Legislative Assembly of Ontario

ANNUAL REPORT, PROVINCIAL AUDITOR, 1990
ADDICTION RESEARCH FOUNDATION

PORTAGE ONTARIO

CONTENTS

Thursday 24 October 1991

Annual Report, Provincial Auditor, 1990

Addiction Research Foundation

Portage Ontario

STANDING COMMITTEE ON PUBLIC ACCOUNTS

Chair: Callahan, Robert V. (Brampton South L)

Vice-Chair: Poole, Dianne (Eglinton L)

Bradley, James J. (St. Catharines L)

Conway, Sean G. (Renfrew North L)

Cooper, Mike (Kitchener-Wilmot NDP)

Cousens, W. Donald (Markham PC)

Haeck, Christel (St. Catharines-Brock NDP)

Hayes, Pat (Essex-Kent NDP)

Johnson, Paul R. (Prince Edward-Lennox-South Hastings NDP)

MacKinnon, Ellen (Lambton NDP)

O'Connor, Larry (Durham-York NDP)

Tilson, David (Dufferin-Peel PC)

Substitution: Ramsay, David (Timiskaming L) for Mr Conway

Clerk: Manikel Tanis

Staff: McLellan, Ray, Research Officer, Legislative Research Service

The committee met at 1007 in room 228.

ANNUAL REPORT, PROVINCIAL AUDITOR, 1990
ADDICTION RESEARCH FOUNDATION

The Chair: The committee is looking at the question of addiction and the facilities that are available in the United States and what we have here. We have asked you to come here to apprise us of what information you have through the Addiction Research Foundation. I do not know about the other members of the committee, but one that interests me is that about three weeks ago it was indicated that the degree of alcohol addiction, or perhaps it was drug addiction, had declined. Maybe you would address that, because it is certainly not obvious to one who is not deeply involved in it that this is the case.

Dr Rush: I can comment on that briefly. The foundation, for quite some time, has been monitoring the extent of alcohol and drug use through surveys of the general population and the school population. The overall trend in those data seems to be going down and it always surprises people. I think it is a reflection of the extent of alcohol and drug use through the entire population, which often stands at odds with the perceptions of people who are dealing with very specific segments of the population; for example, street youth, the unemployed, people who are disfranchised and so on.

It is really a reflection of what is happening overall and it is not meant in any way to indicate that there is not still a significant problem out there. Certainly I do not think it is meant to imply that there is not a need for more treatment resources, because there are lots of other data that are available to suggest the province is in fact still undersupplied with treatment. It is a positive sign, though, that if you take a survey of your average high school, those students using alcohol -- and I think the most recent survey was one of the first to show a decline in some of the other drugs for your average student -- are experimenting less and using less.

It seems to be moving to two kinds of populations of alcohol and drug use. There is a disfranchised segment of society that continues to use drugs and is using drugs extremely heavily, and some extremely dangerous drugs, but for mainstream society -- you and I and maybe our children -- there is certainly a positive indication.

Mr White: Following that along, you were talking about perhaps a general disfavour with the use of alcohol and illicit drugs. Is that reflected at all in terms of the treatment requirements?

Dr Rush: Not really. The data we have on the treatment system show that certainly over the last decade the number of people in treatment has continued to increase quite rapidly. It might mean that we were just extremely short-supplied earlier on, or it could mean that there is a lag or delay. As people continue to drink or use drugs the problems they experience are somewhat delayed from when they are actually involved, such as cirrhosis for example. It takes quite a number of years.

The Chair: Could I just ask you, perhaps for the benefit of all of us, to outline what the Addiction Research Foundation does? How is it physically set up? Does it actively treat addicts? Does it do research into advanced ways to deal with addiction? Finally, have there been any significant breakthroughs in terms of treatment of alcohol or drug addiction? Does that fulfil the committee's wishes? Then you can ask questions.

Mr O'Connor: Are we going to go through the Drug and Alcohol Registry of Treatment program?

The Chair: Yes.

Dr Rush: I will start with a bit of preamble about ARF generally, if that will be helpful. I guess the answer is, all of the above. The major mandate of the organization is to provide research into alcohol and drug problems, but more than what I would call a kind of ivory-tower approach to research. What I see in the organization is research intended to lead to the development and improvement of our prevention programs, treatment centres and so on.

It is quite a different type of research than you might see, for example, in university settings, where the application of those findings might be seen as being somewhere down the road. There is biomedical research. There is research on the effects of different drug treatments. There is research on the effects of different prevention programs. There is a major clinical component treatment centre here in Toronto that is referred to as the Clinical Research and Treatment Institute. They see many thousands of patients each year, not all of whom are in a research context. It is seen as a major service provider in Metro and really a provincial resource for many kinds of problems.

There are also a large number of staff distributed throughout the province and their job is to help co-ordinate or develop treatment and prevention programs at the local level. They are a resource to the district health councils, schools and industry to help them develop programs within their communities. It is really a multifaceted organization. You cannot say it is just research; you cannot say it is just treatment; you cannot say it is just prevention. It does quite a range of things.

Where I fit in, and where the registry fits in, is that for quite some time one of the major programs we have had under way in the Addiction Research Foundation has been to monitor the development of all the alcohol and drug treatment programs in the province. These programs are funded through many different branches of government, including federal and provincial, and it has been extremely difficult to keep track of what is going on out there. The project we have had under way since 1980 has been to monitor the comings and goings of the programs, the number of clients, the types of clients being seen, what it is costing the province. Most important, if the government of Ontario has established certain priorities or policies that it would like to see implemented in the way of developing alcohol and drug treatment services, then our surveys are the only means we have of monitoring the extent to which those policies and programs have been successful.

For example, if it wants to put its money into one or another kind of program or shift money towards young people versus older people, then it is the surveys we do that monitor the extent to which we have actually been able to accomplish that and to get those kinds of programs going and to see how they are used, what they are costing and so on. We are kind of a watchdog, so to speak, for the development of alcohol and drug treatment services. We use that information to help local communities or different branches of government plan new directions. We are quite closely tied to different planning and policy groups within government and locally, using our information and needs assessments to establish what is still required for new services.

I think those experiences really were what led us to the treatment registry. I can give a little bit of background, if people want. When people within OHIP and the Ministry of Health were looking for someone with the expertise and the credibility to mount a project such as this, quite naturally they looked to the Addiction Research Foundation as having the research capacity and also the knowledge of the treatment system in the province to carry it out.

Is that enough background on what we do? I would be happy to provide other information to you in writing or after about the organization as a whole. There are certainly lots of briefing documents about the scope of the organization. Where I fit in is as an expert, if you will, on the alcohol and drug treatment system and someone who was asked to take on this project for the development of the treatment registry.

The Chair: The registry is up and running, I gather.

Dr Rush: Yes, it is.

The Chair: Have you had success in being able to pinpoint where there are services available?

Dr Rush: Yes. Can I come back to that by giving a bit of background, where we are, what we do and what the objectives of the program are? Then I will conclude with some comments about what we have been able to see already.

We have only been running for about three and a half weeks, so it has not given us a lot of time, but I think some impressions that we had early on are being confirmed. For example, some kinds of treatment programs out there are full. There is not much slack in the system. Other kinds of programs seem to be underutilized. I have some questions about that, but I can I come back to that.

I think the idea for the registry really came about in response to the number of people going to the United States for treatment. I am going to cover the four objectives of the program and, I hope, leave you with the impression that if no one was going to the United States for treatment, there are still lots of good reasons to have a registry like this. If that problem goes away, then I think there are still some things the registry can contribute to the province's alcohol and drug treatment system. But it really came from people within OHIP and within other branches of the Ministry of Health struggling with the issue of so many people going to the United States for treatment and the huge costs that were associated with that.

I think, in a nutshell, people were becoming concerned that many of the individuals going to the States for treatment were being sent without having made any reasonable search at all for treatment in the province. It was becoming almost a reflex action. Certainly, the profit motive that is inherent in all of this for the American facilities clouds the issue as to whether the individual in fact needed to go or whether it was the most convenient route to go. I suppose for the average person on the street, it is the ease with which people were going and the amount of money that was involved from the taxpayers' point of view that really served as a catalyst within the government to finally address the issue.

All that people are asking is not so much to stop the option and disallow people from going but to at least make sure there is a legitimate need from a clinical point of view and that there is a reasonable search in Ontario for our own publicly funded resources, to make sure someone has taken the time to look within the province before the decision is made to go out.

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The registry, I think, was part of a three-pronged strategy that we saw develop within the Ministry of Health for dealing with the problem. One was that OHIP would tighten the rules and regulations, and it has already done some of that. I am sure you are aware that they have capped the amount of money they are prepared to pay. They have instituted different procedures for approval and so on. So one part of the solution has been within OHIP, to tighten up the rules and regulations. This has happened, I am sure you are aware, not just for alcohol and drug treatment but really for all health care in the United States, cardiovascular care, psychiatric, brain injury and so on, which by the way is one of the things that really slowed down the process. They felt kind of hampered to deal with the alcohol and drug treatment as a problem itself without also looking at all the other different kinds of health care issues. So OHIP was doing its piece.

