Canada Pension Plan Disability Program The Importance of an Ongoing Return-to-Work Strategy: A Solutions Brief

Presented to: The Sub-Committee on the Status of Persons with Disabilities Dr. Carolyn Bennett, M.P. Chair Presented by: Ontario March of Dimes www.dimes.on.ca

April 2003

Contents Canada Pension Plan Disability Program The Importance of an On-Going Return-to-Work Strategy: A Solutions Brief

Section 1.0

Introduction and Executive Summary

Page 4

Section 2.0

Rationale for a Return-to-Work Strategy

Page 5

Section 2.1

Cost Savings

Page 6

Section 2.2

Caseload Management

Page 8

Section 2.3

CPP Eligibility Requirements

Page 11

Section 2.4

Integration with Provincial Programs

Page 13

Section 2.5

Social Development Goals and Public Policy

Page 14

Section 3.0

Summary of Recommendations

Page 16

Section 4.0

Appendix – Table 1

Page 18

Section 5.0

References

Page 20

Section 6.0

About Ontario March of Dimes

Page 21

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The Importance of Return to Work Services in the CPP(D) VR Program Section 1.0 Introduction and Executive Summary The mission of the Ontario March of Dimes (OMOD) is to assist people with disabilities to achieve a meaningful and dignified life. We strive through our services and activities to help create a society inclusive of people with disabilities. A major area of focus is the provision of employment services that enable people with disabilities to identify viable job goals, to secure the services they need to achieve those goals and to secure and maintain employment. Since 1997, Ontario March of Dimes has been a service provider to the CPP (Ontario) Vocational Rehabilitation (VR) Program. This brief will focus on the Return-to-Work (RTW) and VR strategy of the CPP, eligibility requirements and integration with provincial programs. Our main recommendations and accompanying rationale support enhancement of the CPP VR program. Ontario March of Dimes is in a prime position as a service provider to carry out such enhancements and expansion of the Program. Our experience as a service provider has been positive. OMOD staff report that they enjoy working with CPP clients. They also report that our clients are motivated to return to work so they can earn more income and participate more actively in their communities. Clients, for the most part, have positive relationships with CPP, characterized by few adjudicative disputes (such disputes are quite common in other insurance based benefits systems). In the experience of our organization, CPP staff members are knowledgeable, collegial and pleasant to work with. The range of services that clients can access is broad in scope; although, as we will illustrate, such services can be improved with some modest enhancements.

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Section 2.0 Rationale for a Return-to-Work Strategy In 1996, the Evaluation of the National Vocational Rehabilitation Project was published by Human Resources Development Canada. This report detailed the results of a comprehensive review of the CPPD VR Pilot Project. The Evaluation supported the implementation of a permanent rehabilitation function as part of the CCPD. Five reasons were given. 1.

Significant cost savings are possible, even with the rehabilitation of a small portion of CPP beneficiaries.

2.

Rehabilitation is an effective caseload management mechanism used by other providers of disability insurance.

3.

Several lines of evidence suggest that providing rehabilitation services could significantly increase the proportion of CPP clients who successfully return to work.

4.

CPP regulations support the use of reasonable rehabilitation measures to help clients regain the capacity to sustain regular employment.

5.

Rehabilitation serves social development goals of individuals (eg. employment, income, self sufficiency), goals supported by disability advocacy groups and government policy.

In the experience of the Ontario March of Dimes as a service provider to the CPP CR Program, these reasons are valid and relevant, and our recommendations will be based on each.

