Operational guidelines for the Host Family Program

Effective April 1, 2016

Introduction

Ontario’s Host Family Program, previously called the Family Home Program, enables adults with developmental disabilities to live in a home with non-family caregivers who can provide them with care, support and supervision. Like all developmental services funded by the Ministry of Community and Social Services (MCSS), the Host Family Program is informed by the strong belief that people who have a developmental disability are members of the community and that their independence, dignity and right to self- determination must be respected and fostered.

The overriding goals of the Host Family Program are to:

• provide a safe and secure place where adults with developmental disabilities can live in a family-home setting
• promote a high quality of life
• support community involvement, social inclusion, individual choice, independence and rights and responsibilities

Policy directives

MCSS provides funding to service agencies to administer the Host Family Program for adults with a developmental disability. In accordance with the Services and Supports to Promote the Social Inclusion of Persons with Developmental Disabilities Act, 2008 (SIPDDA), the ministry developed a set of policy directives for service agencies that provide the program. These directives are enforceable by law and provide minimum standards that agencies must meet in the administration of this program.

The MCSS policy directives cover four areas. These are:

1. minimum requirements in the screening process for Host Families
2. minimum requirements to include in the service agreement with the Host Family
3. minimum requirements for ongoing support and oversight of Host Family placements
4. remuneration to the Host Family

Operational guidelines

The ministry has developed operational guidelines to assist agencies in complying with the policy directives for the Host Family Program and to promote a provincially consistent delivery model for the program. These distinct guidelines have been developed to support and complement each of the four policy directives, by setting out guiding principles, best practices and options for consideration.

Application

The Operational Guidelines for the Host Family Program were developed in consultation with a working group composed primarily of representatives from service agencies. The operational guidelines take into consideration the fact that agencies need some flexibility in order to meet the unique needs of individuals with developmental disabilities, and to accommodate local needs and available resources. With this in mind, the operational guidelines provide agencies with practical and implementable considerations, best practices and tools for administering the Host Family Program.

The policy directives require agencies to have written policies and procedures on a variety of topics. Agencies are strongly encouraged to develop clear, written policies and procedures for the delivery and administration of all aspects of their Host Family Program, rather than addressing only the requirements specifically set out in the policy directives.

Agencies are encouraged to use a risk-based approach to guide their delivery of the Host Family Program. When assessing risks, agencies are encouraged to ask questions such as:

• Are there any concerns that could have an effect on the health or safety of the individual with a developmental disability?
• Are those concerns being addressed, or not being addressed, appropriately?
• If something were to occur, what would be the impact?
• Given any concerns, what measures should my agency put in place to mitigate the risk(s)?

The answers to questions such as these should inform the development of agency policies and procedures and guide decision-making.

Definitions

For the purposes of the Operational Guidelines for the Host Family Program, the following definitions apply:

Adult: A person who is at least 18 years old.

Agency staff: Employees of the service agency who may set up and supervise program and/ or support arrangements and complete other functions as outlined within the agency’s service agreement with the host family provider(s).

Caregiver respite: Services and supports that are provided to, or for the benefit of, a person with a developmental disability by a person other than the primary caregiver of the person with a developmental disability and that are provided for the purpose of providing temporary relief to the primary caregiver of a person with a developmental disability.

Family member: A parent, child, sibling, spouse, common-law partner, adoptive parent, adopted child, stepparent or stepchild.

Home study: An assessment process including a series of required interviews and checks conducted to determine whether the potential host family and their home are suitable for the Host Family Program.

Host family: A family composed of one or more persons in which an individual with a developmental disability who is not a family member is placed by a service agency with the host family to reside and receive care, support and supervision and for which the host family receives remuneration from the service agency.

Host family residence: The residence of a family, composed of one or more persons, in which a person with a developmental disability who is not a family member is placed by a service agency to reside and receive care, support and supervision from the host family in exchange for remuneration provided to the host family by the service agency.

Individual: An adult with a developmental disability who is eligible to receive services and supports under SIPDDA and is planning to reside, or is residing, with a host family.

“Natural connections” (to the individual with a developmental disability): The connections made as a result of residing with a family in a community setting, attending community events which may include day-support activities and could also include relationships with biological family.

Operational guidelines: Operational Guidelines for the Host Family Program.