Second, other parts of the ministry, the community mental health branch in particular, were asked to increase funding and expand services in the province. So at the same time we reduce access to the States, we provide more services in Ontario.

Third, the Addiction Research Foundation was asked to develop the registry, which would provide a way on any given day of documenting what space was available in the province and also help direct people to that space, again to make the best use of our own resources. The developmental costs for the project were $1.2 million. Our initial estimate of the ongoing operating cost was about $300,000. We will have a final estimate in our submission to the community mental health branch in February or March, which we suspect will be in the range of $400,000 to $500,000 annually.

The program is established in London. Because of the nature of the program -- it is really a telephone service in a computerized network -- its geographic location did not make too much difference. I work in London. Most of the expertise for developing the project was in London. Partly by coincidence, other registries that operate -- one other one in particular for cardiovascular surgery also operates in London, at Victoria Hospital. If you need to find quick access to a surgeon for cardiovascular surgery in the province, you phone a 1-800 number or go through some process similar to what you could now go through for alcohol and drug treatment. The staff right now is about nine people.

That is kind of what we do and the background. Does everyone have the handout I brought in? I promise not to take too much more time. The first objective we had was really just to inform people.

The Chair: Dr Rush, I missed it. The staff of nine people is DART? There are only nine people?

Dr Rush: Yes.

The Chair: That is a lot of information for nine people to put together.

Dr Rush: I think if there is any reason in the future to expand it, it will be through demand over the phone. When people phone to see what is available in the province, they are in touch with a person, not a computer. You do not dial in directly to a computer. If the program was expanded, say, to the general public or whatever, based on demand, we might have to go to more people, but we have a very efficient method of collecting the information.

Mr White: Will you be addressing these phases, what is going on, a little bit later?

Dr Rush: Yes.

Mr White: I will save my question for later.

Dr Rush: I will just quickly cover the objectives. The first is to inform people. Imagine yourself as a physician in Cochrane or a probation and parole officer in Kenora or Windsor or whatever. You have a client in your office with an alcohol and drug problem, and you would like to place that person in treatment. Maybe you are not even thinking about the US issue. You want to know where treatment is available, maybe in your community or in your region or in the province as a whole. The registry provides you with a 1-800 number that you can call. You can indicate what kind of treatment you have in mind, whether it is a residential program, an assessment program or an outpatient program. The information in the computer, so to speak, would be relayed to you over the phone and would give you two or three options that you can explore.

This is the part that so far seems to be going extremely well. We have calls from detox centres, from employee assistance program counsellors in industry, substance abuse counsellors in unions, physicians calling from all over the province. In the three or four months we have been going, in our estimate now, we have done 200 or 300 calls already, directing people to different facilities, so this part of it seems to be very well received. With one phone call you can find out the waiting periods for all the programs in the province. If you then feel that is too long, you can explore other types of options within your community.

The Chair: How is that 1-800 number advertised or disseminated? What is the number, by the way? I would like it.

Dr Rush: The number is on the pamphlet you have. So far we have done extensive consultation around the province in eight of the major cities: Ottawa, Kingston, Thunder Bay, Toronto, etc. We have done community consultation, inviting a cross-section of people from the community to attend. We are only now gearing up for a major promotion. This pamphlet within the next month or two will be mailed to every physician in Ontario. We intend to do the same with public health units, probation, parole and so on.

We wanted to get the program off the ground and then phase in the promotion consistent with our capacity to handle it. We hope this number really will be at the fingertips of the entire social service system in the province.

The Chair: Could I urge you to do something: Write to every MPP in this Legislature. We each have reports that we are allowed to put out three times a year, and it would be very helpful if that was in there for individuals who might need help.

Dr Rush: In the community consultations around the province, in some of those instances it was really at the discretion of people at the local level. Many of the MPPs were invited and some did attend.

Mr O'Connor: If I may just make a request of the Chair, given that the fine doctor is here to make a presentation to us, could we perhaps make note of our questions and allow him to continue? The question you just raised is very important. In fact, I wrote it down because I was going to ask that question myself. Maybe for the sake of some sort of continuity, so that we could continue to get as much out of him as possible --

The Chair: Note well taken. I am just a little overenthusiastic, I guess. In fact, I had Mrs Witmer on the list and we have not even gotten to her yet. That is fine. I think that is appropriate.

Dr Rush: What I will do is try to limit my comments to, say, five more minutes, so you will have lots of time for questions, because I think you have someone on at 11.

The second objective is really part of our contract with the Ministry of Health, that we will provide it with a routine update, a statistical report every day of what is available in Ontario. We have seen this as a basic accountability issue for the ministry. If it is funding programs in the province, it is really its responsibility to know what space is here. There have been situations in the past, I am sure many of you are well aware, where the Minister of Health or even the staff have been called upon to answer questions about why all the people are going to the United States for treatment and what space is available here. In the past they have been unable to answer that question with a high degree of confidence, so part of our project is to have that information available to you, to the House, to the civil service as to what is available.

The third objective relates to OHIP and the process it has established for people to secure an approval before they go to the United States for treatment. They need to be seen by an assessment centre in Ontario and have a bona fide clinical assessment. They need to see a physician in Ontario who would provide some documentation about physical problems, the extent to which the situation is life-threatening. They are required to call the registry to do a search for treatment in Ontario.

It appears to us that the authority for an approval rests with the district medical consultant of OHIP, so it is not seen as a centralized bureaucracy, I do not think. The physician in Oshawa or Thunder Bay, who has the main responsibility for OHIP, has the authority to approve or reject the application. In areas of indecision he would send it on to head office in Kingston, where Dr Robert Ecclestone is the chief medical consultant. I think he has the final arbitration in some situations. So the registry is tied into this process to make sure there is a reasonable search in Ontario before someone is approved for out-of-country treatment. There have been situations now where I think we have seen those approvals go through.

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We had a situation the other day, someone with a severe psychiatric disorder, in fact multiple personality, and there was no treatment resource available in a reasonable period of time in Ontario for that individual. I believe she was approved to go to the United States for treatment. I think there will continue to be examples where the treatment system in Ontario right now cannot respond quickly enough or where the needs are so individualistic that the options to seek treatment in the United States will remain.

I guess from where I sit and offer you my opinion as someone who knows the treatment system, we should be concerned not to throw the baby out with the bathwater. If we are going to tighten the regulations, do the registry, the whole thing, we should ensure that in cases of legitimate need, the US option should remain, but there should be a reasonable search before it is sought out. I think "reasonable" is kind of the thing I would like to highlight.

The fourth objective relates to using the information in the registry as a way of identifying where our system needs improving. You could picture a year from now -- I would guess a ballpark figure -- we would probably have done 3,000 or 4,000 telephone calls trying to link people to treatment in the province. The kind of treatment they are after might be quite different from what is available or what they eventually end up using. So if we can compare what they needed with what they got and some outcome associated with that, we have a very rich source of information on where the gaps in treatment might lie.

I will give you a couple of examples. It would appear now for people calling to find a treatment spot in Ontario for someone 12, 13 or 14 years of age with very severe alcohol or drug problems, if they in their opinion think that person should be in a residential facility, taken out of his environment, treated in that kind of context, it is very difficult, if not impossible, to find a treatment centre in the province that could take that individual. So over time we would have the information to say, "Yes, I think we need to devote more resources to young people, to native people, people with certain disabilities, this part of the province compared to that part of the province."

In terms of the phases to program development, we are just now entering the second phase. We went through a very busy summer. When we put this project together. We started in May and opened the phone lines on October 2. That was the deadline given to us by the Ministry of Health. I think the idea was that the OHIP regulations were going to change around October 1 and it hoped to have a new funding announcement for how it was going to expand the treatment system around October, and it asked if we could put the registry in place for October. We said yes, but asked for an additional six or eight months to iron out the bugs and so on.

It was an extremely complex project. I do not need to go into that, other than to say there are about 200 of these programs and they offer very varied services. They are funded by different ministries. There is no legislative authority even requiring them to participate in the registry, so we are relying on their goodwill, the perception that we will make a contribution to the treatment system and so on. So I will just describe it as a gargantuan effort to get this thing under way in four months and we are pleased -- actually I am ecstatic -- with the progress that we have made and the extent to which it is already operating quite smoothly. But we have asked for another eight months, through to May 1992, to get the bugs ironed out, to see in what ways we can improve and so on. There is a fairly comprehensive evaluation of the project under way. We would see May 1992 to May 1994 as kind of the full operational period.