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Section 2.1 Reason #1 Cost Savings One purpose of Vocational Rehabilitation in an income benefits program is to reduce the costs of the program by returning beneficiaries to work. Direct cost savings result from the cessation of benefits. Indirect savings result from increased taxes paid by those clients who return to work and by decreased re-launch on other services. In addition, the savings derived from successful clients must cover the costs of unsuccessful clients. Theoretically, if a client returns to work and works continuously for twenty years, the savings to the Program amount to $186,480 (based on the average monthly CPP benefit of $777). OMOD data confirms that cost savings do occur. Table 1 (See Appendix, Page 19) illustrates the following: the number of clients served; number of clients who returned to work; maximum savings if each client worked continuously to retirement age; savings at 50% and 25% labour market attachment; and annual expenditures for all clients served by OMOD up to fiscal year 2001-02. Labour market attachment is a crucial issue. All clients who return to work are deemed to have “regained the capacity to work.” As a result, benefits cease and savings occur. Clients are eligible to apply for re-instatement of benefits but may not be successful. Other clients who successfully complete their programs but do not secure employment may also be deemed to have regained capacity to work--resulting in more savings to CPP. However, for real savings to occur to the benefit of society in general and taxpayers in particular, clients must actually be working. If they are not, they will receive benefits from CPP or from a provincial welfare or disability program. Our data indicates that real savings to CPP can be realized from clients who return to work and from those clients who maintain employment for as little as 25% of their remaining working life. For example, in Hamilton the Ontario March of Dimes served 35 clients during the period from April 1998 to March 2002. Total expenditures were $264,503. Ten clients of the 35 returned to work during that period. At 25% labour market attachment, projected savings are about $500,000. These numbers do not include CPP administrative expenses or client’s monthly benefits, which would be paid regardless of program participation. A further example highlights our work in London, where thirteen of 36 clients returned to

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work. At 25% labour market attachment, savings are projected at $786,000, compared to total expenses of $201,897. In fact, in all locations, substantial savings are projected at the 25% level. It is also noteworthy that in all locations, several of the clients who returned to work were relatively young. With these clients, potential cost savings are substantial because of the greater number of years to retirement age. Our demographic data indicates that the majority of the clients referred were younger than 45 years of age. Despite this, there is some evidence that CPP-D program spending has decreased. Ontario March of Dimes has been selected as a CPP-D service provider under all three Ontario Region RFP’s dating back to 1997. This process has reduced the number of service providers from five to two. Ontario March of Dimes should therefore see about 50% of the activity. Financial projections for the 2002-03 year indicate that spending on CPP-D clients will be about the same as previous years. Clearly, for cost savings to occur clients who return to work must continue to do so for at least a number of years. The experience of the Ontario March of Dimes, coupled with the rehabilitation literature, confirms that job retention rates need to be improved, especially for more severely disabled clients. The HRDC National Vocational Rehabilitation Report (1996) points out that rehabilitation success is measured by the number of completed rehabilitation plans and the number of clients employed in the short term. The report suggested that monitoring of longer-term employment outcomes is needed. Other research evaluating Supported Employment programs notes that many clients achieve intermittent employment, usually lasting only months, clients who may in fact secure two or more jobs during the study period. Furthermore, unemployment rates for people with disabilities remains high (as high as 80% for people with moderate to severe disabilities, An Even Break, OMOD Vocational Needs Study), thus confirming that attachment to the labour market is often tenuous. Conclusions and Recommendations Regarding Cost Savings •

There continues to be great potential for cost savings as a result of Return to Work and Vocational Rehabilitation services. Ontario March of Dimes recommends that CPP should continue these services.

•

Ontario March of Dimes recommends that CPP implement a system to measure longer term impacts of the program. This measurement is necessary to support continued service enhancements or expansions.

•

Most critically, Ontario March of Dimes recommendations that CPP should

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implement strategies to enhance the job retention and longer term labour market attachment. See our recommendations under Case Management later in this report.

Section 2.2 Reason # 2 Caseload Management In insurance-based benefits systems, Vocational Rehabilitation is the service that delivers cost savings. The method that drives the savings is Case Management. As noted above, lasting savings occur when clients secure sustainable, longer-term employment. Effective case management practices will enable clients to enhance their employability and their job security by targeting jobs that are in higher demand, and, whenever possible, jobs positioned above the entry level. This helps to defeat the “first in, first out” phenomena so frequently reported by job seekers with disabilities. CPP is a particularly strong program from a case management perspective for the following three reasons: 1. the Program emphasizes good planning, building on client input to identify a viable job goal; 2. skills development, such as formal or targeted training is funded fairly generously by the Program; and 3. job placement activities are comprehensive, including some limited measures to assist the client to make a successful transition to work and to increase the likelihood of job retention. However, once the client is deemed to have regained the capacity to work, the file is closed and CPP services and benefits cease. The underlying assumption in this practice is that once a client is prepared for work, and meets some job readiness criteria (such as the attainment of entry or prerequisite skills, and completion of a current resume), the job market will accept the client. For many clients, as we have noted, longer-term job attachment does not occur. The Ontario March of Dimes firmly believes that a better, more successful approach would to treat return-to-work as a process rather than an event that occurs at the end of

