Disadvantaged

Disorganized

Disconnected

DISABLED INDIVIDUALS ACCESSING INCOME SUPPORT

Drafted By: The Transitional Support Coordinator Initiative

Table of Contents

Introduction………………………………………………………………………………………………………………………….Page 1

Evolution of the Project…………………………………………………………………………………………………………Page 4

Service Model……………………………………………………………………………………………………………………….Page 6

Timeline and Support Table Page 10

Individual Barriers and Demographics…………………………………………………………………………………..Page 13

Accessing Support…………………………………………………………………………………………………………………Page 15

Income Support Application Process…………………………………………………………………………………….Page 19

Access in Rural Communities………………………………………………………………………………………………..Page 22

Specific Impairments…………………………………………………………………………………………………………….Page 24

Cognitive Impairments Page 24

Mental Health and Addiction Page 26

Statistical Report March 2011 Page 28

Program Targets……………………………………………………………………………………………………………………Page 30

Quantitative Outcomes Page 30

Qualitative Outcomes Page 33

Introduction

Income Support in Durham Region

Ontario Works is a program that provides basic financial and employment supports for people seeking

long-term employment. It provides basic assistance for individuals and the overall goal of Ontario

Works is to assist social assistance participants to prepare for, obtain and sustain employment and to

make the transition to long term self-reliance. There are three (3) components of Ontario Works:

Employment Supports, Placement, and Community Participation.

The Ontario Disability Support Program (ODSP) provides financial assistance to individuals and their

families living with a disability that is expected to last 1 year or more. Individuals are required to

complete an application to qualify for these services and the benefits paid to participants exceed the

maximum allowance provided through the Ontario Works program.

A household applying to ODSP must be:

1. Have a substantial physical or mental impairment that is expected to last more than 1 year

2. Have restrictions in your daily activities (personal care, functioning in the community or workplace)

3. Demonstrate financial need with your budgetary costs

In order to qualify for ODSP, applicants must verify their financial need through a financial intake at

their local ODSP office. Applicants must also complete the “Disability Determination Package”. This

information needs to be completed by a medical professional and is then reviewed by the Disability

Adjudication Unit. Once this is done, the applicant is either granted ODSP Income Supports or often

denied based on the material submitted. If an applicant is not granted, an appeal can be made before

the Social Benefits Tribunal. Many ODSP applicants are deemed ineligible on their first application,

but all applicants have a right to appeal this decision. A large number are then granted the benefits

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through the Social Benefits Tribunal. ODSP provides disabled individuals with a higher monthly income

and services designed to meet the needs of disabled individuals.

Initiative

The Transitional Support Coordinator Initiative is a support that assists individuals with barriers to

access proper income support in Durham Region. These individuals typically struggle to assemble

the necessary materials and supports needed to access income support for the disabled (Ontario

Disability Support Program, Canada Pension Plan). Through experience with individuals as well as

communication with Ontario Works, and various other support services, we found that many individuals

were receiving insufficient income support. This was due to an inability to access the health and social

services necessary to completing a complicated Ontario Disability Support or the Canada Pensions

Plan application process. The purpose of this project was to assist these individuals in completing the

application process as well as support them in their lives through the point of being granted appropriate

income support. This process is a long one, as many individuals must appeal the original decision

through the Social Benefits Tribunal. The entire process can take up to 18 months and involves

submitting an appeal and support documents that are often difficult for disabled individuals to carry out

without assistance. This would involve attaching individuals to a number of formal service agencies

as well as connecting them to essential medical services. The needs of these individuals often involve

an array of vast issues (health, transportation, recreation, education, family, and housing) and are

extraordinarily complex. The Transitional Support Coordinator works with individuals not only to

complete their application for income support but also assist them in stabilizing their lives while the

process is ongoing. Individuals in need of this program are often unable to navigate the long

application/appeal process, and miss required dates and commitments due to the challenges presented

by their disability and life situation. Often times these individuals experienced limited success in the

formal service system and have difficulties advocating for their medical and service needs. These

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individuals are impacted by Durham Region’s limited number of family doctors accepting new patients

and are often rejected by physicians because of their complicated, and challenging medical needs.

Communities in North Durham Region create a particular challenge in this area. Northern communities

face a challenge accessing services largely located in the more densely populated southern area of the

Durham Region. Limited transportation and medical services increase the likelihood that an individual

living in this region will be unable to access the support needed to complete the application process.

The Transitional Support Coordinator Initiative aims to:

a) Make the process of applying for Income Support as accessible as possible for individuals with

disabilities

b) Support individuals in obtaining necessary medical information, including finding a family doctor

c) Ensuring necessary referrals to support services and medical specialists are made and

attended by the individual

d) Assist the individual in following a schedule and organizing appointments

e) Creates solutions in all life domain areas relating to earning a limited income during the

application process

f) Create a best practices process for applying for disability supports in Durham Region.

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Evolution of the Project

This program began through services provided by a diverse group of social service providers in the

Durham Region. These services provide individualized support and service coordination for individuals

with disabilities and economic barriers. Over the course of serving individuals, consistent challenges

presented themselves when staff were faced with the task of accessing income support for their

individuals. Staff found that this was often a complicated long term process involving the coordination

of income support, medical services and required an overall commitment to work with the person in

stabilizing their lives . It involved a long-term commitment with which staff may be working with a client

for 2 years to complete the process where a client was granted Ontario Disability Support Program or

Canada Pensions Plan Disability and in a stable position in their life.

In one particular case a client was living on Ontario Works, with no family physician after suffering an

Acquired Brain Injury. The client had been on Ontario Works for several years. The client was unable

to initiate the process of finding a doctor, access old medical files and completing the paperwork

necessary to apply for disability income support. The process of locating a doctor, completing the

application, appealing the decision, and attending tribunal, took 24 months. During that period the

client experienced several major health issues, a housing crisis, and bankruptcy. Staff spent time

establishing medical relationships, connecting the client with supports, accessing transportation,

establishing memory and organization strategies, completing income tax returns, and maintaining a

budget. At the conclusion of this process, staff were surprised at the degree that this work changed the

individuals life entirely. Staff then began to work on the premise that a formalized service in this area

could be effective in the same way with a large number of Durham Region residents.