The Addiction Research Foundation agreed to take on the project as a three-year demonstration project. This is something new to the alcohol and drug field and I do not think anyone, including the Addiction Research Foundation, wanted to take it on as a long-term commitment without getting it running and seeing how it is going to work. As I say, there is a fairly heavy investment in program evaluation to see how it is going to work, and I do not imagine it would be discontinued. It seems to be something that already looks like a winner, but whether the Addiction Research Foundation would continue to operate it is certainly open for question. It may become its own independent agency, part of the ministry, maybe part of other ministries; I do not know. We took it on as a three-year demonstration project and then it just kind of evolves into whatever, based on the data.

The next page really shows how it works, and then I think I will stop there. Think of the registry in the middle, and it is really no more than information in and information out. All of the treatment programs in the province -- there are about 200 of them participating -- send information to us either every day or once a week about space that they have available or an estimate of when the next available space will come up.

If you are phoning in, for all the programs of the type you are interested in, I can show you on a computer screen if there is any space today. If there is no space today, I can give you an estimate of when the next spot will be available and kind of give you over the phone a shopping list, so to speak. Most people kind of go away with two or three or four options, and some of them have phoned back, as I have mentioned, and been quite delighted with the service, about having a place they can call simply to shop around.

Again, picture yourself as a physician in Stratford. You do not know anything about the alcohol and drug treatment system. All you know is that a person sitting across from you has a horrendous problem. With a call to this number, you can see what the status is at Homewood, Donwood, Bellwood -- really anywhere in the province.

The left side of the chart really shows who I would call our main clients, and that would be OHIP itself that is calling about the availability of treatment for people applying for out-of-country; calls coming to us from alcohol and drug services that have clients they are trying to place either in aftercare or assessment or whatever; calls coming from really across the whole health, social and correctional service system, and the reports that we have available daily to the Minister of Health.

I think really that is all I will say, other than you might want to skim over the things that we do and do not do to help you phrase some questions. Maybe the one question I will anticipate is, is the service available to the general public? The answer is no.

I would like to explain that. It is not really seen as a clinical service that we are providing. If someone calls and asks for a particular type of treatment and he has not yet talked to a counsellor or been involved with a physician or any health care provider, we do not know if that is the type of treatment he requires.

We have had some calls from the general public. They are directed to their local assessment or the detox program. They are not left high and dry, and I would like to really emphasize that. They are not kind of given the runaround, but we do not engage in a discussion with them about what type of treatment they need. We try and steer them to a local resource, and then that professional who they come in contact with after they have been assessed would call us and we get into a dialogue then with the professional on behalf of the client.

In some other countries, in Australia in particular, there is a program. It is a 24-hour information line which is staffed by trained counsellors who do what I have just described. They will do a clinical assessment over the phone and direct people to different programs around the country. We felt that was moving a bit too fast. I am not saying that kind of thing would be ruled out in the future. There are programs offered through the provincial anti-drug secretariat, a help line for the general public. The Addiction Research Foundation offers other programs, information lines, to the general public. Maybe at some point down the road these can be merged, but for now we felt, especially given the time frame we had, that we would direct the program to professionals acting on behalf of the consumer and do our best when the general public call to steer them towards self-help groups, assessment centres, or whatever. I think I will stop there.

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Mrs Witmer: I appreciate your presentation very much. Actually, I have had a number of parents contact me this past year because of concerns they have had with their young people and the inability to get treatment. I am really pleased to see that this service has been developed, because part of their frustration was based on the fact that they wanted to go to the United States and yet they were prevented from doing so. In two cases I was able to put them in touch with the appropriate people. Because of lack of facilities for the age group you are talking about, there just does not seem to be anything available for the younger teenager. It is very frustrating for the parents.

Do you see yourself playing any sort of a role in encouraging the government to develop programs for these young people in the future, or do you think it is going to be a long time before we see anything available in Ontario for these young people?

Dr Rush: We are quite closely tied to the people who make decisions about funding programs for young people. We are funded by the same branch of the ministry involved in deciding on those programs, namely the community mental health branch of the Ministry of Health. As I said, one of our objectives is to document the needs we see around the province, and we have been very upfront about that.

I would like to add that in terms of the under-16 population, it does appear there are outpatient programs being developed for these young people through the Ministry of Community and Social Services in concert with the Ministry of Health. What seems to be at issue is the extent to which these young people should be in residential programs, removed from the home environment and placed in a 28-day or longer program, as in the United States. I think there are situations where that is needed.

One thing we have seen in the registry data already is a reluctance to use outpatient programs. It is something we have seen for quite some time in Ontario really, but now we have the data. We can show there is very little space in residential programs, yet when virtually the same kind of program is offered on an outpatient basis in the same community with exactly the same counsellors, people will not use it. There continues to be a bias or a perspective that to get alcohol and drug treatment, you have to go away somewhere. That applies for some people, but not for everyone.

Mrs Witmer: In the case of these two youngsters, one was a male and one was a female. They were both street kids, so they were no longer living at home, and the parents felt that was the most appropriate placement, because they could not be relied upon. These young people have responded extremely well to the treatment. The parents are keeping me informed. I am glad to hear you say you are not going to cut off treatment in the United States, because I think as long as there is a need, we have to make sure we provide treatment wherever it can be found.

I would certainly follow up on Mr O'Connor's comment. My office gets a lot of calls and I want my staff to be aware of this service. I think we act as facilitators, so whatever you can make available to us in our constituency offices, I certainly would appreciate.

Dr Rush: One thing I would encourage you to do is find out where the closest assessment and referral centre is to your constituency office.

Mrs Witmer: We do have that.

Dr Rush: I think that should be available. Even if we are unable to link you up, put the person in touch there and have him call us. Someone at the assessment centre can provide some continuity to the client at the local level, which obviously your staff would really not be able to do.

Mrs Witmer: That is right. I guess what I am saying is that they need the awareness. I did not know this was in place and have all the information, myself until this morning. I think it is important information for them.

The Chair: I have just been told that research has a list of all the assessment centres, or will try to get one, for all our ridings. Perhaps we could ask that they be made available to all the members of the Legislature, along with maybe a letter from this committee outlining the DART program and their closest assessment centre and ask them to put it in their householder so it will be readily available to these people.

Dr Rush: It may also be helpful for you to have a very clear and precise statement -- it is still in preparation but I believe it will soon be finalized -- as to the process that individuals must follow if they wish to seek treatment in the United States. Since the OHIP regulations have been changed as of October 1, and with the registry, there has been an awful lot of change in a very short period of time. I would say half the calls we had to the registry in the first week were not to find treatment but simply to explain the process.

If you are gathering some materials to keep in your local constituency offices, there is a one- or two-page statement in preparation by OHIP and the community mental health branch which will very clearly state the rules, the regulations, how you go about it, the role of the assessment centre and so on. If you can at least explain the process for the public, you are halfway there. Then you explain what is available in Ontario, I think.

Mr O'Connor: Thank you for coming today and sharing your information with us. I have a number of questions on your presentation. One thing that was brought to our attention when the Addiction Research Foundation was here before us earlier on was identifying trained people. I will bring it in line with the DART program. Do we have enough trained people to provide the service in Ontario and what is the accreditation procedure for treatment centres and for the people providing the treatment in Ontario? Could you share a little bit of that with the committee, please?

Dr Rush: There is no uniform standard that is required by government to be an alcohol and drug counsellor in this province. Many of the people who are counsellors and working in the treatment centres have gone through their own accreditation procedure within -- I cannot name the organization off the top of my head, but a known professional association of addiction counsellors, and they have certainly met the requirement of the management and the staff and their board as being bona fide counsellors. But to my knowledge there is nothing to prevent anyone from hanging out a sign in Ontario saying "I'm an alcohol and drug counsellor" and advertising for business.

I think this is something that should be addressed in the system. It really is around the whole issue of quality assurance. It is broader than just the credentials of the staff; it is what kinds of treatment should be offered and how many staff people should be available for any given individual.

In many types of facilities these things are all worked out. I do not think we have that in Ontario. Part of the reason is that historically they have been funded through so many different branches of government -- the Ministry of Correctional Services, the Ministry of Housing, the Ministry of Health, the Ministry of Community and Social Services -- the United Way and so on. Historically it has been a very fragmented system. A lot of the changes that are coming try to make it a more centralized, systematic kind of planning. With that, I think we need some attention to the credentialing.

Mr O'Connor: In the gathering of information for the registry, will some of that information then be provided for a report to the Ministry of Health -- or the anti-drug secretariat may be more appropriate -- so that it might look into a way of trying to make sure that we are providing a quality program through some sort of assessment of the centres themselves?

Dr Rush: I do not know to what extent DART can help. They are well aware of the problem and will not need too much from us. Where I think the issue involves the registry is that many people who are private counsellors or who are part of agencies that maybe provide some service to alcohol and drug clients but are not specialists or professionals have asked to be listed on the registry. We have had some difficulty deciding whether or not to include them, because we have no standard from government that says they are or they are not.

We have certainly raised the issue several times already with the Ministry of Health in terms of the credentials and the quality assurance issue as to when someone is legitimate enough to include on the registry. Our objective is to inform people about alcohol and drug treatment, and if we cannot define really what that is from a quality point of view, you should be able to see the problem.