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a period of job readiness training. The case management model, therefore, needs to incorporate a broader perspective and include the concept of “placement ready.” Placement ready means that the client has a job goal and the skills required for that job. It also means that the client is willing to work for the prevailing wage and has made arrangements (such as child care, transportation, etc.) to ensure he or she can go to work regularly. Placement ready means that the case manager will ensure that the client receives the assistance to overcome labour market barriers that exist—despite the client’s job readiness. For example, employers may be uncomfortable with the severity of the client’s disability or may feel that the client’s skills are less credible than what is available in the labour market. This is where additional supports are needed to ensure that the client can secure a job and maintain employment. In cases where job loss occurs (such as through temporary contract work or the “last hired-first out” phenomena) re-instituting placements services is needed. This case management approach addresses two key variables that impact on return to work success. First, there is some evidence to indicate that the probability of return to work success increases if the client has made previous return to work attempts. This is an indication of client motivation and also reflects the fact that job-getting and skills retention improve with increased labour market participation. The provision of services to support the client through the developmental steps is needed to help establish firm attachment to the labour market. Second, there is fear of losing benefits. Through various forums the Ontario March of Dimes has heard people with disabilities express fear that participation in vocational rehabilitation will put their benefits at risk. The National Vocational Rehabilitation Program study reported that participants and stakeholder in the CPP pilot project reported that clients expressed lack of confidence in their ability to return to work. They also expressed concern over the consequences, in terms of benefit loss, if they were deemed to have regained the capacity to work but could not maintain regular employment. The report went on to suggest that CPP consider a broader range of services, including longer job search periods, additional follow-up, and measures to address the “loss of benefits” issue. The current CPP model has implemented some of these measures through the provision of a service called a Work Trial period. During the Work Trial, clients who secure a job receive CPP benefits and case management support for the first three months of employment, at which time benefits and services cease.

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It is the position of the Ontario March of Dimes that a longer period of follow-up service is required to improve longer-term labour market attachment for CPP clients. These services generally would include whatever is required to help the client secure and maintain long term employment, including: • follow up services with the client and employer to assist with ongoing training and job accommodation; • placement services if job loss occurs; • job development to find and secure jobs for harder-to-place clients; • job coaching to facilitate training on the job; • supportive counseling and referral to other services when the need arises; and • immediate re-instatement of income benefits if job loss occurs (within reason). The Ontario March of Dimes believes that implementing an extended case management model would address client fear of participating in VR by providing significant incentives, through service provision over an extended period and significantly improve labour market attachment. Research into best practices in Supported Employment (a service model that provides extended employment supports to people with more severe disabilities) supports this rationale. Benefits and positive features include high consumer satisfaction with services, favourable employer perceptions of the services provided, improved job tenure and higher wages and benefits. Furthermore, the research confirms that such services are cost effective in terms of benefits and costs saved. Average cost of extended supports is modest at about $2800 per client annually. From our analysis, this could easily be absorbed within the projected cost savings from successful files. Fundamentally, it is cheaper to keep clients in jobs than to allow them to go back to benefits. Conclusions and Recommendations Regarding Caseload Management •

Ontario March of Dimes recommends that a more useful and successful approach would be to treat return-to-work as a process, rather than an event that occurs at the end of a period of job readiness training.

•

Ontario March of Dimes recommends that the provision of services to support the client through the developmental steps is needed to help establish firm attachment to the labour market.

•

Ontario March of Dimes recommends that a longer period of follow-up service is required to improve longer-term labour market attachment for CPP clients.

•

Ontario March of Dimes recommends that implementation of an extended case management model would address client fear of participating in VR by providing significant incentives, through service provision over an extended period and significantly improve labour market attachment.