Placement: The arrangement made by a service agency for a person to be supported in a home and for which remuneration is provided to the family providing the support.

Policy directives: Policy Directives for Service Agencies regarding the Host Family Program.

Police records check: A record of a person’s involvement with the police obtained through a search of police databases and shall include the vulnerable sector check.

Primary caregiver: The main person responsible for the support and care of an adult with a developmental disability. The designation of primary caregiver may extend to the spouse/ partner of a primary caregiver.

Service agreement: An agreement, prepared by the service agency and entered into between the service agency and the host family, pertaining to the provision of services and supports for an individual with a developmental disability.

SIPDDA: Services and Supports to Promote the Social Inclusion of Persons with Developmental Disabilities Act, 2008. The legislation sets out rules for agencies and people that receive funding from the Ministry of Community and Social Services for adult developmental services.

Vulnerable sector (VS) check: This process verifies whether an individual has a criminal record, or record suspensions (formerly pardons) for sexual offences and local police records for information relevant to the VS check. The information that can be legally disclosed is provided to the applicant.

Operational Guideline 1: Screening process for host families

Policy Directive 1.0 requires agencies to screen prospective host family providers in order to assess their suitability to provide for and support an adult with a developmental disability. Note that screening a prospective host family is a process that occurs prior to the matching process1^{footnote 1[1]}

Agencies must have written policies and procedures on the key considerations they must take into account when developing screening criteria for potential host families. These include the family’s:

• willingness and motivation to accept the individual as part of their family
• physical, mental, social and emotional capabilities to meet the needs of the individual
• aecure financial status with adequate income to provide for the needs of the household
• auitability based on factors such as, but not limited to, the individual’s goals, interests, social connections, health and safety needs and cultural/linguistic, religious background; physical attributes of the home and its surroundings, proximity to natural family members
• vailability and willingness to participate in orientation, training, and ongoing monitoring and evaluation activities, as outlined in agency policies and procedures and the service agreement

Potential host family providers must be screened in a non-discriminatory manner. Agencies will need to apply a level of judgement in the process of screening, based on the review and assessment of the potential host family, whether the family’s home and property seem appropriate for an adult with a developmental disability, the family’s experience with adults with a developmental disability and any associated risks that may come to light in the assessment process. A family’s motivation for supporting an adult with a developmental disability and its willingness to provide a long-term living arrangement should be a key consideration. While the suitability of the primary caregivers is of paramount importance when conducting the screen, the suitability of all members of the household should be taken into consideration.

Agencies should screen potential host family providers based on the family’s written application^{footnote 2[2]} followed by a series of interviews and physical study of the home. All aspects of the screening process must be thoroughly documented and kept on file for at least as long as the family continues to participate in the Host Family Program.

Screening criteria

Physical, mental, social and emotional capability

The policy directives require service agencies to consider a prospective host family’s physical, mental, social and emotional abilities to meet the needs of an adult with a developmental disability. In making this assessment, agencies should consider the host family in its entirety, considering both risks and opportunities. For example, a potential host family with a primary caregiver who has minor mobility challenges might possibly be considered as a match to an individual who does not need physical support (e.g., lifting and transferring).

Secure financial status

The policy directives require that agencies take into account whether the family has a “secure financial status with adequate income to provide for the needs of the household”. While agency staff should be sensitive, respectful and tactful when assessing a family’s financial security, they should consider the following:

• the family should demonstrate sufficient financial means to meet financial pressures that may be created by adding an adult with a developmental disability to the household
• the family’s motivation for becoming a host family provider should not be based solely on the remuneration (per diem) that would be received from the program
• the family should not be solely dependent on the remuneration from the program and should be able to demonstrate additional sources of income upon request

Agencies should use a risk-based approach to developing screening criteria for assessing a potential host family provider’s financial security. An agency may consider requesting that the family provide documentation, such as a letter of employment, which would support the assessment of financial security.

Caps

The policy directives allow for no more than two placements in a Host Family’s home. This includes adults who have been placed by an agency funded by the Ministry of Community and Social Services and children placed in the home where the home is also a foster home under a foster care licence issued by a Director for the Ministry of Children and Youth Services. This cap does not apply to short- term caregiver respite placements that are less than four consecutive weeks per year. The ministry recognizes that some current host family arrangements predate this new rule. For that reason, arrangements existing prior to April 1, 2016 where there are more than two placements need not be affected, at the agency’s discretion.