A collaborative committee was established and in February 2009. Discussion took place on how to

address the issue and a pilot project was developed. A collaborative proposal was drafted and

submitted to the Ontario Trillium Foundation and funding was granted in July of 2009. The (then

named) Brain Injury Association of Durham Region agreed to act as the lead partner in the venture.

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Staff were hired and individuals were being referred in September 2009 and a Launch Event was held

in Uxbridge Ontario.

Who is Involved

 Literacy Network of Durham Region

 Durham Region Social Services-Income and Employment Support Division

 Community Employment Resource Centre Beaverton-Durham College

 Cornerstone Community Association

 Durham Community Legal Clinic

 Durham Mental Health Services

 Brain Injury Association of Durham Region

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Service Model

This project provides services to individuals with disabilities, serious mental health issues, cognitive

impairments and other complex issues. These client populations typically require lengthy and

extensive support and support required, is not offered by the Ontario Disability Support Program

(ODSP) or by Ontario Works (OW). The Transitional Support Coordinator (TSC) is a staff member

designated to coordinate and provide support services for individuals with disabilities who are

accessing appropriate income support (ODSP/Canada Pensions Plan-Disability-CPP-D). The TSC

works not only to complete the application, but also to improve and stabilize the individuals lives. Often

the lengthy application process further complicates this, if the initial application is denied. The program

aims to minimize barriers to accessing services, and is set out to have as few requirements for service

as possible.

To obtain our service the individual must:

 contact the service directly (no third party referrals are taken)

 feel they require support applying for ODSP/CPP

 identify themselves as an individual with a disability, that impacts on their ability to obtain and

retain employment.

Referrals most often are from Ontario Works and presentations took place at those local offices to

encourage contact when the program began. The TSC receives referrals from various community

support services as well. The referring staff provides the TSC service information to the individual, and

request that the individual in need of services contact them if they would like support. Individuals

contact the service and an appointment is arranged. A meeting then takes place as soon as possible

and the meeting location is set up close to or at the individual’s home in order to minimize

transportation and scheduling barriers. Staff then works to establish goals and supports.

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 First Meeting Location

1% 1% Coffee Shop
2%
8% 3% Home
1%
1%
1%
1% 35% Ontario Works
8% HIAD
DMHS
4%
Library
Hospital
Durham College
34%
Cornerstone
YMCA
CERC-Beaverton

*HIAD is the Head Injury Association of Durham Region**DMHS is Durham Mental Health Services ***Cornerstone refers to the
community men’s shelter

TSC staff work with individuals to secure required identification, obtain medical services and

assessments, access social service supports, complete income support applications and navigate the

process of appeals and hearings, if necessary. Staff would also support individuals in applying for

additional income through Ontario Works as well and completing income tax returns, to provide them

with income through refunds and tax credits. The TSC arranges services and accompanies individuals

to medical, and income support appointments. In addition, staff supports the individual maintaining

Ontario Works funding, assisting when responding to requests from case workers and suspension

letters. Often TSC staff will keep notes and reminders for the person to ensure they follow instructions

given to them at appointments. Reminder phone calls will often take place as to ensure necessary

follow through.

Individuals are supported when locating previous medical documents to establish a medical history.

This ensures a continuum of care with their family doctor and often improves the information being

submitted to ODSP/CPP. Individuals are supported in collecting their documents to confirm income

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eligibility. The TSC ensures individuals receive the ODSP application package at the appropriate time

and will make certain that the application is completed and received on time by the Disability

Adjudication Unit (DAU). The staff supports individuals through the internal review process (IR) and

Social Benefits Tribunal (SBT), if necessary. Efforts are made to assist when people feel unfairly

treated and staff will support them in contacting provincial regulators to ensure their rights are being

respected. Additional work is done to ensure individuals are supported to pursue other goals including

employment and education. On several occasions, once supported, individuals were able to apply for

school or return to work despite their disability.

The role of the Transitional Support Coordinator is to be a support worker, an advocate, and a

coordinator with the person throughout the process in order to reduce and remove the numerous

barriers they would otherwise experience. Staff play a critical role of community-based support and

guide through the ODSP application process, making a complex system more accessible. The

program operates with a single full time staff responsible for all client related services and

administration. The lead partner, the Head Injury Association of Durham Region, provides the

additional financial administration and supervision.

Additional goals of the service were to provide learning materials, and insight in to the application

process. Staff developed a service manual and Train the Trainer sessions were designed and will

conducted throughout Ontario. This provides a resource for existing support services, and will provide

a basis to improve community services for individuals with disabilities.

Attached is a chart detailing the process of applying for the Ontario Disability Support Program Income

Support, and supporting an individual through that process. Note that not all individuals were referred

at the initial application stage. They often initiated contact with the program after already being denied

benefits. The purpose of this chart is to establish a routine for how the service is typically applied and

the timeline experienced by the individual. It also only details the ODSP application process as the vast

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majority of individuals served were pursuing that form of income support. Canada Pensions Plan

applications almost universally took place along with the ODSP application.

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Time Line and Support

Stage Timeline Support Provided

Individual referred to TSC program
Begin to gather necessary information,
testing arranged if necessary and available
Referrals to ODSP through OW –Application
can be obtained immediately (through
Ontario Works office)
Self Referrals to ODSP-Meeting time with
staff took from 2-4 weeks and staff would
not issue the application until full financial
eligibility was obtained and processed
If financially eligible, individual receives
Disability Determination Package, family
doctor visited and forms completed
Individual meets with medical professional
to have Health Status Report completed
Completed forms sent to Disability
Adjudication Unit
1-2 weeks  One on one appointment set up near or at
person’s home
 At persons’ request, Ontario Works staff is
contacted to obtain ODSP application package
and inform them of TSC involvement with the
program
6-8 weeks for  Staff support writing former doctors, hospitals
testing to and specialists to obtain health records
complete  New doctor located, if needed
Immediate  Application can be obtained by contacting
Ontario Works staff
 Application could be mailed out or left for pick
up
2-4 weeks  Staff accompany individual to ODSP local office
for a financial review
 If client is deemed eligible, support is provided
for application package
Varies based  Staff will accompany client to medical
on individual appointment if needed
situation  New doctor located and staff accompany to
initial “Meet and Greet” appointment
Varies based  Staff will accompany client to medical
on individual appointment if needed
situation  New doctor located and staff ,accompany to
initial “Meet and Greet” appointment and
subsequent appointments, if necessary
 Staff review the documents and support the
individual in completing their Self Report Form