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Section 2.3 Reason # 3 CPP Eligibility Requirements It is our belief that the CPP eligibility requirements act as a barrier or even a disincentive to return to work for CPP clients. To be eligible for CPP benefits, one must meet the criteria for “disabled” under the legislation. The CPP website defines “disabled” in the following way: “Your disabling condition can be physical or mental. Under the Canada Pension Plan legislation, your disability must be severe and prolonged. Severe means your condition prevents you from working regularly at any job, and prolonged means your condition is long term or may result in your death.” At application, the client and his or her doctor must prove that the client is too disabled to work. Then, to be accepted into the CPP VR program, the client and his or her doctor must then say that the client is motivated to return to work full time and that the doctor supports (agrees with) participation. If as a result of participation in VR, the client regains capacity to work--even if a job is not secured--benefits can be discontinued. Furthermore, the CPP website states that the VR program is for those clients “whose medical condition has stabilized and who will likely become ineligible for benefits...” The Ontario March of Dimes believes that these criteria send a confusing message to the client and contribute to the client’s fear of losing benefits and the fear of failure in the program. In effect, some of the content on the CPP website and the CPP eligibility criteria suggest that the purpose of the VR program is to assess client’s continued eligibility for benefits. To be fair, other content on the CPP website states that the VR program is for clients who are motivated to return to work and that the program is there to help clients succeed. Our recommendation is that CPP eligibility criteria be amended to de-link the definition of “severe” from the ability to work at any job. Instead, the definition should be based on the client’s inability to complete activities of daily living that were within the client’s capacity before the disability became severe. In addition, we recommend that a need for VR services to return to work be included in the eligibility criteria. Therefore, the eligibility criteria would reinforce the voluntary nature of the program and the importance of client motivation to return to work by positioning the VR program as a means for the client to return to work rather than as a means to re-assess eligibility for benefits. There are two other issues related to eligibility criteria. One is the eligibility for CPP

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benefits for people who have disabilities that affect them to varying degrees at different times. For example, an individual living with Multiple Sclerosis may experience periods during which they are in remission and can pursue Employment; but at other times the disability is severe. Individuals living with AIDS may have similar circumstances. It is recommended that flexibility be built into CPP to accommodate the variable needs of these populations for income supports. Such a system may experience some increased administrative costs—but the benefits of some periods of Employment should outweigh these costs, especially if these clients have access to an extended Case Management Services like that described above. The second issue is part-time Employment. As indicated in this Solutions Brief, return to work is a process not an event. Part-time work, for some clients, is a useful transition to more permanent work. For others, such as those living with AIDS or MS, or those with cyclical psychiatric disabilities, part-time work may be the best match at a particular time because of the disability. Again, the benefit is increased labour market attachment, which increases the likelihood of more permanent Employment and reduces dependence on income support. Conclusions and Recommendations Regarding CPP Eligibility Requirements •

Ontario March of Dimes recommends that CPP eligibility criteria be amended to de-link the definition of “severe” from the ability to work at any job.

•

Ontario March of Dimes recommends that the definition be based on the client’s inability to complete activities of daily living that were within the client’s capacity before the disability became severe.

•

Ontario March of Dimes recommends that a need for VR services to return to work be included in the eligibility criteria.

•

Ontario March of Dimes recommends that, as regards income supports, flexibility be built into CPP to accommodate the variable needs of people who have disabilities that affect them to varying degrees at different times.

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Section 2.4 Reason # 4 Integration of CPP (D) with Provincial Programs It should be noted that our comments under this topic reflect our experience in Ontario. Several years ago, the Ontario provincial government re-designed its income support and vocational rehabilitation programs. The new services for people with disabilities were consolidated under the Ontario Disability Supports Program (ODSP). There has been much criticism of the ODSP, especially the adjudication of benefits applications and appeals processes. We refer you to two recent reports that detail these concerns: • Denial by Design...The Ontario Disability Support Program (Income Security Advocacy Centre • Access to ODSP Campaign, Summary of Forum Reports (ODSP Action Coalition) It is vital to reinforce several important differences between CPP and ODSP that make the Ontario March of Dimes apprehensive about greater integration between the two programs. • CPP clients pay CPP premiums and therefore have certain entitlements to benefits and services. The current design of the VR program recognizes this. For example, the program is voluntary, clients who lose their jobs may be fasttracked back onto benefits, clients can now earn up to $3900 without impacting benefits. In contrast, ODSP operates more like a welfare program, with numerous provisions to avoid spending on clients. For example, ODSP will not fund formal training. Clients must apply to the Ontario Student Assistance Program for a loan. • ODSP has incorporated consumer choice as a key service principle. This means, for the most part, that the consumer can choose their service provider. It also means that the consumer has some say over what services they will receive and how they will pay for those services. However, the range of services is limited to Employment Planning, Job Placement Services and a number of interventions such as Job Coaching. CPP offers all of the above. Consumers participate in the development of their return-to-work plan. Most importantly, CPP will pay for more costly interventions such as education and extensive skills training. Therefore, CPP offers the consumer considerably more choice and support. • CPP offer a more traditional case management service, which requires professional staff to assist the client to select and secure funding, and access appropriate services to achieve their job goal. ODSP requires that clients access all other available sources for services and funds before ODSP will pay for or provide service. Their case management model does not help clients to do this.