The directives do allow for exemptions to the cap in certain extenuating circumstances. These are:

• Where the foster family has more than two foster children and where one of those foster children has a developmental disability, and would continue to stay with the foster family as a Host Family Program placement after he/she turns 18 years of age. Where this exemption applies, no additional placements for adults or children beyond those allowed by the above exemption are permitted.
• When there is a need to provide a temporary or interim placement on an urgent or emergency basis for an individual in the Host Family Program who cannot stay in his/her current placement.
• If there is common parentage (e.g., the sibling of an individual placed with the host family also seeks a host family placement).

There is no latitude for the agency to make exceptions to the cap beyond those specific circumstances identified in the policy directives.

Agencies are encouraged to consult with their regional office if they have questions or concerns about application of the cap vis à vis a particular host family arrangement.

Home study

The directives require agencies to conduct a home study of a potential host family and prepare a written report. It is important to note that this applies not just to new prospective host family providers, but also to families already hosting one adult with a developmental disability and who are looking to host a second individual.

Interviews

As noted above, interviews with prospective host family members (and adults with a developmental disability if one already lives in the home) form a critical part of the screening process. Through these interviews, the agency can:

• Gain insight into the family’s motivation to become a host family provider, assess the nature and quality of the family’s relationships and confirm the willingness of everyone living in the home to accept an adult with a developmental disability into the home.
• Assess the family’s “soft” skills, e.g., patience, adaptability, understanding, warmth, open-mindedness, acceptance, maturity, stability, commitment, integrity, cooperativeness and flexibility.
• Develop a holistic view of the family that considers family history, attitudes, lifestyle, outside interests and hobbies and philosophy on supports for adults with a developmental disability. This could include a discussion, if applicable, about pets in the home.
• Confirm the family’s expectations regarding smoking (both as it may apply to the family and the individual), alcohol and visits from the individual’s natural family and other guests, as appropriate.
• Discuss the family members’ experience and/or education regarding adults with a developmental disability.
• Ask questions and make observations that would help verify character references.

Driver’s record

In situations where a prospective host family may or will be transporting the individual in a vehicle, the agency may wish to consider requesting a driver’s record from the driver(s). Licensed drivers may obtain a three-year driver’s record from service Ontario.

It contains the following information:

• driver identification (e.g., name, driver’s licence number, date of birth, gender, height, class, conditions, but not address)
• licence status
• expiry date
• medical due date (controlled class only)
• earliest available licence date
• Active Highway Traffic Act and Criminal Code (Canada) convictions, suspensions and reinstatements over the past three years,
• the conviction dates and any demerit points accumulated
• active defaulted fine suspensions

Police records check

As per Policy Directive 1.3, agencies must review a police record check completed within the last six months, including vulnerable sector check of all adults living on a full-time or part-time basis in a potential host family home. This means that if an adult with a developmental disability is already residing in the home through a previous placement, the agency must also review a police records check with a vulnerable sector check for that individual before an additional adult with a developmental disability may be placed in the home.

Physical safety verification of the Hhme

Agencies are required to verify the physical safety of a potential host family’s home and property, whether owned, leased or rented.

Depending on the agency’s assessment of associated risks, the physical safety verification could include alternative dwellings, such as cottages or trailers.

Ideally, and where resources permit, the agency should consider sending two staff to conduct the physical review to augment the level of inspection on site. At minimum, staff should consider the following:

Entrances and exits to building/home

• Are there obstacles to the entrance(s) and exit(s), such as bushes or trees?
• Are the entrance(s), exit(s), steps and/or walkways well lit?
• Are there appropriate handrails on exterior stairways?
• Are the stairs broken, steep and/or narrow so they could be a potential hazard to the adult with a developmental disability?
• Is the driveway cleared of hazards?
• Are the walkways even, flat and not slippery?

Chemical/biological/environmental hazards

• Are the conditions reasonably sanitary and clutter free?
• Does the home smell fresh and clean?
• Are there signs of rodents and/or insects?
• Does the plumbing appear in good working order?
• Do the kitchen ventilation systems or range exhausts function properly?
• Are there any signs of mould in the house?
• Does the water source supply potable water?