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Mr Hayes: On certification or qualification for these counsellors, you say there is no legislation here, but we have also heard stories about people who have gone from here to the United States and taken the treatment in a matter of weeks or a couple of months. They take the treatment and then they come back here as counsellors and refer people to some of those places. Is there legislation there?

Dr Rush: I am not an expert on all the legislation, but I do not believe so.

Mr Hayes: So really there is no difference. There are no real qualifications over there either.

Dr Rush: Over there, for that individual to operate within some of the states, I believe he would be required to have gone through a formal accreditation process, but I do not believe there is anything preventing him from coming here without those credentials to advertise himself.

Mr O'Connor: I think the program he is talking about is through their education program down there, not going through the treatment program.

Mr Hayes: Not a training program but a treatment program.

Mr O'Connor: No, but the person from Ottawa whom we saw was going through a training program.

In the registry then, the private and public centres, where do the numbers fit as far as who funds them? Let's say "public" is something that is non-profit as opposed to a profit-making centre, and Ontario centres, comparing the numbers to US centres that are part of your registry right now. I suppose you could use the same ruling for both sides of the border, but what I am looking at is the number of places you have registered so far.

Dr Rush: In Ontario there are very few private, for-profit organizations. I could list them on one hand, with the exception of private counsellors where you might pay $50 or $100 an hour or whatever. We have started the registry program listing only programs which receive some government funds. For a program to be listed, it may have a part of its service which is fee-for-service, for example Bellwood Health Services here in Toronto, but it also receives some government funds so we have put it on the database.

It is not an either/or situation. You can have some hospitals in Ontario which provide alcohol and drug treatment that have different rules of thumb for private, semiprivate or ward. If you have private insurance or if you can pay the difference, you can get in quicker than if you just take a spot on the ward, where you will have quite a bit longer wait. Even some of our public programs have fee-for-service options. It gets a bit confusing.

Mr O'Connor: In the United States the numbers --

Dr Rush: In the United States there are many more.

Mr O'Connor: No, I mean within your registry right now.

Dr Rush: Within the registry, we do not list any American programs.

Mr O'Connor: It is all Ontario programs.

Dr Rush: It is all Ontario programs. We asked the Ministry of Health if they wanted us to list any of the American programs and the answer was no.

Mr White: I have several questions. If I could start at the outset, you have been the program director of ARF for how long?

Dr Rush: I have worked with ARF since 1977.

Mr White: And you have been program director since when?

Dr Rush: I have been assigned responsibility for this project, so I have a title of project director for DART.

Mr White: Oh, so it is project director for DART. Are you the program director for ARF as well?

Dr Rush: No. I am a senior scientist within the organization with other projects on my plate. This is one of the them.

Mr White: You are a doctor. Is that an MD or PhD?

Dr Rush: It is a PhD.

Mr White: Who is the present executive director?

Dr Rush: Mr Mark Taylor.

Mr White: And the present program director?

Dr Rush: There are many different programs. There are a variety of vice-presidents and program staff and so on.

Mr White: We have a couple of problems with that. It says program director here. It looks like Mr Crowley is a parent as opposed to an executive director. It is good to have that clarification.

Dr Rush: I am the director of the DART project.

Mr White: There are a number of questions following that. You talked about credentials and training for addiction counsellors. I was struck with that because as a counsellor myself, I have a certificate from the Addiction Research Foundation saying I have completed a course in addiction counselling. So do many of my colleagues. The Addiction Research Foundation is one of the most established institutions in the field, in the province and the country. I have always thought that gave me some market credentials.

Dr Rush: I am not questioning that. I am only saying you do not need it to say you are an alcohol and drug counsellor.

Mr White: No. It certainly helps though, as well as my degrees. Would that not be an excellent standard? Is there any attempt to network with the people who have those qualifications?

Dr Rush: There are lots of attempts from the bottom up, so to speak. There is an association in the province, the Alcohol and Drug Recovery Home Association, which represents all the residential programs, recovery homes and so on. They have also initiated their own credentials process. The Addiction Research Foundation has its courses. There are courses in at least two of the community colleges, so I think we are missing a universal standard.

We are also missing some legislative requirement that says if you want to identify yourself as an addictions counsellor, if you want to be part of the treatment network, part of the registry or whatever, then you should have something. I do not want my comments to be misinterpreted to imply that the people working in the treatment system are not well qualified, but only that you do not need it. There does not seem to be a uniform standard of training that you have in many other areas of health care.

Mr White: Most counsellors who are employed publicly have credentials like myself in social work, which of course is not at all recognized by the province by statute or any other form. I would agree with you that it is important to have those kind of universally recognized standards, probably also important to include courses on substance abuse in any kind of clinical training program, such as MDs, psychologists or social workers.

That leads me into the issue about the outpatient service. My understanding is that the 28-day formula is a magic number, universally used. You are suggesting there is a gravitation towards the 28-day program as opposed to outpatient or day programs and a tendency to refer to a holus-bolus program. There it is. It is intensive, residential. It may be in North Bay but it is a holus-bolus program. Has there been any evaluation of that kind of programming as opposed to counselling or day treatment?

Dr Rush: There have certainly been lots of studies. The best of those studies would take a large group of people and randomly assign them to get one kind of program versus another.

Mr White: Which you cannot do.

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Dr Rush: In some instances we have. We have at least 20 of those studies internationally, and not one of them has demonstrated an advantage to the 28-day residential program, and I would like to emphasize that -- not one of them.

What you need to do is separate some of the people who have the most serious problems and refer them to those programs and refer other people who would have less severe problems, who are just beginning to experience problems or whatever, to outpatient programs.

When you start to explain that to people, especially a client, they say, "Does it really have to be that complicated?" You try to recommend different types of programs for different types of people, and so far that is an idea that people resist. They like to think you are an alcoholic or you are not and you need treatment or you do not. They like to see things in black and white, and the black would seem to be residential treatment and the white no treatment. People are resistant to the idea that you have different levels of intervention.

I would like to reinforce that historically there has been a preference for residential treatment that is not warranted in all cases but certainly warranted in some.

Mr White: In my experience in terms of working with people with substance abuse or any other form of a disease like that -- I use that phrase guardedly because I am not sure I necessarily believe in the disease hypothesis. But is the flip side of "No, I'm not; I can control my drinking; I don't have a problem," to say "I have such a problem I need to be in a hospital"? The flip side of denial is the total holus-bolus, as you suggested.

Dr Rush: For some individuals that is what is required.

Mr White: Indeed.

The Chair: Mr White, I do not want to cut you off, but we have a second presentation.

Mr White: We are running out of time, yes. Thank you very much, doctor.

Mrs Fawcett: Very quickly, is it your idea that people in Ontario, and I include, let's say, physicians or anyone who would be referring, have an idea that maybe the US facilities are better than Ontario's? Is there that idea, or is it just lack of education that we do not get our message out that we have top facilities here that can handle these things?

Dr Rush: I think what has attracted them primarily to the US programs is the immediacy of access, that they could be there virtually within a day or two days. They will send a plane up to get you if necessary. More than anything, I think it is that which has really contributed to the use of the American programs.

There is a perception among some -- I am not disagreeing completely -- that because many of the American programs have the credentialing standards and the quality assurance standards they might be better.

Mrs Fawcett: And they are advertising.

Dr Rush: They advertise very aggressively.

Mrs Fawcett: Yet we seem to have beds. When we were at facilities, I do not know that we were full to capacity, but maybe for the type of particular needs we do not have enough. Certainly I would agree for young teenagers. I guess we really have a lot of work to do to sell what our own abilities are.

Dr Rush: There is some capacity in the residential treatment centres, but not very much, and there is certainly capacity in the outpatient and day programs which I believe is underutilized.

Mrs Fawcett: So we really need to look at expanding our --

Dr Rush: The overall network, I think.

Mr Johnson: It has taken about four months to set up the DART program and you have been active for three and a half weeks, you said?

Dr Rush: Yes, since October 2.

Mr Johnson: As I am sure you are aware, and everyone is, the provincial government is trying to reduce its OHIP expenditures, and one of the areas where we see that it is not a cost-effective expenditure is to fund for services in the United States if there are services available here in Ontario. Within your program, do you know now or will you know in the future whether there are adequate services for the needs of clients in Ontario and do you plan to make this information available to the Ministry of Health so that it can possibly use this information in establishing programs in the near future?

Dr Rush: I do not see any information that we have now in the first three weeks that would say there is enough treatment here. The waiting period, on average, for the residential programs is a month or longer. In some of the best programs, the most highly respected programs, it is six months.

Mr Johnson: So that is the underlying reason for people to go to the US -- immediate accessibility to their programs?

