Beyond a Placement: Supporting Children with Disabilities and Complex Needs in Ontario

But for children living with disabilities, complex medical needs, developmental delays, autism, mental-health needs, communication differences, or significant trauma, a safe place to stay is only the beginning.

A child may also need medication routines, mobility equipment, feeding support, therapy appointments, school accommodations, sensory supports, respite, transportation, cultural connection, family contact, and adults who know how to respond when distress shows up as behaviour. In those situations, the question is not only, “Where can this child stay?”

The better question is, “What does this child need around them in order to be safe, included, and well?”

Complex needs are not one thing

“Complex needs” is not a diagnosis. It is a way of describing children and youth whose daily support needs cross more than one area of life.

A child may have a physical disability, a developmental disability, a medical condition, autism, a communication disorder, a mental-health concern, trauma-related needs, or more than one of these at the same time. Some children need support with movement, feeding, toileting, medication, sleep, communication, learning, emotional regulation, or personal care. Some children use wheelchairs, walkers, feeding tubes, oxygen, communication devices, visual supports, or other equipment. Some children are medically fragile. Some children are palliative. Some children have needs that change from day to day.

The Canadian Paediatric Society explains that children and youth with medical complexity can have different diagnoses but often share common features, including high care needs at home and in the community, technology dependence, high health-care use, and care that involves multiple providers and settings. The Society also notes that this can lead to fragmentation, communication challenges, and care-coordination challenges.

That is why it can be misleading to talk about “a placement” as if the home alone is the whole answer. The home is important. So are the systems around the child.

Children need care that works across systems

A child with complex needs may be connected to many people: parents, siblings, relatives, foster caregivers, child welfare workers, doctors, nurses, therapists, school staff, respite workers, personal support workers, mental-health clinicians, developmental service providers, cultural or faith supports, and community programs.

When these people are not connected to one another, the child and caregiver can become the ones carrying the whole system.

A parent or caregiver may have to repeat the child’s story over and over. They may be expected to track appointments, funding applications, school meetings, medication changes, equipment needs, safety plans, waitlists, and crisis supports with little practical help. When a child has urgent needs, that burden can become overwhelming.

Ontario recognizes this challenge through coordinated service planning for children with special needs, which is intended for children and youth with multiple or complex special needs and connects families with a dedicated service planning coordinator. The goal is to help families bring services together instead of navigating every door alone.

That principle is important whether a child is living with their parents, relatives, kin, or foster caregivers. Children do better when the adults around them are working from the same information, the same plan, and the same understanding of the child.

Ontario families are feeling the pressure

The pressure on families of children with complex needs is not imaginary.

In its 2024-2025 Annual Report, Ombudsman Ontario said many families who contact the office about children with complex special needs feel overwhelmed by the complexity of the system and by emotional and financial stress. The report also noted that urgent help can be hard to find, especially in remote areas where there are fewer support and treatment options.

The same report said Ombudsman Ontario received 29 complaints in 2024-2025 from families who had difficulties accessing programs and services through the Ministry of Children, Community and Social Services’ Children With Special Needs Division. It also described 15 cases that year where families surrendered custody of children with complex special needs to children’s aid societies in order to get the care their children needed, even though the issue was not a child-protection concern.

Those cases are painful to read because they show what can happen when the right supports are not available early enough. Families should not have to reach a breaking point before a child gets care.

When child welfare becomes the last door

Child welfare is sometimes pulled into situations that are really about gaps in health care, developmental services, mental-health care, respite, housing, disability supports, or specialized treatment.

The Ombudsman’s annual report says that in some cases, lack of appropriate services puts children at risk of self-harm or harming others, and children are placed in the care of a children’s aid society. It also notes that Ontario’s Ombudsman has continued to follow the issue of families surrendering custody to access care, an issue first investigated in the 2005 report Between a Rock and a Hard Place.

In September 2024, Ombudsman Ontario also announced an investigation into the practice of child welfare agencies placing young children and teens in hotels, motels, offices, and trailers. In the 2024-2025 Annual Report, the Ombudsman said many of the children and youth affected by this practice have complex special needs.

No child’s needs should be reduced to whatever emergency arrangement happens to be available. Children need settings that are safe, stable, appropriate, and supported by people who understand them.

What good support can look like

Good support starts with seeing the whole child.