Fall hazards

• Are there electrical, telephone or other cords placed in the flow of traffic?
• Are there slippery area rugs and runners on the floors?
• Do floors have loose or broken tiles?
• Do stairways lack appropriate handrails, and are the stairs in good condition?
• Do steps allow secure footing?
• Is there clutter around the home?

Fire hazards

• Are there electrical cords running beneath furniture and rugs or carpeting?
• Is there exposed wiring?
• Do receptacles and switches have appropriate cover plates?
• Are flammables such as gasoline, paints and solvents stored away from ignition sources?
• Are smoke and carbon monoxide detectors present, functioning and appropriately located?
• Does the home have a functional portable fire extinguisher conveniently located in case of emergency?

Information from a Property Information Statement or similar document may be useful to confirm that the property and residence do not have environmental or structural problems that may prove a hazard to an adult with a developmental disability. A checklist for structural concerns should include confirmation that:

• There are no obvious moisture/water problems or leakages in the home.
• Air conditioning and heating systems are in good working order and maintained. The agency may consider asking for confirmation of this.
• Woodstoves, chimneys and fireplaces are in good working order and are appropriately maintained, including regular chimney cleanings. The agency may consider requiring proof that the wood-burning system has been evaluated/inspected by a qualified body such as Wood Energy Technology Transfer Inc. (WETT). Building permits have been obtained where required for any renovations, additions or improvements to the property, as may be applicable and that the renovations have passed inspection once completed.
• The home meets all applicable bylaws of the municipality in which it is located and applicable requirements of legislation such as the Fire Code under the Fire Protection and Prevention Act, 1997 ^{footnote 3[3]}. If applicable, agencies should also confirm that any firearms on the premises are kept unloaded and stored separately from ammunition, in a locked cabinet.
• Where a property includes a pool or a pond, the water feature is in compliance with any local bylaws, including appropriately fenced and gated. Should the property be located on a larger body of water such as a lake or river, the agency should confirm that the family’s safety plan includes waterfront safety.

Basic health and comfort

Agencies should also examine the home for confirmation of basic health and comfort factors. These might include:

• Is the house kept at an appropriate temperature?
• Is the bedroom that would be used by the individual with a developmental disability appropriate to meet the needs of an adult with a disability?
• Does the bedroom include at least one window that opens and closes, and window coverings?
• Do sleeping accommodations include a bed of appropriate size with a suitable mattress?
• Do sleeping accommodations provide sufficient space to keep personal possessions?
• Are the toilets clean and functional?
• Is hot and cold water available from faucets in sinks, tub(s) and/or shower(s)? Is the water so hot that there could be a risk of scalding?
• Is there nutritious, fresh and appropriately stored food in the fridge and cupboards?
• Are litter boxes, cages, etc. clean and maintained? Have pets received recommended shots (e.g., rabies)?

Screening for part-time residents

The policy directives require that in addition to screening adults who live in the home full- time, agencies must also screen adults who live there part-time. Agencies should make a risk-based assessment of the impact on the individual in determining whether a houseguest is a part-time resident and so would require screening under the directives. At the time of the assessment, the agency should consider at least the following:

•  what is the length of time the guest is expected to be living in the home and with what regularity (e.g., weekends)? How much time will the part-time resident spend alone with the adult with the developmental disability?
• what is the impact, if any, of the presence of the part-time resident in the home? For example, are there financial implications? Is there a risk that the main caregiver will have less time to spend supporting the adult with a developmental disability? Has the living space been affected and, if so, what is the impact?

Reassessment

In addition to regular checks and monitoring, a reassessment of a host family provider must be conducted if a significant change in circumstances occurs – for example, a change in the health status of a host family member, or a decline in the family’s financial situation – such that care for the adult with a developmental disability is or is likely to be adversely affected. The policy directives contain a full list of circumstances requiring a reassessment. The agency must determine which elements of the home study should be reassessed based on the particular circumstances. Safety of the individual should carry the highest weight in any assessment.

In determining how the reassessment should be carried out, agencies should:

• determine the nature and extent of the change
• consider the appropriate screening criteria from the home study process to assess the change
• assess the potential impact/risk to the individual

Service agencies must ensure that host families advise them of changes in circumstances that would or could necessitate a reassessment. Where appropriate, agencies are expected to inform their ministry program supervisor of such changes. Where a change in circumstances may precipitate the need for the individual to move from the host family’s home, Developmental Services Ontario should also be informed.