Dr Rush: That is one of the things. They are not prepared to wait for the length of time in the residential programs, but it ties into the bias against the other types of programs. In some communities the same program would offer residential and outpatient alternatives. The outpatient alternative might have 15 spots available, but if people will not access it, if people do not consider it to be a viable alternative, they still ask for treatment in the US.

Mr Johnson: Within the range of programs, are we top-heavy in one particular area and maybe weak in another?

Dr Rush: We are definitely weak in terms of outpatient and non-residential programs, and I believe we are definitely weak in terms of residential programs for young people.

Mr O'Connor: I will make this brief because our time has run out. One of the things the registry will do is provide assessment in cases of indecision. You have mentioned you have a staff of nine employees within the DART program. Are they all qualified therapists or something, who can make referrals? I am just curious about it.

Dr Rush: They will not provide the assessment over the phone. They will recommend that the individual make contact with the local assessment service.

Mr O'Connor: No, that in cases of indecision it "will recommend assessment."

Dr Rush: Let's suppose you are the physician and you call us looking for treatment, but you cannot really give us an indication of what type of treatment; you just think the person should be somewhere. We would try to put you in touch with the local assessment centre or a clinic which does assessment. We would not perform the assessment ourselves over the phone.

Mr O'Connor: Okay, I was questioning that. Thank you very much. You have cleared it up.

The Chair: I want to ask one final question which I do not think has been asked, but may have been while I was out of the room. What type of program is available in the correctional system? That has always been something that bothered me, because in my former life I practised in the criminal field -- I was not a criminal -- and I found that 80% or so of the crimes that were committed were either drug- or alcohol-related, and there was nothing, other than Alcoholics Anonymous -- which I am not putting down; AA is a marvellous program -- for these people. They were just spun out on to the street the same as they went in.

Dr Rush: I think my colleagues from Portage would be in a better position to comment.

There are a small number of programs which operate in some correctional institutions like the Rideau Correctional Centre in the east, for example. There are some programs operated in community resource centres, I believe they are called, and there are others like Portage Ontario, which is a treatment centre for young offenders. So there is a range of programs. My opinion is there are not enough.

Also related to your question, I think there are too many restrictions placed within many of the programs. They will not take the client if there are legal charges pending or if they are on probation or what have you.

The Chair: That is right. Maybe when you are reporting to the ministries, you could point out that in order to get into a place like Ontario Correctional Institute, a minimum eight-month sentence has to be imposed, which sometimes results in a person getting far more than he should. We used to have an excellent way of getting people in on a section 9, which was taken away. You simply fictionalized a section 9 and sent them over to OCI for a quick assessment. That was taken away many years ago. Those quick ways of getting them in should be reinstated.

I am sorry; I probably have taken more time than some of my colleagues.

We appreciate your coming, doctor. We also appreciate the information you said you would provide to us so we can disseminate it among all the MPPs for their householders to make people aware of this service. Thank you for coming.

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Dr Rush: Would it be appropriate for Tannis to give me a specific list of things you might like for the group?

The Chair: Yes, sure.

Dr Rush: Then I can ensure that you have it.

The Chair: Okay, and we will be the vehicle.

Mr White: I would like to follow the doctor's suggestion here that the number not be published in householders. It should not be for the general public. People, if they use it, will often get information they do not know how to deal with and really need to have initial clinical interviews with either their physician or a counsellor.

The Chair: Okay, I think that is well taken. We will put it perhaps in our householders that they can contact our constituency offices and we will have the information for them.

PORTAGE ONTARIO

The Chair: We now have Michael Crowley, director of development for Portage Ontario, and we have two gentlemen with him who will not be identified on the record for a number of reasons. They are parents. That is all I will say. It is at their request, and I think it makes sense that they would not be identified by name on the record. I think Hansard will be able to accommodate that. Welcome, Mr Crowley.

Mr Crowley: Thank you.

The Chair: I almost fell into the trap. Normally I would say, "Would you identify the two people to your right?" But I will not do that. We will call them X and Y for purposes of just who is speaking at what time.

Mr Crowley: Okay, I will introduce them by their first names. On my far right is Dave and Paul. The reason they have asked not to be identified and the reason I have asked them to come today is that both of their children were young offenders. Dave's daughter is in our program currently in the residential phase, and Paul's son has completed the residential phase and is living at home again. I asked them to come this morning as a part of our presentation to describe to you -- and answer your questions perhaps -- what it is like to be a parent of a young person who is a substance abuser and the difficulties they had in trying to find appropriate treatment for them.

Just briefly listening to Brian at the end, the DART program is working. We received a call from a worker up in Geraldton the other day about a 13-year-old female alcoholic. Normally we do not treat adolescents under 16. I asked the worker how she got our name, and it was through DART. I asked if she had tried any other programs, and the answer was yes, but nobody would look at a child under 14. I do not know that we would be the appropriate program, but there apparently is no other program in the province. If there is not, she will send the girl to the States, which I do not think would be the appropriate thing to do.

The Chair: I think we have information on Portage, but perhaps you could explain who you are and what you are.

Mr Crowley: Yes, I will briefly describe our program in Elora and touch on the nature of the program we provide, which is a therapeutic community. Portage as an agency has existed since 1973. We have provided a therapeutic community environment, a drug treatment residential program, for adult drug addicts in Quebec since that time. When the Young Offenders Implementation Act came into existence in Ontario the government here approached our agency in Quebec and asked us to come to Ontario to open a young offender residential treatment facility as an open-custody facility, which we did.

The program is long-term and residential and has a number of phases. Our belief is that drug addiction or substance abuse is an indicator to us that a person is having a lot of problems in terms of how he sees himself and his life and that he has turned to drugs or alcohol in order to cope day to day. That is true of adolescents as well as adults. What we try to do is work on changing their behaviours, work on the way they look at themselves. At the end of our program what we hope to have is a teenager like any other teenager, still full of doubts and concerns and fears but an adolescent who can also cope, feel that he is independent, feel that he can be successful in the world the way he sees the world, not the way we would see the world.

Our program is long term because we feel it is appropriate to get someone away from the streets, away from the temptation, away from the issues that he has been facing unsuccessfully for so many years. We provide a safe environment, a safe milieu. Sometimes a therapeutic community is called milieu therapy also. By "safe," I mean drug-free and alcohol-free safe, safe from violence. It is a place where they can learn to be themselves. It is long term. Usually a child will be with us for a minimum of six to eight months in our residential phase. Once they have gone through that phase, instead of just returning them to the street, we realize they are probably not quite ready to cope with those issues and pressures yet, so we have a transition and re-entry component as well. The transition phase is a 12-week program, and the re-entry phase could last as long as eight months. Re-entry or aftercare, it is the same thing.

The Chair: Is this custodial?

Mr Crowley: In Ontario we are. We are classified as open custody, although we have private beds. So we do have people in our program who are not there by virtue of custody.

The Chair: Is Quebec non-custodial?

Mr Crowley: Yes.

The Chair: I was going to ask you how you keep them there.

Mr Crowley: Even in Quebec, people leave when they find the treatment is no longer appropriate for them, and 20% of our population in Quebec come from the justice system, usually federal inmates on day pass or on parole. They return to jail because jail is a lot easier time for them than being in a therapeutic program where they have to do something all of the time every day, where they have to talk, where they have to express their feelings and, in a sense, can never hide.

We know that in jail, unfortunately, it is all too easy to just sit in your cell all day or read a book all day or disappear into the walls, if you will, all day. It is something that we never allow in Portage. The day is very structured. The kids are up at 6:30 and lights out is at 10:30. During the day they are either in school for about five hours each day or they are in group or individual counselling.

Most of our staff are ex-offenders; 90% of our staff are former drug addicts. They have all gone through our program or some other program. For staff who are not former drug addicts, if they just have university degrees, as part of their training they will do our program, live in our program for at least a month, sometimes longer, as if they were a resident, so they learn what it is like to be a resident and to have to live that kind of life.

It is important, I think, for us to state and have you understand that therapeutic communities are one end, probably, of a spectrum of drug treatment that goes from outpatient counselling to short-term residential to perhaps mid-range residential to long-term. For serious opiate addicts, methadone maintenance would be nearer our end of the spectrum as well.

There was an international conference on drugs and drug treatment in Montreal a few weeks ago that I attended and spoke at. It appears that the next generation of methadone programs is probably going to be joined up with treatment. That is, stand-alone methadone without treatment probably is pretty well frowned on by most of the research, scientific and treatment world these days. We think that is probably quite appropriate.

Our program is co-ed, which presents its own unique difficulties. We found over the past few years that the girls who commence treatment are much more serious drug abusers than the boys at equal ages: While very few of the boys that we have inject drugs, almost all the girls would have.

The Chair: The information we have from research is that there are residential programs for males but not for females. Is that still the same situation?

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Mr Crowley: For adolescents or adults?

The Chair: Young offenders.

Mr Crowley: There are none that I know of.

The Chair: So a female who is in closed custody would not have access to your program?

