other individuals with ASD, is urgent.
¨ The constant increase in the number of individuals with ASD, ignored by the government, considerably affects the waiting lists and weakening of the network.
¨ Everyone condemns the lack of expertise. Without expertise, we are not able to evaluate the needs adequately, to have a vision and to plan the services required. The consequences are disastrous.
¨ The lack of budget is also catastrophic. The government shows very little interest for us.
¨ Behavioral disorders are still increasing and not addressed in a proper way. The CRDITEDs are once again using medication and hospitalization, even though parents have fought against those in the past.
¨ The transfer of clienteles to the CSSSs as well as the lack of services and complications have not improved our situation. On the contrary, it is now worse. Thus, this is the context in which we are talking about the merger of CRDITEDs.
Comments on the merger of the CRDITEDs
The health and social services network has been going through a reform for a very long time. When the change is major, ATEDM is invited to express its opinion in large committees where the emphasis is put on the structure, programming and planning of ideal services. On paper, everything is perfect for the adequate functioning of the organizations involved, but what about the client? They talk about partnership and collaboration and this often leads to other committees instead of direct actions for the client. They all have their access procedure and protocol and the clientele is still waiting.
It is not the first time that that the merger of the CRDITEDs of Montreal has been debated, but it is still an emotional subject. I am always surprised by this. Throughout the years, I have also been surprised and disappointed to observe petty politics and fights for power from organizations offering services to the most vulnerable clienteles, that receive less subsidies and are not really considered a priority. This lack of efforts and energy are quite negative for our clientele. We are far from a partnership and the well-being of the clientele.
We hope that this time, the priority will truly be given to the clientele and collaboration and partnership will be more than wishful thinking. We also hope that this merger will lead to a complete reorganization of services to innovate and respond to all the needs of individuals with ASD.
In the beginning, ATEDM was hoping there would be only one rehabilitation center so that the reform could be complete. Instead of having several centers offering the same services, it would be more appropriate to centralize the services depending on the types of clienteles, for example:
- A center for individuals with an intellectual delay
- A center for individuals aged 5 years old and less, where a better expertise could be developed and a variety of services and innovative programs offered, as well as diagnoses
- A center for individuals with ASD
- A center for individuals with ASD without ID
- A center for the development of various residential services
- A service center for SBDs.
The development of the expertise is an essential pre-requisite.
Thus, if there are two major rehabilitation centers, our comments and wishes are the same:
- A valid evaluation of the needs of each person
- Diversified services to be able to meet the needs of everyone
- The ability to evaluate the quality and the results (field) of the services offered.
Since we have asked that services be offered by the organizations of our choice, we agree with the proposal of the Agence de la SSS de Montréal regarding a one-stop service. This is similar to our vision. The fact that we would have to receive services according to our postal address was considered unfair and restrictive by parents and individuals with ASD without ID.
However, to help parents or individuals with ASD make a choice, there will have to be innovations. Caregivers who know autism and individuals with ASD well will have to evaluate the needs of each individual to have a clear picture of the services required. Otherwise, this will not work out. The social workers of the CSSSs are not capable of doing this type of evaluation at the moment.
The implementation of a variety of services is essential and the development of field expertise is a key element. The future of individuals with ASD depends on it!
Because of the perpetual crisis situation in which we are, we are hoping that there will be major changes made to improve the quality of life of individuals with ASD and their families. Therefore, we are in agreement with the December 2, 2010 proposal of the Agence.