Screening of caregiver respite providers

The screening of caregiver respite providers is clearly separate from the screening of host families, but still forms a critical part of the process to ensure that adults with a developmental disability are appropriately cared for and supported. Agencies must screen all respite providers, including members of the host family’s extended family or adult friends of the family. Screens should be triggered based on the service agency’s assessment of the risk associated with the host family arrangement.

In developing policies, procedures and processes regarding the screening of respite providers, agencies should take a risk-based approach that considers at least:

• the respite provider’s relationship to the individual and/or the host family
• the length of time that the individual would be alone with the respite providert
• the regularity with which the respite provider will provide respitet
• the location where the individual and respite provider may spend time together

Operational guideline 2: Service agreements with the Host Family

Directive 2.0 requires agencies to have a signed, written agreement with all host families prior to commencing a placement and lays out specific minimum requirements that the service agreement must include. Where a host family provides support to more than one adult with a developmental disability, it is left to the agency’s and family’s discretion as to whether one agreement could reflect both placements appropriately, or whether two separate agreements would be preferable. The agency may wish to include roles and responsibilities of the adult with a developmental disability in the agreement and include the individual (or his/her representative) as an additional signatory.It is suggested that the host family signatory be the primary caregiver.

Directive 2.0 applies to all host family arrangements, regardless of when they began. This means that any agency that does not have a service agreement with its host family providers that reflects the requirements in the policy directives is required to develop and execute one. The ministry recommends that service agencies seek legal advice when developing a service agreement template and develop a schedule for reviewing the agreements with host families. These service agreements between agencies and host families must address, at the minimum:

• the host family’s participation in orientation
• the host family’s participation in training.
• the host family’s agreement for the agency to conduct ongoing monitoring and physical safety reviews of the home and property of the placement, including home visits at least every 60 days with at least one annual unannounced visit to assess whether performance standards continue to be met
• the requirement for the host family to report any significant changes involving members of the family, the individual and/or the overall living situation.
• the host family’s requirement to report when a new person begins living in the home on a full-time or part-time basis.
• the host family’s requirement to report any other significant concerns that could affect the individual.
• the roles and responsibilities of the host family, include but are not limited to:
  • providing a comfortable and safe living environment and fostering the individual’s independence, dignity, self-determination, social inclusion and community participation
  • assisting the individual with health care, basic needs and other activities of daily living
  • Providing nutritious meals, snacks and beverages.
  • helping the individual attend school, work and social activities.
  • implementing components of the individual support plan according to the terms of the placement
  • maintaining financial and administrative records
  • participating in initial and ongoing training and reviews with the service agency at least annually
  • maintaining regular communication with the service agency and providing updates
• caregiver respite provided by the service agency where applicable, using only agency- screened respite providers
• confirmation of insurance coverage. This could include home, property, vehicle and liability insurance (agencies should encourage host family providers to discuss insurance needs with their insurance providers prior to finalizing any placement.)
• problem resolution and complaint processes
• changing/ending of placement

Conflict of interest

The Policy Directives for Service Agencies Regarding the Host Family Program require that the service agreement include ways to address actual or potential conflicts of interest. A conflict of interest can exist or be seen to exist where a person or organization is involved in multiple interests, whether financial or otherwise, and one of these interests could possibly negatively affect the motivation of the individual or organization. In the context of an agency/host family relationship, a conflict of interest could arise if, for example, a host family provider were also on staff at the agency or on the agency’s board of directors and thereby able, or be perceived to be able, to influence the agency’s policies and procedures, including the host family’s remuneration or processes regarding home visits. The service agreement should clearly outline how to address such concerns, including setting out clear roles and responsibilities for all parties.

Operational guideline 3: Ongoing support and oversight for Host Family placements

Policy Directive 3.0 requires agencies to have policies and procedures to support host families and monitor host family placements.

Orientation

Upon being accepted as a host family provider, agencies should provide general orientation that could include but is not limited to:

• the goals of the Host Family Program
• the roles and responsibilities of the host family
• the roles and responsibilities of the individual
• the roles and responsibilities of the service agency
• the policies and procedures of the service agency

Additional orientation should be provided to the host family and the adult with a developmental disability once a placement has been made. At this point, the orientation may be tailored to the needs of the individual as much as possible.