Mr Crowley: No, we are co-ed, so she would have access. I am sorry. What I meant to say was that there are no stand-alone, female-only facilities.

The Chair: We based it on the 1989 Addiction Research Foundation --

Ms Haeck: Mr Chair, we have a concern that we get through the presentation.

The Chair: I appreciate that, but I am trying to clarify this because that is the information we have.

Mr Crowley: We have 42 beds. We made it co-ed after this was published and we have been waiting, like everybody else, for a reprint of that for the past year.

Our program is difficult to finish, to graduate from. To graduate from our program requires having passed through all the residential and non-residential phases of the program and doing aftercare for at least eight months in which you stay drug-free, alcohol-free, crime-free, be working or in school, have money in the bank and be living an appropriate lifestyle.

Nevertheless, we feel that some kids who go through our program for perhaps three or four months will still have gained a great deal from that time, we think more than they would have in other kinds of programs. We think that if they stayed with us for three or four months, they would be much more able to participate successfully in community outpatient programs.

I would like to end my presentation with this and ask Dave and Paul, if this is appropriate, to tell you a little bit about their experiences with their children. Then we would go to questions.

Dave: I would like to make my presentation in two parts. First, I will tell you a little bit about what it is like to have a drug-abusing teenager as a daughter and follow that up with a little on what she is like now after about six months in the Portage program.

My daughter was a fairly normal young girl growing up and had good grades at school, up until about grade 9. She passed through grade 9 with a little trouble. She started becoming lackadaisical about her work at home. At the beginning of grade 10, she started complaining about the teachers not being good enough for her, not wanting to stay at home, wanting to be out all the time and not doing any homework.

At age 15 she ran away from home and was gone for about two weeks. We managed to get a two-week court order to have her returned to us and we were lucky enough to be able to have her brought home at age 16. She came home. She was a mess. She stayed home for a short time, over the summer, at which time we tried to assimilate her back into the family. We went away on a vacation. We had a great time. It was the first time we had had a great time for about a year and a half. We came back and she went back to school. She started off at another school. Again, she did about two or three weeks of grade 10, never did any work, never showed up at home after school and ran away from home again. We followed her around town. We tried to find her. By now she was 16, and of course under the Young Offenders Act we could do nothing to legally have her brought back home where we could care for her.

She moved to various rooming houses around town and stayed with various people. We had no idea who they were. When we did see her, which was very rare, it was fairly obvious to us that she was not leading a particularly good lifestyle. We did not see her actually stoned, but we were pretty sure that drugs went along with living on the street and living in these kinds of places.

Her visits to us became less and less frequent and she was in worse shape as we saw her each time. She got involved in crime. She was charged with minor assault. She was charged with shoplifting. She was on probation. She was seeing a probation officer on a regular basis. It was obvious to us, even though we only saw her from time to time, that she was a drug user and we had no idea of what. No help was forthcoming to her at that time.

The situation became worse and worse. She phoned us in about November of last year and said she was dancing. She was now stripping to make money, so we knew that she was probably making a lot of money. She never had any money. She never had any clothes whenever she came home. We had done everything we felt we could as parents to try to get some help for her. We just did not know where to turn and eventually you reach a stage where you have to get on with your life. I have a younger daughter and I figured, "Until she comes to me and tells me that she needs some help, there's nothing more I can do."

At the end of April this year we got a phone call from my daughter and she said the words I wanted to hear. She said, "I need help." I said, "Where can I find you?" She said, "I'll meet you in a gas station at the corner of -- " I cannot remember, some corner in Scarborough somewhere. So I went to the appointed spot at the appointed time and, of course, she was not there. So I drove around Scarborough for a couple of hours and went back to the place where she said she would meet me. She came down the street towards me. She weighed about 85 pounds. She had filthy, dirty clothes on, ripped and torn. Her hair was bleached blonde and looked like straw. My daughter is five feet 10 inches tall, so 85 pounds is not a very big girl.

She said, "I can't take you back to where my stuff is, but I'm going to go and get it." So she walked down the street to a crack house where she picked up her belongings, which consisted of a Loblaws bag with a couple of pieces of clothing in it. She came back to me in the car, having done another snort of coke, I guess, to get her back home. I would have given her at that time maybe 10 more days, otherwise she would have been dead. There was no doubt she was dying when I picked her up.

She had outstanding charges against her. She had not been to the probation officer she should have been to, so obviously there was a warrant out for her arrest. I called a few friends of mine in the police department and I said: "What do I do? Where do I turn? Where do I get her some help?" They said, "Go to the ARF." I said to my daughter, "We're going to phone the ARF." She said: "There's no point in going to the ARF, because that's where I used to buy drugs. That's where they hang out, outside the day programs. I need more than that."

I called my family doctor the next morning. I said, "Where can I go for help?" He put me in touch with Bry-Lin in Buffalo. We drove down to St Catharines and had an appointment with them the following morning and they accepted her in the Bry-Lin program. We had to get her across the border and she could not go across the border with a warrant against her. So we called the police that night and said, "There's an outstanding warrant. She'd like to give herself up the following morning." We went to the police station at 6 in the morning so they could process it so that we could have her go through the court system and, as the police wanted and as we wanted, be released to us so that we could have her entered into a program.

To make a long story short, the judge decided he was going to send her to jail for this breach of probation, not get her any help. When we said that we had a program that we had already gotten her accepted into, he hummed and hawed and did not seem to want to know about this program. He would rather send her to jail. We just did not know where to turn at that time. We knew, if she went back to jail, she would probably be getting more crack that night, because it is fairly openly known that crack is available in jail.

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We were very lucky that the crown attorney and the defence and the police all said, "It's ridiculous that this should be happening." The crown attorney, I guess, somehow managed to get another judge to hear this case again. We went to the probation department upstairs in old city hall and Marg Welsh told us about Portage at that time. She said: "There's a wonderful program in Ontario for drug abusers with criminal records. It's a marvellous program. I'm sure if we can explain to the judge about this program, he will release her to your custody overnight so we can get her there the next morning."

We were able to convince the judge of this, even though when we got up in front of that second judge and said, "We have a program that we would like to get her into and we're pretty sure she's going to be accepted to it," he said, "Where's this, in Texas or Alabama or somewhere like this?" When he was told this program was in Ontario, he was surprised because he had never heard of it.

Anyway, we did, thank God, get her accepted to Elora. At the Elora program, for the first six weeks we did not see our daughter. That is part of the program. I guess you probably have details of the program. We saw her after six weeks. She had put on 30 pounds, she was clean and she looked well. She was not happy because it is a tough, tough program.

A few weeks after that, she called us -- she called us every week at home -- and said that she was doing well at school. She had gotten 80% on a test at school. She had been doing art work, which is magnificent. She is clean. She talks to us. She comes home on a regular basis. She comes approximately every two weeks on a pass, first of all with another family member from Portage and now alone.

She is a wonderful person again. She is easy to talk to. She wants to finish this program. I am absolutely amazed at how well she has done. She is now in the Elora program in Quebec for a short time because for a long time there were no other female residents at Portage. It is surprising to me because I am sure there is more than one criminal drug-user adolescent female in Ontario, but for some reason they are not getting the message that this wonderful program exists.

She is doing tremendously well. We expect her to move on to the next phase of this program within the next month to six weeks, which would be a transition phase. I cannot say too much about the Elora program. It has amazed me how well my daughter is doing, how she associates with us, how she talks to us, how she wants to work hard, how she realizes the error in her ways. I guess that is my story. Portage and Elora have just been marvellous places for my daughter.

The Chair: Thank you. Maybe we could have the next parent.

Paul: I am going to pick up my story a little bit further along than Dave's. A lot of the situations he went through, I went through similar situations with my son, except for the fact that he never ran away from home. He liked the security of the home, but he went through all these drugs, alcohol, etc, within the house. He got in trouble with the law on a couple of minor charges, but nevertheless he was charged as a young offender.

As we got into the situation and realized there was a problem with addiction -- it was a combination, quite frankly, of drugs and alcohol -- we were looking around. "Well, what do we do?" I mean, here are two parents, middle class. "How do we access help? There must be professional help somewhere." We were directed first to the ARF, Addiction Research Foundation, to which Dave was also directed. Once again, I share some of Dave's concerns about that. The location of the four-week program right in the heart of available drugs at Spadina and College does not make it the best programs for kids who want to beat the habit.

He was there a week and for a minor rule infraction he was kicked out, or sent home. So then we said, "Okay, we'll bring you back and maybe this will help." I guess he was home for probably two or three months and the situation continued to be bad, so we gave him some ultimatums, one of which was Portage because we had read an article in the Toronto Star about one year before. But he knew that was an 8- to 12-month program and that was not a big incentive for him. The second option was a treatment facility in the US and the third option was being kicked out of the house. The last one was not even acceptable for him, because he did like the comfort and safety of home, so he opted for one of these US treatment facility centres. We went through an agent or a broker -- I do not even remember his name at this point in time; it is not relevant really -- and within 48 hours we were in a US treatment facility. He thought this was a 28-day program. I knew it was 56, which is two months. Otherwise I would not have got him on the airplane to get down there.