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Conclusions and Recommendations Regarding Integration with Provincial Programs •

It is view of the Ontario March of Dimes that the CPP VR program is a more effective service. However, there are ways in which the two programs could complement each other.

•

One area is health care (which is not a CPP benefit but is provided by the provincial program). Accessing the provincial program can be difficult due to relatively complex eligibility rules and varying benefits depending upon income and date of entitlements. CPP could secure an agreement with the provincial programs to ensure that adequate health care benefits are in place.

Section 2.5 Reason #5 Social Development Goals and Public Policy Rehabilitation serves social development goals of individuals (eg. employment, income, self-sufficiency), goals supported by advocacy groups and government policy. According to the results of the Evaluation of the National Vocational Rehabilitation Project (1996), “the research suggested that important social development impacts can result from the successful rehabilitation of participants, although these outcomes are not strongly facilitated by current rehabilitation goals of the CPPD, which are to provide basic entry-level skills for returning people to work. These impacts (improved incomes, improved self-esteem etc.) are relevant to CPPD beneficiaries, and also relevant to Canada's policies in related areas, such as the Strategy for the Integration of Persons with Disabilities.” Consistent with the major recommendations in this Solutions Brief, the 1996 NVRP suggests that “the NVRP goal of providing entry-level skills is not strongly supportive of other, more social-development outcomes for participants in the area of independent living. These results point to the need for further exploration of employment situations of former NVRP clients and other project impacts generally. They also underline the fact that many NVRP clients may still have important unmet needs, even after they have reintegrated into the workforce.” Within the category of Independent Living, the following responses from 242 respondents on the reported impacts of the Program on social development are noteworthy: • • •

33.9% reported acquiring new or improved skills; 25.2% reported increased health and well-being; 34.3% reported increased self-esteem; and

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•

58.5% reported the elimination of the need for benefits.

Therefore, in the area of achieving and improving social development goals vis-à-vis the importance of an ongoing return-to-work strategy, the Ontario March of Dimes makes the following recommendations. Conclusions and Recommendations Regarding Social Development and Public Policy •

There is sufficient empirical evidence demonstrating that rehabilitation does serve and enhance social development goals and government policy, and could be significantly improved.

•

The Program could achieve more, and in fact do more, through partnerships with other government training programs.

•

For example, clients could be linked to career or other training options in conjunction with the rehabilitation plan. This could achieve substantial, long-term results, such as further improving client motivation for rehabilitation, and thereby enhance the underlying social development rationale of an ongoing return-towork strategy in a meaningful way. This might also assist in achieving such goals as obtaining and maintaining employment over the longer-term.

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Section 3.0 Summary of Recommendations •

There continues to be great potential for cost savings as a result of Return to Work and Vocational Rehabilitation services. Ontario March of Dimes recommends that CPP should continue these services.

•

Ontario March of Dimes recommends that CPP implement a system to measure longer term impacts of the program. This measurement is necessary to support continued service enhancements or expansions.

•

Most critically, Ontario March of Dimes recommendations that CPP should implement strategies to enhance the job retention and longer term labour market attachment. See our recommendations under Case Management later in this report.

•

Ontario March of Dimes recommends that a more useful and successful approach would be to treat return-to-work as a process, rather than an event that occurs at the end of a period of job readiness training.

•

Ontario March of Dimes recommends that the provision of services to support the client through the developmental steps is needed to help establish firm attachment to the labour market.

•

Ontario March of Dimes recommends that a longer period of follow-up service is required to improve longer-term labour market attachment for CPP clients.

•

Ontario March of Dimes recommends that implementation of an extended case management model would address client fear of participating in VR by providing significant incentives, through service provision over an extended period and significantly improve labour market attachment.

•

Ontario March of Dimes recommends that CPP eligibility criteria be amended to de-link the definition of “severe” from the ability to work at any job.

•

Ontario March of Dimes recommends that the definition be based on the client’s inability to complete activities of daily living that were within the client’s capacity before the disability became severe.

•

Ontario March of Dimes recommends that a need for VR services to return to work be included in the eligibility criteria.