Orientation materials distributed typically include but are not limited to:

For the Host Family provider:

• a description of the Host Family Program, including philosophy and goals, organizational structure, applicable legislation, the role of the agency and services provided
• agency policies and procedures that are relevant to the Host Family Program, including complaints procedures, serious occurrence reporting procedures, information about the Services and Supports to Promote the Social Inclusion of Persons with Developmental Disabilities Act, 2008 (SIPDDA) and its Regulation on Quality Assurance measures (Ontario Regulation 299/10) and the Policy Directives for Service Agencies Regarding the Host Family Program
• the rights and responsibilities of the service agency, the host family provider and individual.
• the terms and conditions of the service agreement (once a placement is made, the service agreement template must be customized to address that arrangement)

For the individual and their natural family/designate:

• the purpose and goals of the placement/ program; provide information and supports to the person with a developmental disability regarding activities in their individual support plan
• mandatory orientation to the service agency’s mission statement, service principles and statement of rights
• roles and responsibilities of the provider, agency and individual
• a review of the service agency’s policies and procedures on privacy and confidentiality and consent to collection, use or disclosure of personal information in a language and manner and with a level of support that is appropriate to the capacity of the person with a developmental disability and with any person acting on their behalf
• mandatory education and awareness-building on abuse prevention and reporting to persons with a developmental disability receiving services and supports from the service agency in a language and manner that is appropriate to the capacity of the person with a developmental disability
• agency policies and procedures that are relevant to the Host Family Program, including complaints procedures, information about the Services and Supports to Promote the Social Inclusion of Persons with Developmental Disabilities Act, 2008 and its Regulation on Quality Assurance Measures (Ontario Regulation 299/10) and the Policy Directives for Service Agencies regarding the Host Family Program

The agency may also wish to provide host family providers with information, policies and procedures on topics such as:

• information on developmental disabilities
• information regarding challenging behaviour, medical concerns and sexuality issues
• information on the importance of developing independent skills and initiating community involvement for the individual
• person-centred planning and individual- support planning. Process and expectations for developing, implementing and reviewing the individual plan for the adult with a developmental disability that addresses the individual’s goals, preferences and needs, and agreements for service
• the rights of persons supported, as may be outlined in the agency’s statement of rights for people who are supported by the agency^{footnote 4[4]}
• training requirements
• record-keeping requirements
• systems of support for the home provider (e.g. host family staff support, vacation and planned respite, emergency back-up, etc.)
• process and expectations regarding ongoing monitoring and review procedures
• working relationships with the transfer payment agency, other service providers, the individual’s family and significant others
• pre-placement visits
• process and expectations to determine the amount and type of initial and ongoing supervision and support that will be provided
• problem-resolution process

Training

Service agencies are required to provide training on various topics to host family providers. As a best practice, training should be tailored to the host family provider and the individual being supported.

Training must be provided in the following areas:

CPR and first aid

The policy directives require that host family providers have at least one of the primary caregivers receive training to be certified in CPR and first aid at the beginning of the placement. The agency must make provisions for at least the initial training if the primary caregiver is not already certified. The service agency may also provide additional resources on CPR/first aid.

Abuse prevention, identification and reporting

The Regulation on Quality Assurance Measures (Ontario Regulation 299/10) under SIPDDA requires agencies to provide education and awareness building on abuse prevention and reporting to the adults with a developmental disability whom the agencies support. As a best practice, agencies may consider providing training on abuse prevention to host family providers as well.

Fire and emergency response planning

Host family providers should receive training about fire drill and evacuation procedures and receive information about basic fire safety procedures, such as keeping a conveniently located list of emergency telephone numbers. In addition, host family providers should be encouraged to develop fire safety plans and procedures that include identifying an accessible meeting place in the event of an emergency, how to use a fire extinguisher and a schedule for conducting maintenance on smoke and carbon monoxide detectors (e.g., changing batteries). Agencies are encouraged to review this plan with families on a regular basis.

Caregiver respite support

Caregiver respite can play an important role in sustaining a host family as they provide ongoing care and support to individuals with a developmental disability in their homes. Host family providers are required to use caregiver respite providers who have been screened and approved by the service agency. (See Guideline 1 – Screening for Caregiver Respite). Agencies are also responsible for making the necessary arrangements for caregiver respite as may be reflected in their service agreements with host families.