He got down there and it was a hospital facility. It was staffed by medical practitioners and psychiatrists and doctors and whatever and seemed to be a reasonable kind of recommendation, and I did not know any better. I am not an expert in drugs and alcohol addiction, so we left him there. We actually went down and saw him about a month later and had some consultations with the staff. Then my wife and I went down at the end of the eight-week program and actually spent another, I guess, five days. We went through the situation with him with some counsellors and psychiatrists and whomever, and then he came home with us.

We thought, "Well, there's supposed to be an aftercare program." That is what we were told through this broker. Unfortunately we got home and there was no aftercare facility or aftercare program available. I would say that he kind of tried to rehabilitate himself, but with with all his friends being, let's say, negative, which is the word they use at Portage, he just really buried himself in the basement and ultimately four to six or eight weeks later he got back on to the street with his old friends.

We could just see him slide down, and then about three months later we finally said, "That's it; you're gone," and we kicked him out of the house. He left the house, and then at the place where he lived, they got sick of him in three months. He asked to come home, so we said, "Fine, come home." Then about two and a half months after that he continued to go downhill. We were going to kick him out again, but we said: "There's one other option left. That's Portage." He did not like it, but he took it. In our opinion, he had kind of reached the bottom. He had been through ARF, this US facility and then said, "I want to have a roof over my head." He did not particularly want to go to Portage, but he had no choice.

He went there. That was about 14 or 15 months ago. He did not like the program initially. It took him four months to really get into the program. We did not talk to him for I guess two or three months at a time, because he would not call us. He could have, he was allowed to, but he did not want to because he just felt that we had abandoned him.

Anyway, he did finish 10 months of the program earlier this year. He then went through the transition period in the Lansdowne house that Michael mentioned earlier, and he has now been home with us for about two and a half or three months.

He has a job, he feels good about himself, he is talking to us, much the same things Dave said about his daughter in terms of being, let's say, a relatively normal human being again. He feels good about himself, and I guess that is the big thing that changed at Portage, that he felt he was worth while, that he was a decent human being.

I guess my point in terms of talking about Portage and coming here is the fact that I think there is a need for long-term facilities for teenagers, whether they be young offenders or people who are not in trouble with the law. It is not for everybody; there is no question about it. There is a fairly high turnover at Portage. But if a kid has reached the bottom in his own perception or he thinks he has reached the bottom, then I think this is the kind of thing that really is long enough and intense enough to be able to change his basic behaviour and he will come out feeling that he has some worth in the world. Basically that is why I am here.

The Chair: Thank you very much. Do you have any further comments before we go into questions?

Mr Crowley: I think my final comment partly follows what Dr Rush was saying to you as his last comment with respect to, is there sufficient treatment for adults in Ontario or adults within the correctional system? My feeling is no, and I have worked in the addiction system for about 20 years now. We think there should be more programs like ours in Ontario for adults as well as adolescents. We would very much like to be able to provide beds for adolescents who are not offenders as well as the few who in fact are young offenders and are appropriate for our program. That is my final comment.

Mr White: I have a couple of questions, one I guess for Dave and Michael. The issue I am picking up on really is the long-term residential nature of your program. You are talking about six or 12 months, right?

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The Chair: Drummond, you tend to speak very softly. I wonder if you could speak up a little bit so we can all hear you. I am having trouble hearing you up here.

Ms Haeck: We want to hear your words of wisdom.

Mr Crowley: You would think a politician would know how to speak into a microphone.

Mr White: We had discussed earlier with the good doctor the four-week program, the 28-day program, which is sort of a standard. My personal experience with teenagers is that they have different needs than adults, and I think probably a longer-term need, a time to pull together. Could you comment on the reasons, from your standpoint, that you would need a longer term than a four-week period? And I could ask Paul, as well, because he has been through that four-week or twice-four-week program as well.

Mr Crowley: In terms of a client profile, most of the kids in our program are 16 or 17 when they come. Most started using drugs or alcohol at age 10, 11 or 12. If a kid starts at 12, that is a late onset, as far as I am concerned. We are talking about kids who have had four years or five years of serious substance abuse, who dropped out of all normal activities and dropped out of school at 14. It takes a long time to get into that kind of cycle, to get ingrained in that kind of cycle, and into the kinds of things that Dave's daughter was doing, stripping and perhaps living on the street, even though she grew up in a fine home. To change a person, whether he is a child or an adult, to have a different lifestyle, to have a different way of behaving, a different way of making decisions, cannot, in our view, be done overnight, cannot be done in four weeks.

If you look at the history of 28-day programs, you have to understand that 28 days was the figure set by insurance companies in the States. They used to be 36, and then two or three years ago, Spofford Hall tells me, it got changed to 28. They had to create a 28-day program because that is what the insurance company said they would do. I cannot think of any other kind of program that is predicated on a number of days rather than the needs of the individual, so we look at the needs of the individual rather than at some pre-set amount of time.

Having said that, we also run a 28-day program at our adult facility in Quebec for employee-assistance programs within the context of a therapeutic community, but we provide very intensive aftercare for a year. I do not want to leave the impression that you cannot have an effective short-term program, but the aftercare component has to very intense, probably much more intense than most programs in Ontario. This would include urine testing, I would say, based on American experience, which does not, by and large, exist in Ontario.

Dave: I would agree with what Michael said, but my daughter's treatment, as she carries on with it right now, is still evolving. I spoke to her yesterday. She is still a little concerned about what she is going to do when she comes out. While she is still an awful lot better six months into the program, she is still somewhat concerned about what she is going to be like when she comes out, which is why they have a very good aftercare program at Portage.

When I first spoke to her after six weeks -- and after six weeks she was clean -- she was not ready and could not possibly have been ready to come back to society. The only lifestyle she knew was going back to prostituting and stripping and taking drugs. That was all she knew. So certainly I do not believe a 28-day program, while it may have cleaned her up, would have been in her case a long-term program that could have been stuck by.

Paul: I echo some of the things that Michael said. Basically, our son went through that progression of the 28-day, then the 56-day, and then he needed something longer. I think he had to come to grips in his own mind with the fact that he had hit bottom and he wanted to come back up, and I do not think he had in either of the two programs.

Once again, the Portage program is not for 100% of the population, the drug addicts or the alcoholics, in terms of young people. It is basically for what I would refer to maybe as the hard core. It is hard to say that my son was hard core -- there are a lot of kids in Portage who did a lot worse things than he did, by and large -- but there was no hope for him, in my opinion. My wife did say at one point that she felt he would be dead in a year if he had not gone into Portage.

Mr White: One final question in regard to, again, my clinical experience in the past. I have worked extensively with families and to a fair degree with adolescents, both individually and in the family context. I have been struck in the last perhaps half-dozen years with the tremendous number of young girls. I think, Michael, you referred to that. The young girls in the program tend to be into more serious abuse situations, and I hesitate to qualitatively characterize the difference between your children. The situation you present today is something I have run into many times before, extreme changes and very dramatic situations with girls, more so than with boys.

I know there has been some recent research by a psychiatrist out of McMaster, I believe, which identified adolescent girls as having particular problems that have not been addressed within our treatment programs. I wonder if that fits with your experiences, and if there are any recommendations you might have in regard to services for those young women.

Mr Crowley: I would say it fits with our experiences. I am not sure I am qualified to give recommendations. As I say, our program is co-ed; the groups are done in a co-ed fashion. I am not entirely sure that we feel comfortable with that. We think the girls may have sufficiently serious issues that are theirs alone, that they do not share with the boys, particularly with respect to sexuality and related issues. We think we may need to have them do more of a program separate from the boys. We do that a bit more in Quebec. The women -- and they make up about 20% of our total population there -- do more things separately because they have tremendous issues. Most of the girls we have had experience with in Ontario have had more histories of sexual abuse and physical abuse than the boys have, and so that is an added issue we have to deal with. We could count on a lot of the boys, up to 50% at one time, as having been abused at home.

Mr White: Up to 50% of the males have been sexually abused?

Mr Crowley: Yes. Every time we do a snapshot analysis that is what it appears to be, about 50%. Sometimes it takes a long time for a boy to be able to talk about that as well. They do not tell me at assessment. They will talk about it after being in the program for six months, when they finally feel comfortable and able to bring out that issue they have perhaps been hiding for so many years.

It is the emotional crux that perhaps caused them to turn to substances in the first place, or other kinds of behaviour. We have had some kids in our program who are not substance abusers but their behaviour is relatively the same. What we do is to essentially change behaviour, so we take those kids into the program anyway.

Mr O'Connor: Thank you for coming today. I missed the first part of your presentation, so I apologize for that. I was wondering if you had mentioned the vacancy rate, and if you do not mind repeating for me if I did miss it.

