Here are three steps the federal government can take
Irving Gold
QUOI Media
Eight-year-old Maya can’t bathe safely without a custom chair. Her occupational therapist filed the paperwork months ago. The request is still in a federal queue. Maya grows; the tub doesn’t. A simple piece of equipment is stalled by a system that was designed — by law — to put the child first.
Jordan’s Principle is not a nice-to-have. It is a legally enforceable child-first rule born of Canadian Human Rights Tribunal rulings beginning in 2016 that require timely access to services for First Nations children, with governments sorting out who pays later.
That’s the standard. We aren’t meeting it.
What should worry the Canadian government is that this isn’t about a few hard cases or the occasional slow form. Indigenous Services Canada has acknowledged a massive backlog — about 140,000 requests in late 2024 and roughly 135,000 as of February 2025 — including thousands marked urgent.
That’s not drift; that’s a standing failure.
Two tracks matter here. For First Nations children, requests go through Jordan’s Principle. For Inuit children, supports run through the Inuit Child First Initiative (ICFI). Both pathways are experiencing delays and policy whiplash, with Inuit partners publicly flagging slowdowns after Ottawa’s late-2024 changes. Treating them as interchangeable erases real governance differences and hides specific fixes each needs.
Process is policy. Right now, process defects are doing the damage. Problems include:
• Unclear, shifting timelines
Tribunal materials and government guidance mention timelines, but practical service standards are uneven — 30 business days for certain capital decisions, shorter targets cited for non-urgent cases — none of it consistently measured or published by region in plain language. Families and providers live in the gaps.
• Payment lags that push costs onto families and front-line providers
When the government doesn’t provide payment in a timely fashion, in practice, clinicians often extend no-interest credit to the Crown while invoices age. That is not child-first.
• Administrative duplication
Multi-form intakes, inconsistent regional requirements and no clear, real-time tracking of request/claim status — forcing therapists and schools to re-send the same information, burning time that should be spent on kids.
The good news is that the process is fixable without a single new dollar. Ottawa can repair the machinery it already owns, and legislators, staff and reporters could all verify progress quickly.
This is not rocket science.If the government is serious about meeting its commitments, here are three things it can do now to prove it:
• Publish and meet service levels
Set a 10-day decision standard for non-urgent requests (24 hours for urgent) and a 30-day reimbursement standard — reported monthly by region, including volumes, aging buckets and the number of urgent cases. Make the standards operational and transparent.
• One intake, one status page
Replace duplicative forms with a single digital intake for therapy and equipment requests, usable by families, schools and providers; provide real-time claim status and a defined escalation path. This is basic case management, not transformation.
• Direct deposit by default, blanket approvals where appropriate
Mandate direct deposit for providers and enable semester-length blanket approvals for school-based group programs (e.g., therapy blocks), so children aren’t stranded between sessions while paperwork catches up.
For Inuit children, co-develop ICFI-specific fixes with Inuit organizations and publish them alongside Jordan’s Principle metrics so differences in pathway and performance are visible.
Some will say the backlog is already “coming down.” Good, but not good enough — hold that line and steepen the slope. A backlog measured in six figures — after years of Tribunal orders and non-compliance motions — is not a metric of success. It is a warning light that’s been blinking so long we’ve stopped seeing it.
Others will point to the billions of dollars committed since 2016 and the historic compensation settlement. Both are real. Neither excuses slow approvals, unclear standards or late payments for services that help children bathe, learn, communicate and participate at school.
Money announced is not care delivered.
This is a test of management, not sentiment. If the federal government publishes tight service standards, merges duplicative forms, pays on time and reports honestly, families and front-line clinicians will feel the difference within weeks. If not, the next “update” will again be about the size of the queue, not the number of kids who finally got what the law says they deserve as essential care.
Irving Gold is CEO of the Canadian Association of Occupational Therapists.