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Individual has 90 business days (4-5
months) to get decision from DAU
DAU grants individual ODSP
Ontario Works transfers file to ODSP office-
average wait time for first cheque 2 to 5
weeks
Individual not deemed disabled, denied
ODSP:
Individual has right to file internal review
Individual granted appeal – Local ODSP
office has 20 days to issue a cheque
Individual loses internal review
Individual connected with Community Legal
Clinic and has one month to file for Social
Benefits Tribunal Date
Social Benefits Tribunal Hearing
 Staff mail the package and make copies upon
request
4-5 months  Staff support clients in stabilizing their lives
during this time in health, social, and financial
areas
 Staff support the individual communicating
with Ontario Works and ODSP
2-5 weeks  Staff support the individual communicating
with Ontario Works and ODSP
 Individual offered support adjusting to new
income level and is referred to long term
support services
10 business taff supports individual in drafting a letter of
days internal review
 Additional medical documents are included if
available and extensions are requested if
necessary
20 business  Staff support the individual communicating
days with Ontario Works and ODSP
30 days  Staff accompany individual to Community
Legal Clinic to obtain representation
8-12 month  Staff support the person in obtaining further
wait period medical information
 Staff support the person in stabilizing their
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Adjudicator decision after Social Benefits
Tribunal Hearing
Client is granted and Ontario Works file is
transferred to ODSP office and has 20
Business days to issue cheque
Individual then adjusts to new income level
lives during this time in health, social, and
financial areas
 Staff ensures individual attends hearing
60 Days  Support continues during wait period
20 business  Staff support the individual communicating
days with Ontario Works and ODSP
 Staff attends ODSP intake meeting if necessary
 Staff support person in accessing long term
support services and setting long term goals
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Individual Barriers and Demographics

Statistical information indicates that the initiative has been serving the intended target group. The

youngest person was 19 and the oldest person 64, indicating that individuals need support from all age

groups. Men account for 64% of the total caseload, with 36% of the caseload being women. Of the

157 people connected to the service 135 or 86% are receiving Ontario Works benefits at some time

while being supported. All individuals involved with the service identify themselves as having a

disability and require support accessing income. Service is provided for both ODSP and CPP-D

applications but a vast majority are pursuing ODSP. When CPP applications are being completed, they

are almost universally being completed along with ODSP or in some cases when the person was found

financially ineligible for income support through ODSP.

This results in very little data on the CPP application.

The project is collecting specific data on the types of

Participant
Gender
disabilities when a diagnosis is available or when the
Male Female
individual reports specific issues. A majority of people
36%
report mental health issues, which often are present along

with other conditions. Cognitive barriers (which include 64%

brain injury, learning impairments, and developmental

issues) have also been very common and are reported in

a majority of the people involved in the program. Descriptions of symptoms and health struggles

exhibited by the individuals included; memory impairments, poor insight, poor impulse control, severe

anxiety, depression, addiction, trauma, literacy issues and difficulties with comprehension.

One-third of individuals have housing issues (homeless, in shelter situations, staying with friends or

family) during the time connected with the program. Two thirds of individuals report a fragile hold on

this housing and need to live with family or move multiple times to sustain shelter. Private market rent

in Durham Region exceeds the maximum Ontario Works shelter allowance and individuals are facing

considerable housing affordability issues. Those in shared accommodations or rooming houses pay

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lower rent but report significant housing instability such as; lack of access to food and food storage,

limited contact to outside services, and typically had safety concerns with other tenants.

At the point of intake, 75% of individuals are in receipt of regular Ontario Works benefits, while most of

the remaining people had no income due to financial qualifications or an inability to complete the intake

for Ontario Works. At this point, 42% have required support in maintaining their income support, as

they struggle to complete the basic requirements. Ongoing support is needed as mental health and

cognitive barriers interfere with the individual’s ability to communicate with Ontario Works staff and

comprehend correspondences. Often individuals were introduced to our program while struggling to

complete their intake for Ontario Works. At the time of intake 76% of individuals were unconnected to

any community support services and 20% had no income at the time of intake.

This section explores the individuals connected with our program and the barriers they experience. We

detail both the impairments and the systematic challenges faced by people involved in the program.

Individual Barriers

Literacy

Hearing

Learning Impairment

Developmental

Illness

Mental Health

0 20 40 60 80 100 120
.

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Accessing Support

Medical Services

A majority of individuals report a great deal of difficulties accessing and maintaining medical services.

Of the individuals being provided support 47% report that they lack medical support they need and 18%

had no family physician at first contact. Many report that they had no meaningful relationship with their

medical professionals. The reason for this varies but most often relates to; the availability of doctors

and specialists, the person’s ability to advocate for their own health, and their overall insight into their

impairments. Individuals report difficulties organizing prior to appointments and often feel being

uncomfortable or unable to articulate concerns. In many other cases they are unaware that their

impairments constituted a legitimate health issue.

In many cases, the person requires staff support at medical appointments. This ensures that

individuals are prepared for appointments, asked questions that they wanted to ask, obtain necessary

referrals to specialist and can recall medical instructions for future treatment. Without the support

individuals often forget to address issues they had been having or fail to communicate key issues they

needed support with. Increasing the level of communication with medical professionals is especially

needed when completing the income support application.

Key barriers identified by individuals were

 Obtaining a family physician willing to accept them as patients

 Keeping and following through with medical appointments

 Following through with medical instructions

 Being able to communicate meaningfully with medical professionals

 Obtaining past records to complete applications and maintain consistent care

 Accessing the cost of past medical records

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  Large number of individuals with cognitive barriers lack insight into their condition and are

unable to advocate for their own health

 Lack of health card or identification

 Literacy, memory and comprehension issues

Colin: Case Example 1

Colin is a 32 year old man with severe diabetes and medical concerns. He was hospitalized 2-3 times
per month and is legally blind due his diabetes being untreated for so long. He and his son are living
with parents and he had been receiving Ontario Works Income Support for the past 8 years.
He connected with the Transitional Support Initiative after being denied twice for ODSP. He was
unable to follow through with the appeal process on each occasion. He was also unable to find a
doctor willing to treat him for the past 7 years due to being too difficult to service. His Ontario Works
caseworker referred him and TSC staff began meeting him in a coffee shop close to his home.
Staff began to gather information on his medical history and located a new family doctor. Support was
required at his doctor’s appointments both to ensure Colin attended the appointment and that he
understood what the doctor’s instructions were. Information was gathered from previous specialists
and the doctor began to complete the ODSP application package. Colin was also supported in
attending Ontario Works appointments and additional funding was obtained since he had not accessed
funding for diabetic supplies or special diet.
Frequent hospitalizations made his application forms a long process and Colin eventually had his
stomach removed due to the long-term effects of his diabetes going untreated. Colin now continues to
be in hospitalized weekly and his health is a critical concern. His ODSP application was submitted and
approved within two weeks. Support for medical appointments continues with the TSC program as
community based support is has not been located through other service agencies.