A child is not just “medically fragile.” They are a child who may love music, hate itchy clothing, need extra time to process language, miss their siblings, struggle with transitions, enjoy school when the right support is in place, or calm down when one trusted adult sits nearby without crowding them.

Good support also means having a plan that is practical enough to use in daily life.

The Provincial Council for Maternal and Child Health describes Complex Care for Kids Ontario as a provincial program designed to improve care continuity, collaboration, and service delivery for children and youth with medical complexity and their families. The program aims to provide integrated and coordinated care across health and social support services, strengthen community services, and improve access to care closer to home.

That kind of thinking matters beyond one program. A child’s care should not fall apart because one adult is away, one appointment is missed, or one provider does not have the full picture.

Caregivers need support too

Supporting a child with complex needs can be deeply meaningful. It can also be physically and emotionally demanding.

Canada’s Drug Agency, formerly CADTH, highlighted caregiver support as one of the key issues in its 2024 Watch List on children and youth with medical complexity. The report notes that families and other caregivers often provide emotional support, medication and medical-device management, care coordination, household support, transportation, feeding, dressing, bathing, and other personal-care tasks.

Those hours represent more than tasks. They represent sleep interrupted by medical needs, appointments that require time off work, siblings whose routines are affected, forms and funding applications, school calls, emergency-room visits, advocacy, worry, and the emotional labour of staying alert.

Caregivers should not have to prove exhaustion before support arrives. Respite, training, practical help, and clear communication are part of child safety. When caregivers are supported, they are better able to stay steady, patient, and responsive.

Belonging is part of care

Children with disabilities and complex needs are sometimes discussed only in terms of risk, services, or deficits. That can make it easy to forget the ordinary things children need: friends, routines, school life, birthdays, play, privacy, hobbies, culture, identity, and a sense of belonging.

A child who uses a wheelchair should still be able to join family activities and school events wherever possible. A child who communicates without speech should still be offered choices and included in conversation. An Autistic child should not have to be treated as “difficult” because their sensory needs are real. A medically fragile child should not be defined only by appointments and risk. A child with trauma and developmental needs should not be seen only through behaviour.

The care plan should make room for the child’s life, not only the child’s needs.

Matching matters

The Ontario Association of Children’s Aid Societies says foster parents work with Children’s Aid staff as part of a team to develop and support a plan of care for each child or youth in care. OACAS also notes that Ontario agencies work to match foster caregivers based on their experience and on the needs and identities of children and youth, and that there is an urgent need for placements supporting sibling groups, older children and youth, infants, and children with complex needs.

For children with disabilities and complex needs, matching is not only about whether a bed is available. It is about whether the home can support the child’s daily reality.

Can the caregiver manage appointments and transportation? Is the home accessible or adaptable? Can the caregiver follow medical routines? Are there other children in the home whose needs also have to be considered? Is there enough support for respite? Can the child stay connected to family, culture, community, and school where possible? Does the caregiver understand that behaviour may be communication? Is everyone clear about what the child needs on an ordinary Tuesday, not only in a crisis?

A good match does not make complex care easy. It makes care more realistic, safer, and more stable.

How this connects to Annie’s Havens

Annie’s Havens has a particular connection to this issue because our work began with lived family experience.

Annie’s Havens is named for Annie Wilson, the daughter of our founders, William and Hilda. After a cerebral haemorrhage during surgery left Annie with severe physical disabilities, her parents learned to care for her, advocate for her full inclusion in school, and work alongside medical, therapeutic, and educational professionals. That experience shaped the agency’s focus on children and youth living with developmental, physical, and medical needs.

Our special-needs program serves children and youth living with developmental, physical, and medical needs. The needs described in the program include mobility needs, autism spectrum disorder, global developmental delays, tube or IV feeding, medically fragile children, and palliative care. Annie’s Havens also provides specialized training and, where needed, Personal Support Worker hours to support higher daily care at home.

That support matters because children with complex needs deserve more than crisis management. They deserve care that is steady, informed, respectful, and matched to who they are.

A child’s diagnosis or disability may shape what support they need, but it should never become the whole story. The child is still a child. They need safety, belonging, patience, relationships, and adults who are willing to build a circle of care around them.

A placement is a place to begin. The goal is a life where the child can be known, supported, included, and loved.

To learn more about Annie’s Havens’ approach, you can read about our care programs, children in care, and what foster parenting involves.

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