•

Ontario March of Dimes recommends that, as regards income supports, flexibility be built into CPP to accommodate the variable needs of people who have disabilities that affect them to varying degrees at different times. 15

•

It is view of the Ontario March of Dimes that the CPP VR program is a more effective service. However, there are ways in which the two programs could complement each other.

•

One area is health care (which is not a CPP benefit but is provided by the provincial program). Accessing the provincial program can be difficult due to relatively complex eligibility rules and varying benefits depending upon income and date of entitlements. CPP could secure an agreement with the provincial programs to ensure that adequate health care benefits are in place.

•

There is sufficient empirical evidence demonstrating that rehabilitation does serve and enhance social development goals and government policy, and could be significantly improved.

•

The Program could achieve more, and in fact do more, through partnerships with other government training programs.

•

For example, clients could be linked to career or other training options in conjunction with the rehabilitation plan. This could achieve substantial, long-term results, such as further improving client motivation for rehabilitation, and thereby enhance the underlying social development rationale of an ongoing return-towork strategy in a meaningful way. This might also assist in achieving such goals as obtaining and maintaining employment over the longer-term.

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Section 4.0 Appendix

Table 1 Summary of CPPD Vocation Rehabilitation Activity

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Table 1;

Summary of CCP-D Vocational Rehabilitation Activity

Num ber of Consum ers

Maxim um M onths of Maxim um Benefits Savings (@ Savings 777/m th)

Employed

Savings at 50% LM Attachm ent

Savings at 25% LM Attachm ent

1998-99

1999-00

2000-01

2001-02

Total

W aterloo

46

6

1,005

780,885

390,443

195,221

30,101

117,949

85,832

116,089

349,972

Ham ilton

35

10

2,576

2,001,552

1,000,776

500,388

47,640

107,857

78,769

30,236

264,503

Niagara

16

5

1,255

975,135

487,568

243,784

13,923

41,689

58,125

35,105

148,842

London

36

13

4,046

3,143,742

1,571,871

785,936

28,635

42,933

82,764

47,563

201,897

East Ontario

9

3

498

386,946

193,473

96,737

27,516

37,020

52,797

58,397

175,729

SSM

8

3

787

611,499

305,750

152,875

3,071

5,827

9,837

52,965

71,702

Sudbury

32

12

3,314

2,574,978

1,287,489

643,745

13,155

78,902

109,820

113,921

315,799

Thunder Bay

13

6

1,666

1,294,482

647,241

323,621

10,771

27,332

40,892

34,547

113,534

195

58

15,147

11,769,219

5,884,610

2,942,305

174,812

459,509

518,836

488,823

1,641,978

Totals

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Section 5.0 References Human Resources Development Canada. Evaluation of the National Vocational Rehabilitation Project – Vocation Rehabilitation within the CPPD. Ottawa: HRDC, 1996. See online report at: http://www11.hrdc-drhc.gc.ca/pls/edd/CPPVOC_brf.shtml SPR Associates. CPPD Evaluation. March 1996.

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Section 6.0 About the Ontario March of Dimes During the 1930s, 1940s and 1950s, polio epidemics ravaged North America. In 1951, the Canadian Foundation of Poliomyelitis, more commonly known as March of Dimes, was established to fund research and provide medical and rehabilitative assistance to people who contracted polio, a highly contagious, disabling and sometimes fatal disease. Mothers, determined to help find a vaccine, canvassed door-to-door, raising funds one dime at a time. The perseverance of the Marching Mothers inspired the involvement of everyone in the community - from celebrity endorsements to school children filling up slotted cards of dimes. Ontario March of Dimes and the Marching Mother's endeavours had a direct impact on the discovery of the Salk vaccine in 1955, which virtually eradicated the disease in North America. The Canadian Health Minister at the time, Paul Martin Sr, who had himself, battled polio as a child, made the historic decision to proceed with this vaccination program. Canada led the world in using the Salk vaccine, and by 1960, the fear of polio had subsided across North America. With the threat of polio greatly diminished, Ontario March of Dimes began funding centres for people who had already contracted the disease. These early programs focused mostly on rehabilitation and job training. In the early 1960s, Ontario March of Dimes developed and grew into a multi-service organization, with its mandate shifting considerably to serve the broader needs of all adults with physical disabilities. Today, the vision is "creating a society inclusive of people with physical disabilities."

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