Access to Support Services

A majority of individuals connected with the Transitional Support Coordinator Initiative were not

receiving support for any other services. This was especially problematic when dealing with people

who have cognitive and mental health conditions. At initial contact, 78% of individuals were not

Page 16 of 38
connected to any other local services agencies providing support services. This further illustrates the

broad isolation that individuals connected with this service were face. It also illustrates the need for

direct support services.

Many lack the diagnosis or insight into their impairment that they would need to connect with specific

services. A majority of support services in Durham Region are funded in specific categories or “silos”

which only provide services for individuals with a specific impairment. Examples of available services

included the Brain Injury Association, Durham Mental Health Services, Durham Region Adult

Community Support Services, and Associations for Community Living, among many others. All offer

certain supports for individuals with specific impairments but individuals struggling with learning

impairments along with various unknown cognitive and mental health concerns often have no options

for support.

Reasons individuals remained unconnected to services were;

 Lack of diagnosis to connect with specific services

 Unawareness of help being available

 No support services available for their conditions

 Reluctance to disclose specific impairments

 Inability to navigate community services and advocate on their own behalf

Lucy and Wayne: Example 2

A married couple, Lucy and Wayne, were living for 10 years without income support. They both
experienced acquired brain injuries, Lucy from a motor vehicle accident and Wayne from a stroke.
They were living off a small insurance settlement they obtained after Lucy’s car accident nearly 10
years before. Ontario Works referred them after nearly two years of being unable to meet the
program requirements. This was due to an inability to complete paperwork and respond to
correspondences.

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When staff arrived, Lucy and Wayne had no gas or electricity and had no income due to being
unable to follow through with requirements of ODSP, CPP or Ontario Works. A notice for
termination of water was received and they had not addressed this bill in nearly six months. They
had also not paid their gas or hydro bill in over a year. They disclosed that they were also buying
food by selling household items. Each had not had a family doctor in over 5 years and needed
support attending appointments.
Both were supported in obtaining ongoing Ontario Works support and have obtained a family
doctor, neurologist, and psychiatrist. Staff now accompanies them to psychiatrist, family doctor,
and specialist appointments. Special Diet Allowances were obtained when both clients have been
diagnosed with wasting due to losing more than 20% of body weight. Lucy’s ODSP application
was submitted and denied. An internal review was completed along with complaint due to Lucy
being denied without explanation. The internal review was granted.
Support was obtained through the Durham Region Energy Bank and Ontario Works-Community
Start-Up and the utilities were turned back on. Currently, Lucy and Wayne have stable housing
and are continuing to work with staff to obtain further medical support. After an assessment
Wayne was told he needed to be using a wheelchair and one was provided through the Assisted
Devices Program. They now are connected with the Brain Injury Association of Durham Region’s
Community Supports Service, and TSC support continues to work with them on CPP-D
applications.

Page 18 of 38
Income Support Application Process

Understanding the Requirements

The ODSP application requirements and process have been complex and inaccessible for many

individuals. Most people feel the application process and requirements of ODSP were unclear and

unavailable to them. The complexity of the ODSP application package, the lack of transparency in the

adjudication process, the long timeline involved, and the lack of resources in place to support the

applicants results in many individuals with significant disabilities remaining on Ontario Works Income

Support. Many individuals supported had applied for ODSP in the past but could not navigate or

understand the process. Instead, some remained on Ontario Works for years, even decades. Others

were denied on their initial application and were unaware of their options to appeal, could not

comprehend correspondences from the Disability Adjudication Unit or incorrectly thought that the

appeal process was pointless.

Individuals are required to provide proof and documentation to support their application, which they also

struggle to comprehend. Medical practitioners similarly struggle, at times, when completing an

application. They often complain about not understanding when an application is denied and being

unsure what additional material is needed when they feel an applicant should be receiving the support.

Doctors complain that the package is especially difficult to complete when the individual is unable

articulate their own impairments. Frequently, they do not have information to complete the forms and

knowledge of how the individual functions in the community. Doctors have been unable to refer these

patients for diagnostic testing, as these tests for adults are not available in the Ontario Health Insurance

Program. Due to the lack of income, none of the people involved in the TSC program have access to

funds to pay for these assessments. Health practitioners consistently comment that the application

form requires a depth of knowledge about the applicant that few of the “approved” health practitioners

will possess.

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Timeline and Communication

The length of time also represents a significant barrier for many involved. Long wait periods in the

application and appeal process result in many applicants being unable to follow through with their

application. Many individuals miss essential dates that disrupt their application and then often must

restart the process and apply again. Once an application is submitted the Disability Adjudication Unit

informs the applicant that a decision will be made in 90-business days. Applicants frequently

misunderstand this term, as they often required far clearer language to accommodate their

impairments. The use of this timeline and terminology often resulted in the person having to place

follow up calls or mentally adjust waiting an extra 6 weeks from the time they originally hoped a

response would be provided. Several people require support calculating when a decision should be

made while others requested support making complaints as deadlines for responses were often

missed. It is common for the 90-business day timeline to be missed by the Disability Adjudication Unit

by several weeks, even months.

Information is not available on the specific process and requirements for ODSP adjudication. Often,

individuals are denied despite the fact that medical professionals and support staff feeling that a strong

and clear disability application has been submitted. When an application is denied, each individual is

denied with the same letter, where only the date, name and the member ID number is different. The

individual is not provided with any context for the decision made and is simply told that they fail to meet

the legislative requirements. This key omission makes the internal review a very difficult task for the

person and their medical support people to submit new or key information since they have no basis for

why the application was unsuccessful. The absence of this information makes the internal review

inaccessible for many. It also presents an even more significant barrier for individuals with cognitive or

mental health impairments as the anxiety and disappointment of being declined often leads to further

detriment to their health.

