This section of the paper provides an overview of enforcement mechanisms utilized in government-funded developmental services systems in selected national and international jurisdictions. Within Canada, we examined four provinces: Alberta, British Columbia, New Brunswick and Quebec. Outside Canada, we examined selected provinces or states in Australia, the United States and the United Kingdom. 

The purpose of this section is to facilitate a basic understanding of the enforcement mechanisms available in other jurisdictions in order to determine innovative approaches to enforcement that could potentially influence or be replicated or adapted in Ontario. This is not an exhaustive review or analysis of the laws and practices in these jurisdictions, as such a review is beyond the scope of this paper. For accuracy, we use the terminology employed in each jurisdiction.

 

A. Alberta

1. Government Inspections and Oversight of Developmental Services

Alberta’s Ministry of Seniors and Community Supports administers the Persons with Development Disabilities (“PDD”) Program, the focus of which is to support the community inclusion and independence of adults with intellectual disabilities.[123] The PDD Program funds, monitors and evaluates the provision of specific services for adults with intellectual disabilities, including  community living supports, employment supports, community access supports to promote participation in society, and specialized community supports.[124] These services supplement the support of family, friends and community members and assist the individual in living as independently as possible in the community.[125]

Six regional PDD Community Boards work with individuals, their representatives and families, and service providers to deliver services throughout Alberta. Their purpose is to manage the provision of services, determine community priorities, assess the service needs of the region, and work with local agencies to provide services.[126] The Community Boards are agents of the Crown and are overseen and evaluated by the Ministry of Seniors and Community Supports. 

The PDD Program is governed by the Persons with Developmental Disabilities Community Governance Act.[127] The Act contains a preamble which states that statutory programs, resources and services are, “best provided to adults with developmental disabilities in a manner that acknowledges responsibility to the community and accountability to the Government through the Minister.”[128] The Act states that the role of the Minister includes evaluating results with respect to services for adults with developmental disabilities, setting standards for the provision of services, and monitoring and assessing the Community Boards.[129] Community Boards are required under the Act to manage the provision of services to adults with developmental disabilities in a way that is responsive to the needs of those adults.[130]

The Act also sets out inspection powers. An inspector can be appointed by the Minister or the Community Board, or can be a member of the Community Board itself.[131] The inspector is authorized to ensure compliance with the Act by entering premises, requiring the production of documents or records in the possession of the Board or service provider, copying those records, and inspecting and taking samples of any material, food, medication or equipment being used in the provision of services to adults with developmental disabilities. An inspector cannot exercise any of these powers without obtaining the permission of the service provider.[132]

The Minister may appoint someone to conduct an inquiry in respect of services for which funding is allocated by a Community Board, or in respect of how the Community Board carries out its activities under the Act.[133] For these purposes, the person appointed to conduct the inquiry has all of the powers, privileges and immunities of a commissioner under the Public Inquiries Act.

 

2. Accreditation of Service Providers

The Alberta Council of Disability Services, a representative organization for 130 agencies that provide services to people with intellectual disabilities, offers accreditation to service providers that meet the criteria and standards outlined in a document entitled Creating Excellence Together.[134] Under the agreement that governs the relationship between service providers, Community Boards and the PDD Program, service providers must comply with these standards or another recognized accreditation process.[135]  The extent to which a service provider has complied with these criteria is measured through an on-site visit conducted by the Council of Disability Services. Two levels of accreditation are possible: primary and advanced. Both levels address issues such as whether people who receive developmental services are supported to make decisions about every-day matters; are treated with dignity and respect; have strong, positive relationships; are included in the community; are supported to take care of their health; are free from abuse; and are able to access fair, equitable and reasonable dispute resolution processes.[136]

 

3. Complaints and Appeal Mechanisms

The PDD Program emphasizes that disputes are to be resolved at the service provider, Community Board or regional level wherever possible. Individuals who have concerns or complaints about decisions made regarding their services can file an appeal using the service providers’ appeal process. The Community Board is responsible for ensuring that the appellant is given adequate access to dispute resolution and appeal processes.[137]

The PDD Program has an appeal process that individuals who receive services can use when they are unhappy with decisions of a Community Board or PDD staff member that affect them. The appeal process is independent from the program itself. Decisions that are not subject to appeal are those that affect contractual arrangements such as decisions to enter into, amend or terminate a contract with a service provider. Reductions or suspensions of services, or disagreements concerning the level of services being provided can be appealed.[138] A person files an appeal using the Notice of Appeal form, which must be completed and submitted to the Appeal Secretariat within 30 days of receiving the decision that is the subject of the appeal. The Secretariat contacts the person who filed the appeal to discuss the concern, and may refer the matter for dispute resolution or mediation. Dispute resolution is voluntary and entails referring the appeal to the CEO of the relevant Community Board, who may investigate the appeal. Likewise, mediation is voluntary and is generally pursued when dispute resolution has not been successful.[139] The majority of complaints made to the appeal process are resolved through the mediation process. The PDD program may also refer individua