Change in circumstances support

Where there is a change in circumstances (See Guideline 1 – Reassessment), the service agency should work with the family to determine the appropriate action.

In some cases, the host family may no longer be able to continue supporting the individual in their home. In those cases, the agency should determine the course of action that best meets the needs of the individual and contact both the appropriate ministry regional office and the local Developmental Services Ontario office.

In cases where the host family have confirmed that they would like to continue to be a host family, the agency should determine the nature and implications of the change in circumstance, discuss options with the host family and the individual, and determine if and how the placement can remain viable with any modified support from the agency.

Relocation support

Where a host family has indicated their intent to move to a new residence:

• If applicable, discuss with the host family whether they wish to continue to support the individual in the new home/location, and discuss with the individual whether he/she would like to move with the host family to their new home/location.
• Advise the regional office. If the family is moving out of the catchment area, Developmental Services Ontario should also be informed.
• If the individual does not plan to accompany the host family to the new location or cannot be accommodated in the new location, the service agency should work with their ministry program supervisor to consider whether and how the individual may be supported and accommodated elsewhere.
• The agency responsible for overseeing the host family should conduct a physical safety verification of the host family’s new residence before the individual moves in; if the responsibility for overseeing the host family is transferring to a different agency, the new agency should conduct the safety verification.

Regular visits

Regular visits (at least every 60 days) are required to assess whether the host family is compliant with its contractual obligations, and that the individual with a developmental disability is living in a safe and supportive environment. The time gap between visits must not exceed 60 days. Using an approach similar to the original screening and home study process, regular visits should cover at least the following:

• Discussion with host family to assess the status of the placement; to identify issues and/or concerns with the placement; and/or to discuss other supports that the individual and/or host family may access.
• Discussion with the individual and his/her family/designate, as appropriate, to identify
• issues and/or concerns with the host family; and/or to discuss other supports that the individual may access.
• Discussion of any changes that have occurred since the previous visit and changes anticipated in the near future that have or will/ may affect the individual.
• Physical safety verification of the home.

The visits should also be used to identify and address needs for additional training and information on any aspect of the Host Family Program. Identified needs should be documented and a plan discussed with the host family and/or individual for implementation.

Unannounced visits

At least one of the required visits that must take place during the year must be unannounced. This is in order to provide a spontaneous “spot check” and assess the level of safety in the Host Family Program. Requiring at least one unannounced visit every 12 months^{footnote 5[5]} enables agencies to exercise greater diligence in monitoring that individuals with a developmental disability are living in a home that is safe and that they are supported in an appropriate manner by the host family. This requirement aims to balance the need for individual choice, independence and privacy with the need for enhanced and appropriate oversight of the Host Family Program.

Where geography or other factors make it challenging to conduct unannounced visits, the service agency could contact the host family to confirm the family’s availability over the next several days, without actually scheduling an appointment.

Extra monitoring

The service agency may determine through its risk-based assessment of the situation that monitoring, in addition to visits, is necessary. The agency may consider adding visits, or encourage the use of other options to keep in regular contact with the host family and the individual. This could include Skype, email and telephone contact.

Reporting

Agencies should have a process in place for host family providers to contact agency staff immediately to report issues of concern, such as serious injury, allegations of abuse or unexplained situations where the individual is absent from the home for a prolonged period of time. MCSS and MCYS have provided eight categories of serious/enhanced serious occurrences that agencies must report to MCSS and/or MCYS^{footnote 6[6]}.

The Serious and Enhanced Serious Occurrence Reporting Guidelines describe the process and procedures by which agencies must report both serious and enhanced serious occurrences. It is intended for use by service providers as an orientation for new staff, a refresher for experienced staff and a “quick reference” for those involved in serious/enhanced serious occurrence reporting.

Operational guideline 4: Remuneration to the Host Family

A guideline to support Policy Directive 4 will be developed at a future date.

Amendment and review

These operational guidelines are intended to be a living document and may be edited and updated at the ministry’s discretion to help keep the document relevant. The ministry will ensure that any updates to the guidelines reflect engagement with the sector and are distributed to all agencies. It is the responsibility of the agency to ensure that it retains and follows the most current copy. At the minimum, the operational guidelines will be reviewed whenever the policy directives are revised or every five years, whichever comes first.