Page 20 of 38
Social Benefits Tribunal

When individuals are denied on their internal review, they must pursue a Social Benefits Tribunal

hearing if they disagree that they are not a person with a disability. The individual generally requires

support connecting with the Community Legal Clinic to file for a hearing date and provide

representation at their hearing. The standard wait time to get a Social Benefits Tribunal date has been

between 6-12 months. During this wait time individuals commonly experience a variety of issues

relating to income, housing, health and social stability. Specific support is required to ensure the

person makes appointments, responds to mailings, attends medical appointments, maintains Ontario

Works income and attends their hearing date. Support is also provided preparing the individual for their

hearing. Many report being nervous or scared of the process and require staff support to ensure they

will attend.

Major barriers identified included:

 Individuals being unable to follow through with and complete paperwork

 Lack of transparency of the Disability Adjudication Unit into the application and decision making

process

 Lack of clear language in Disability Adjudication Unit communications

 Lack of any relevant information provided by the Disability Adjudication Unit when an individual

is denied

 Limited access to health services

 Difficulty for the person to comprehend the application and appeal process

 Difficulty to obtain medical information

 Lack of insight of the person into the into impact and scope of their disability

 Difficulty of the person to stabilize their live during Social Benefits Tribunal wait period

 Difficulty of the person to comprehend and respond to correspondences

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Access in Rural Communities

Rural communities faced particular barriers. 22% of the people being serviced reside in rural

communities. These communities include; Uxbridge, Port Perry, Beaverton, Cannington, Sunderland

along with many other small towns and hamlets. Particular challenges are faced individuals with

disabilities residing in rural communities. A majority of these issues relate to geographic access as

many must travel long distances to obtain services and most have limited access to public

transportation.

Individual Locations
Oshawa Whitby Pickering Ajax Clarington Rural Locations

23%
48%
6%
11%
8% 4%

Available services in northern and rural areas are fewer and more dispersed than in the more densely

populated southern areas of Durham Region. Due to the disability and limited income most individuals

supported have no vehicle and only can access limited public transportation options. In many cases, if

the individual did not live close to the bus route, even the limited transportation service was too far for

them to reach on foot.

People residing in northern, rural and remote areas of Durham Region are faced not only with fewer

health and social services, but with a limited number of practitioners who can provide services. Often

people were required to travel out of the Durham Region to receive medical support.

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Barriers faced in northern/rural communities included:

 Accessibility to services and transportation

 Geographic distance and limited services in rural communities

 Limited knowledge of available services

 Lack of access to health care and health care professionals

Page 23 of 38
Specific Impairments

Cognitive Impairments

From the inception of the program staff discovered a majority of individuals reported cognitive

conditions interfering with their abilities to function in the community. Those suffering from cognitive

impairments represent 70% of the people of connected with the program. These individuals include

those with acquired brain injuries, learning disabilities, developmental issues, and unknown

impairments. Often these individuals reported long histories of difficulties including challenges in

school requiring special education. When asked, the client would often report serious injuries,

educational challenges, behavioural issues or illnesses they felt were still impacting them today. 53.5%

of individuals reported that a medical professional was not treating their cognitive condition and a

majority of individuals stated that their family doctor was not even aware that the barriers existed.

Difficulties accessing medical services is consistently present as an issue with individuals reporting

cognitive related conditions. Of these individuals, 24.2% of these individuals had no family physician

when they connected with the program. The major challenge faced is a gap in medical services for

individuals with cognitive conditions. Psycho-educational assessments are not available health

services in Durham Region. Individuals have been able to access private diagnostic assessments paid

for by the Region of Durham’s Income Support Division. These assessments cost an estimated

$1300.00 through Durham Region Social Services and are paid for when a client is unable to have a

doctor complete their forms. Client’s physicians often do complete the ODSP application but usually

lack significant evidence relating to cognitive conditions. As a result, the application is often denied.

Individuals being serviced by the program have displayed long term difficulties accessing income

without support. At the time of intake, 28% of individuals supported by the program had no income

source and 79% of individuals required Ontario Works Income Support as their only source of income.

Alarmingly these individuals often required Ontario Works Support over extended periods. 60% of

Page 24 of 38
individuals had been on Ontario Works for more than one year, 32% had been a recipient for more than

5 years, and 10% for more than 10 years. Of the individuals with cognitive conditions, 82.8% were

unsupported by any community based services. They report high levels of isolation, and report being

unaware that support in any fashion was available to them.

Clients with Cognitive Conditions

Income Support(Time on Ontario Works)

90

80

70

60

50

40

30

20

10

0
No Income OW 1 year 5 years 10 years

Brian: Case Example 4

Brian contacted the program after struggling for 10 years to obtain employment. He was dismissed
from over 20 jobs in the past 10 years and had struggles in school and in the community. At first
contact he had no financial support and was suffering from unknown learning/cognitive barriers. He
had no family doctor during his adult life and his medical history was unclear.
Brian stated that he suffers from severe ADHD and was seeing a psychiatrist to renew his medication.
Brian was supported to obtain a family doctor and staff attends these appointments with him. Without
support Brian frequently would miss medical appointments and shortly after contact with program lost
the support of his psychiatrist when he had missed too many appointments. He would also frequently
let his prescriptions run out and need to renew them after they are empty. Staff met Brian at Ontario
Works and Brian was referred for a psycho-educational assessment. The assessment revealed

Page 25 of 38
significant cognitive barriers, along with a major diagnosis of ADHD. An ODSP application was
submitted but at this point the response is pending approval.
Staff currently meets with Brian weekly to maintain a schedule and complete the requirements of
Ontario Works. Whenever possible all medical appointments are attended with staff support so Brian
can remember his instructions.

Mental Health and Addictions Barriers

A majority of individuals connected to the service disclosed mental health conditions that contributed to

their need to apply for income support. Of those connected 68% reported having mental health

conditions. These conditions were often accompanied by other cognitive and health impairments.

Barriers reported included; severe anxiety, depression, obsessive-compulsive disorders, panic

disorders, and behavioural disorders. The disorders often resulted in low levels of medical care as the

person struggled to build trusting relationships in the community. Only 8% of these individuals were

seeing a psychiatrist, while 28% required support attending and medical appointments. 84% were not

receiving support for any community support services at the time of first contact. A majority of these

individuals lacked a family physician and a large number require staff support attending medical

appointments.

Of those connected, 22% reported addictions issue, often requiring methadone treatment. These

individuals almost universally had accompanying mental health and cognitive impairments, which made

recovery and support an increasingly difficult process. Along with this a high number of these

individuals required support obtaining identification, including obtaining a health card. A majority also

reported long term struggles at work and school and a high percentage also reported cognitive deficits,

and low literacy levels.

Page 26 of 38
Gary: Case Example 5
Gary was a young man living North Durham with no income. He contacted our program after
unsuccessfully applying for Ontario Works and was living with no income at the time he contacted the
program. He had worked at several jobs but always quit due to what Gary called feeling of panic and
attacks from his peers. He did have a family doctor, but had not been to see him in several years.
TSC staff attended a meeting with Gary at Ontario Works and were able to obtain the income support.
The reason Gary was denied in the past is he inaccurately explained his school history making him
ineligible under Ontario Works legislation. Staff investigated Gary’s medical history and attended an
appointment with his family doctor. The doctor stated that although he had treated Gary for
significant behavioural issues as a child, no current file existed on his health. The doctor did confirm
that as a child Gary was unable to live and home and his behaviour resulted in him having to live in a
group home setting on several occasions. Despite this intervention no records were kept by the family
or the doctor. Staff contacted Ontario Works and was able to advocate for a psycho-education
assessment of Gary. This resulted in the ODSP package being completed. The assessment revealed
possible psychosis or Asperger’s disorder to explain the historical issues Gary was having. The doctor
also concluded that Gary was not employable at this time. His application was approved within two
weeks.
Gary had never filed income taxes and staff completed his taxes from 2002-2009 with over $4000.00 in
refunds owing to him. Gary was also supported in filing for bankruptcy since he had accumulated a
large amount of credit card debt when he had no income. Currently, staff are working with him to find
a new housing option as he still lives with his parents. Despite the diagnoses, no long-term
community support service has been located, since his conditions cannot be confirmed.

Page 27 of 38
Data: March 2011

Total Number of Individuals that Received/Receiving Support: 157

Income Support: All Individuals

Detail Number % Comment

ODSP/CPP Applications 89 57% Includes only applications completed with staff
Completed support
Appeals Filed 67 43% Includes number of Individuals who have been
supported in making internal review/SBT
requests(maximum one individual counted per
appeal)
Applications granted 50 or 32% ODSP/CPP files granted at any stage-
47 30% Note that 3 Individuals had both CPP and ODSP
files granted
Individuals with 127 81% Includes all individuals who have completed an
applications completed application
or granted
Final decisions lost SBT 2 1.3% Individuals at this stage are offered support to
reapply

Client Conditions

Detail Number % Comment

Individuals with 110 70% Includes Individuals with conditions like
Cognitive conditions Acquired Brain Injury, developmental
disabilities, learning disabilities, and unknown
cognitive impairments. % indicate percentage
of total caseload that have identified cognitive
difficulties
Individuals With Mental 103 66% Include all Individuals reporting mental health
Health Conditions concerns
Individuals With 32 20% Includes all Individuals who reported learning
Learning Impairments impairments
Individuals from Rural or 34 22% Individuals from rural/north Durham mainly
North Durham being serviced by Uxbridge OW office
Individuals on OW 108 69% Client of program who have been on Social
income Support for more Assistance for more than 1 year
than 1 year
Individuals who required 27 17% Client that were support in locating a new family
support locating new doctor
doctor
Individuals with no 123 78% Individuals who had no additional community
support at initial contact support at first contact

Page 28 of 38
Cognitive Conditions: Stats only concern Individuals who identified cognitive
impairments/barriers
Cognitive Related Number
Individuals with
Cognitive conditions
Individuals with no
doctor
Individuals supported to
obtain new doctor
Individuals whose
cognitive condition was
untreated
Diagnosis obtained
Individuals with cognitive
impairments that have
completed ODSP/CPP
application
Individuals who have
accessed specialist for
their cognitive conditions
Individuals granted
ODSP/CPP income
support
Individuals with no
income
Individuals on OW
Individuals on OW 1+
years
Individuals on OW 5+
years
Individuals on OW 10+
years
Individuals receiving no
service support at first
contact with TSC
program
% Comment
110 70% Includes Individuals with conditions like Acquired
Brain Injury, developmental disabilities, learning
disabilities, and unknown cognitive impairments.
% indicate percentage of total caseload that have
identified cognitive difficulties
27 25% Number of Individuals that had no family doctor at
time of first contact with TSC program
26 24% Individuals that found new doctor with support of
Transitional Support Staff
62 56% Individuals who reported no current/historical
treatment for cognitive conditions at time of first
contact with TSC program
25 24% Number of Individuals that were diagnosed with a
cognitive impairment with support of TSC
program
79 72% Individuals whose completed ODSP/CPP
application is being supported by TSC program
25 23% Individuals whom received support accessing
medical specialists for cognitive related condition
37 34% Individuals who were granted ODSP/CPP while
supported by TSC program
32 29% Client whom had no source of income at first
contact with TSC program
86 78% Individuals receiving OW support at any time
during TSC service
66 60% Individuals who were receiving Ontario Works
Support for over one year
38 35% Individuals who were receiving Ontario Works
Support for over five years
12 11% Individuals who were receiving Ontario Works
Support for over ten years
93 85% Individuals not in contact with any community
support service when first in contact with TSC
program
Page 29 of 38
Program Targets

Quantitative Outcomes

Individual data reported below reflects service delivery for 18 months at 5 days per week with one full

time employee. The TSC supported a total of 157 individuals during this reporting period. As of March

31, 2011, the program is not accepting new intakes and has 113 active participants with 46 who have

exited the service after completing their goals or have lost contact with the service. 129 or 81% of

individuals have completed their ODSP application package, while 62 have been supported in obtaining

ODSP or CPP income support. Of the 62 successful candidates/applicants, many continue to receive

staff support adjusting to ODSP funding or stabilizing their lives because no additional supports are

available. The TSC continues to work with the remaining individuals still connected with the service to

complete the income support packages, while 31 who have already been granted continue to be

supported through the transition. 64 final decisions from the DAU/SBT had been received. This

includes all applications that were granted from the original application, the internal review, and at the

Social Benefits Tribunal. Three applicants were denied at the SBT and all have been offered support

completing a second application.

There are still 70 individuals, as of March of 2011, who are either waiting for their initial ODSP decision

or continuing to struggle to complete the application. These individuals would also include those who

are lost contacts, unable to maintain contact with the program, and those who, with support, managed

to return to work or attend school. With the support of a staff member the overall approval rate of the

ODSP applications is anticipated be very high, but it appears that the rate improves greatly if they are

supported from when the original application is submitted. When individuals are supported in building

foundational relationships with medical professionals, supported in maintaining their income and given

a resource for their day to day issues, the program has great success.

The TSC is working with 28 individuals who do not yet have an ODSP application package completed.

More than half of these individuals have been lost contacts that only had one meeting with staff and

Page 30 of 38
could not maintain the support. In the other cases the TSC is still building a trusting relationship with

the individuals or is in the initial stages of helping them to secure the resources they require before

submitting an ODSP application. A considerable amount of effort is invested in assisting individuals to

obtain a doctor and the medical documentation to support their application.

Income at Intake
Ontario Work s No Income CPP-D Employment ODSP

4% 3% 1%

20%

72%

At this point the TSC program works and average of 122.86 hours providing direct service for

individuals per month.

The majority of this time is one on one service where the staff and the individual are working together,

but it also includes indirect service, and phone support. Indirect service often includes writing letters,

completing income taxes, organizing information, arranging transportation and placing calls to income

and medical support services. The high number of service hours along with the high volume of intake

makes it apparent that there has been strong demand for a community based support worker to assist

with the income application process. 60% of the referrals to the program have been from Ontario

Works demonstrating that there has been significant need for the resource within that service. Due to

the high numbers, intake has not been continuous, making it impossible to assess the total need in

Durham Region.

Page 31 of 38
Along with the direct goals of the program, the goal was to have a direct impact on the overall well-

being of the people being serviced.

Added Value

 49 individuals have been supported in filing their income taxes and 117 income tax returns

have been filed

 59 individuals were provided support in obtaining accessible transportation and

transportation funding

 28 individuals have received Special Diet Allowances

 3 have obtained the Trillium Drug Plan

 19 had no income and were supported in obtaining Ontario Works

 68 individuals were supported in dealing with Ontario Works suspensions

 27 individuals were supported in obtaining a family doctor

 26 individuals have received medical assessments(with diagnosis)

 10 individuals have applied for the Disability Tax Credit

 21 individuals have been supported to obtain Community Start-up funding

Total Number of Individuals that Received/Receiving Support: 157

Income Support: All Individuals

Detail Number % Comment

ODSP/CPP Applications 89 57% Includes only applications completed with staff
Completed support
Appeals Filed 67 43% Includes number of Individuals who have been
supported in making internal review/SBT
requests(maximum one individual counted per
appeal)
Applications granted 62 or 40% ODSP/CPP files granted at any stage-
59 38% Note that 3 Individuals had both CPP and ODSP
files granted
Individuals with 127 81% Includes all individuals who have completed an
applications completed application
or granted
Final decisions lost SBT 2 1.3% Individuals at this stage are offered support to
reapply

Page 32 of 38
Qualitative Outcomes

The mobile support of the TSC allows for hands-on accessible services for the individuals application

along with opportunities to explore supporting them in other areas. The service coordination benefits

people in all basic life areas including, health, housing, recreation, access to food, and income security.

While supporting the person with the application, staff also can set up appointments with food banks,

refer to additional support services, set up counselling appointments, arrange transportation, or provide

any other support needed. Rarely is the support solely focused on the income support application and

people involved found that having an accessible staff resource led to vast changes in several areas of

their life. It also provides a support service that an individual can trust. The initiative enhances the

effectiveness of other services that are involved, improving access and communication. Staff will place

phone calls for people reluctant to follow through with service referrals or contact Ontario Works to

maintain their income when they lack the comprehension or patience to follow up on communications.

The TSC is able to reach out to marginalized individuals in the community and found that the majority of

those in contact with the program were unsupported by any other support services. The program has

connected with people who, often for many years, have been isolated and have been unwilling or

unable to establish support. This includes many who were recipients of Ontario Works for years and

even decades. These people often have significant mental health or cognitive impairments which

directly impacted their ability to access medical services and navigate the ODSP application process.

Many lacked basic literacy skills and require staff to read their mail for them. Referrals from Ontario

Works have identified these individuals who have been long-term recipients with apparent disabilities,

but who never completed the application process. As an accessible community based service, people

serviced related well with staff and found community or home based setting more comfortable and

accommodating. The less formal atmosphere appears to increase long-term connection.

The relationship that is developed between the TSC and the applicant can be quite intense and staff

has needed to be cautious not to establish dependencies that could not be sustained in a pilot project.

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Individuals were encouraged to play as large a role as possible in their own life and staff made efforts

to establish cues and reminders to improve the person’s ability to function independently. The

information shared during the support often included intimate materials, often relating to trauma, and

was sometimes difficult for the applicant to acknowledge and share. Staff would support and

encourage those involved to connect with counselling and other social support services to deal with

issues that had often never been addressed. This would lead to referrals to long term medical and

social services once it was determined that the participant would qualify for support. Many sustainably

connected to the program would form a very trusting relationship with the staff and rely heavily on their

support for other areas of their life. The TSC could then facilitate the building of relationships between

the individual and the various professionals that they met during the application process. Staff also

encouraged them to access informal supports and friends and family often joined in on meetings in

order to improve their ability to support their loved one.

These strong service relationships proved to be increasingly valuable when building working with the

family doctor, and staff could support the physician by communicating that a patient also had memory

or literacy deficits, which they then would accommodate. In some cases, it has taken several months to

establish a relationship with individual or medical professionals to complete the application. In other

scenarios the process is short and seamless with the person completing their application and being

granted fairly quickly with minimal support required. Common concerns/issues of those connected

with our program are;

 difficulties recognizing their own impairments

 feeling intimidated by doctors and health professionals

 fear of being hospitalized and fear of being medicated

 inability to comprehend the requirements of the ODSP application process

 lack of literacy or ability to comprehend communication with income support services

 inability to advocate for oneself

Page 34 of 38
These are all valid issues that this designated support service have been able to address. By working

directly with people in the community, staff has the opportunity to be an advocate for the person in

doctors’ appointments or income support services, participating in meetings, reviewing mail and

providing support returning phone calls. Situating the TSC in the community enables them to devote

substantial time on individual relationships, and offering intensive support and accessible services have

been critical.

Medical Support

The struggle to find a doctor is being experienced by many people in Durham Region and often people

connect with our program after years of being unconnected to stable medical services. Many rely on

walk in clinics and the emergency rooms as their primary medical care. Those who are trying to find a

doctor will tell you that doctors accepting new patients are often looking for relatively healthy,

predictable, easy to serve patients who have few demands. They also spoke of not being able to

articulate their needs or not being aware that cognitive or mental health impairments are something that

they should share with medical staff. Accessing a family doctor was increasingly challenging when an

individual had an addiction issue or required narcotic medication for their conditions. It continues to be

unlikely that a family doctor will prescribe narcotic medication and getting support for patients that

require these medications for legitimate health issues is increasingly difficult.

The TSC has experienced a number of occasions where they had referred individuals to doctors who

refused them service despite accepting patients. This improved; however, when staff attended

appointments with the potential patients. Over time, the TSC developed strong relationships with

medical staff in the community and supported the doctor in treating patients that are more difficult. Staff

knowledge of available medical professionals is expanding as well and knowledge of what clinics would

be more accepting to these potential patients is also growing. Equally as challenging was supporting

those who had family doctors, but had a poor or estranged relationship with them. Many individuals

receiving support had not seen their doctor in years or had never addressed major cognitive or mental

health concerns.

Page 35 of 38
The lack of medical support is a major barrier, and does prevent many from securing better financial

assistance. Once a relationship is established and the doctor is starting to know the individual, the TSC

could often complete the application and obtain the doctors support if appeals or Social Benefits

Tribunal Hearings were necessary. Staff would ask the doctor what materials they would need to

complete the application and would support the individual in completing requests for previous medical

records and school records if necessary. Staff can also relay how the person interacts in the

community and can explain the barriers that they may have, that a family doctor would never have the

opportunity to see.

Medical assessments can sometimes be arranged for people through Ontario Works funding. This

was most often utilized when the person suffered from an unknown or undiagnosed cognitive

impairment, and allowed the individual to meet with a psychologist to determine specific barriers and

whether an application for disability income support would be appropriate. When these were arranged

staff would ensure that the individual attend the appointment and would often go over the results with

them.

When an individual has a doctor, it can sometimes be difficult to obtain the doctor’s support for an

ODSP application. Doctors have limited contact with their patients and see them in a specific setting

over brief periods. The impact of the individual’s condition on their daily living might not be apparent to

the doctor especially when cognitive or mental health impairments are involved. Our initiative provides

a resource medical staff can use to learn more about their patients. Staff are able to relay information

on the persons struggle in the community and this can be reflected in the application

Financial Assistance

The partnership that the TSC developed with Ontario Works staff has been crucial to the success of the

project. At first, the relationship was expected to be challenging, as TSC staff often would assuming

the role of advocate and be required to challenge the positions of Ontario Works staff. However, what

has developed is a partnership where the TSC can enhance the ability of Ontario Works workers to

respond to individuals who have been on the service for a long time and clearly have a disability. Their

Page 36 of 38
numerous challenges have resulted in an inability to successfully apply for ODSP or respond

appropriately if unsuccessful. Feedback from Ontario Works staff has been very positive. The initiative

successfully supported ODSP applications for many long-term Ontario Works recipients, individuals

with mental health problems, cognitive disorders and individuals who have a hard time following

through with Ontario Works requirements . In many cases, the Ontario Works staff had tried but not

succeeded in having the individual successfully apply for ODSP. The TSC, being in the community

with more time to devote to one on one individual contact and engagement, was able to facilitate this

process.

The Disability Adjudication Process also requires the extensive support of staff. On average it took 7.9

months for all participants in the program to receive a cheque from ODSP from their initial application.

Applications granted on initial submission generally took 5 months for the individual to receive a

cheque, while those needing to appeal took 14 months to get their response and first ODSP cheque.

The TSC has individuals who were denied in March of 2010 and who, by May 2011, have not yet had

their hearing with the Social Benefits Tribunal. In the past many of these clients missed their hearings

after the long wait.

The relationship the Community Legal Clinic was also essential. The TSC service could respond to

legal workers, when an individual was not reachable, required further documentation, was struggling to

keep appointments, or was afraid of the hearing process. Staff would refer (and accompany) the

individual to a Community Legal Clinic to prepare for a Social Benefits Tribunal appeal. Over the

course of this project staff represented some individuals at their hearing, when Legal Clinic Services

were unavailable. Staff would also support people to draft letters when they felt they were being

treated unfairly by the adjudication process. Most often concerns arose at the lack of context for

decision made by the ODSP adjudication process. Each applicant is denied with the same letter where

only the name, date, and member ID were different. Staff would support the client in pointing out that

accessibility law, requires clearer communication than is provided and that individuals have the right to

see all documentation the DAU has on them. Often the client would request support writing the DAU

Page 37 of 38
to find out why they were denied and why they are not provided information that is clear. Unfortunately,

although many individuals were granted benefits following their letters their questions were ignore by

the adjudicators and answers were not provided..

.Most of the people who have been granted ODSP contact the staff for ongoing support. Whenever

possible staff refer to long term services and on occasion extend services when the individual has no

options for additional support. This is a particular challenge when no alternative long-term support is

available, especially when the person’s condition is not represented in one of the social service

“silos”(referring to support services specializing in Brain Injury, Mental Health, Developmental

Disability). Referrals are not always successful, as some individuals have difficulty making connections

to new services.

There is concern that once on ODSP, the individuals served by the TSC project will struggle to maintain

their benefits if they do not have support to deal with the requirements. Community workers already

hear from many ODSP recipients about how fearful they are about losing benefits. Every letter or

communication from ODSP causes panic in some recipients and the need for an established long term

support has been suggested. Continued efforts from community organizations are necessary to

establish long-term supports for many connected with the program.

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