Mr Crowley: No, I had not. We average about 70% filled. Right now I think we have 33 kids in the program, out of 42 young-offender beds, and that is fairly typical for us.

Mr O'Connor: What do you mean by private beds?

Mr Crowley: Portage, as an agency, has a program in Quebec. We have a program in Portugal, and we do treatment for the government of Bermuda and some other places as well.

Sometimes we will bring adults who are drug addicts but not offenders into our program. They form a cohesive, slightly older group than young offenders. It is important, we think, for kids to realize that turning 18, 19, 20 or 25 is no magic solution in itself. They know they still have a lot of problems to work on.

By and large, those private beds are used for people who are already from Portage. Sometimes we are able to use those beds for a referral from children's aid or a referral from Community and Social Services in Ontario, but they are not young offenders. If somebody was wealthy enough to pay our per diem, we would have somebody use the bed and pay a per diem. We have never done that, but it is always feasible. Our per diem is $93.

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Mr White: That is cheap.

The Chair: Are those six beds that have just not been licensed by the ministry? Is that what those six private beds are?

Mr Crowley: They are not licensed.

The Chair: The other 42 are.

Mr Crowley: The Ministry of Correctional Services does not license. There is a contractual arrangement.

The Chair: They fund you absolutely, then.

Mr Crowley: Yes, and we have to meet standards and all that.

Mr O'Connor: When you consider the percentage of time of the adolescent on the addiction, that certainly points to the need for a lengthy stay to try to make sure the recovery is complete. You never mentioned your aftercare. Could you elaborate a little bit on what your aftercare is like.

Mr Crowley: The aftercare comes in three different phases. The transition phase is a 12-week program after the large residential program with 30 or 40 kids. About five or six or seven will be in a transition stage with a specific 12-week program where they work on the family issues. We work with families while the kids are in the program as well, so we know what those identified issues are. We emphasize life skills, budgeting, nutrition, those sorts of things that kids will need to have as skills in order to successfully be independent in the world.

The re-entry phase is the next phase, where kids are actually going out to work or to school, coming back every day, sharing those experiences with staff and the other kids in the program. Once they have left the program, physically left our facilities, they come back once a week for counselling with staff and the group they went through their program with. We continue to do urine testing while they are in those phases, so we have a pretty good handle on how they are doing. For them to graduate, which is the ultimate phase, they have to be clean for a minimum of eight months, that is, not use drugs or alcohol.

It may well be that a kid will fail, will take a drink or have marijuana or something like that. They are certainly allowed to come back in and say, "I've goofed," and might spend a weekend in our program and just continue on again. We make a commitment to kids. If a kid leaves after six months, maybe a year from now he will say: "Gee, what Portage said to me makes sense. I want to come back." They are no longer young offenders.

We will take them back in the program with no fees charged or anything like that, because we realize that kids who may need a 12-month program might take three years to do the program because they are adolescents and they need to test -- kids always test -- what you are telling them as parents or as educators or as clinicians. They want to test out those theories in the real world and come back and rethink how they are going to approach life again. For us that is fine. If they are too old or they are adult offenders now, we will send them to our program in Quebec, again at no cost to anyone, because we try to make a commitment to a kid or to a person.

Mr O'Connor: How long do the one-week revisits -- how long a period is that?

Mr Crowley: That a person can come back for a week?

Mr O'Connor: After their residential program and they have gone through all that.

Mr Crowley: It is a minimum of eight months and it could last up to a year. They will stay in touch with each other on a voluntary basis for much longer than that.

Mr O'Connor: Are there more questions?

The Chair: I wanted to ask a couple.

Mr O'Connor: The parenting program and the involvement of the parents, could you just elaborate a little bit on that? Then I will turn over the floor.

Mr Crowley: I will ask the parents to respond to it, because they are both involved in the Toronto group. We do groups in Toronto and Guelph. As we get more kids from specific areas of the province, then we can start up parents' groups in those parts of the province.

Paul: Is that what you wanted to hear?

Mr O'Connor: That and your involvement while you are going through the process.

Paul: What we have, and we alluded to the parent groups, is that every two weeks there is a group which is specifically aimed at having the parents, mother and father or mother or father, as the case may be, come together as a group. It is basically a confidential meeting. None of the information gets back to the kids themselves. It is more to deal with the feelings and the issues that the parents are going through. We have one of the staff from Portage come down and there are a couple of adult leaders or leaders who have had their kids go through the program. There we get our issues out in terms of how we are feeling and how we are managing these feelings. It has been very helpful for a lot of people in terms of trying to come to grips with the thing. "Was it our fault? Did we go wrong? What could we have done differently?" It has been very effective. That goes on. You can keep going to that one for as long as you want.

Mr Crowley: Whether your kids are in the program or not.

Paul: Yes.

The Chair: You told us your program could be used for young offenders who were placed in secure custody.

Mr Crowley: They have to get a change of disposition to open.

The Chair: I see. So there is no ability to come there in secure custody?

Mr Crowley: We have made an arrangement with the ministry that it will release somebody for 15 days on a temporary release so we can do an assessment of him in the program.

The Chair: So that is a while away.

Mr Crowley: Yes.

The Chair: I thought you said that in Quebec you take referrals from the adult population. Is that right?

Mr Crowley: Our Quebec program is an adult program. We are starting an adolescent program there.

The Chair: Is that also a program that is on a non-secure basis, that you have to be out on parole or on probation or whatever?

Mr Crowley: No, 80% of the people there are just from the street; 20% would come from the justice system.

The Chair: But what I am getting at is, is there any facility there that would provide for a person who is in the penitentiary system or the correctional system to come from jail and be held in secure custody?

Mr Crowley: On temporary absence.

The Chair: Just temporary absence? I know that the Clarke Institute of Psychiatry has a few secure beds and I think the Queen Street Mental Health Centre will take a certain number.

Mr Crowley: Oh, I see what you are saying. What we do in two federal and one provincial institution in Quebec is train correctional officers to run therapeutic communities in those maximum security institutions. So federal inmates in two facilities, or provincial inmates in one, can participate in a Portage-type therapeutic community.

The Chair: Within the prison?

Mr Crowley: Within the prison.

The Chair: The other thing was, in your profiles of young people whom you have had come to you over the years, you have listed that some of them have been found to be abused children. Have you also discovered a degree of learning-disabled kids?

Mr Crowley: Yes.

The Chair: Is that part of the scenario?

Mr Crowley: I am not an educator so I do not know the significance of the percentages, but I am advised by our teachers that the percentage of kids who have learning disabilities they see as being extraordinarily high. Often in fact they have become so adept at seeing this that the teachers -- we do not employ them, they are employed by the county board of education -- have discovered learning disabilities in 16- and 17-year-olds that were never discovered in the regular school system. So by virtue of their being in our program, they are finally able to get the learning experiences they need as well.

The Chair: I gather your educational program, while they are there, has a very small classroom size.

Mr Crowley: Yes.

The Chair: And they seem to flourish in that?

Mr Crowley: They seem to, yes.

The Chair: Maybe I could ask either or both of the parents if they perceived any degree of learning disability in their children. Was it that which caused them to have perhaps less achievement in school as they proceeded and a bad feeling about themselves, which may have been the impetus to the problems they had?

Dave: In my particular case, we did not really see that. Right through junior school, she did very well. She was a pretty good student. She started to struggle in grade 9 a little bit and perhaps by struggling, she looked for another outlet, but no sign of any kind of learning disability.

The Chair: Was she ever examined as a child with a learning disability?

Dave: No, she was not. She passed her grade 9. Even though she was struggling a little bit, she passed with decent grades. It appears to me more that at that time she was probably experimenting with drugs and that was the reason for her dropping out in grade 10.

The Chair: It is kind of which came first, the chicken or the egg, I guess.

Dave: Yes. Again, when she went to Elora, she got good grades at the Portage facilities.

The Chair: It is classic that learning disabled kids do flourish in a very small, almost one-on-one classroom scenario, where as they get lost in our Hall-Dennis scenario where you put them all in open concept. Finally, do you see any perception of learning disability?

Paul: No, nothing that would be explained by anything other than perhaps getting into alcohol. I think our son got into drugs and alcohol in that 11 or 12 age range, but I do not think there was any major learning disability that we have any concern about or any knowledge of.

The Chair: Are they diagnosed before they come into your program? Are they examined for that particular problem?

Mr Crowley: No, they are examined for that before they start the school program.

The Chair: And you say it is a very high incidence of those people?

Mr Crowley: That is what I am told. I cannot tell you what the percentages are.

The Chair: Okay. I am sorry. I have taken more time.

Mrs Witmer: That is okay. I wanted to say, in relation to what you have been asking questions about, the two teenagers I talked about earlier this morning who ended up going to the States for treatment because there were not appropriate facilities here were actually exceptionally bright young people. It is really important to recognize that students who get into this type of difficulty have all sorts of different levels of academic achievement and ability.

Mr White: It is also important to distinguish the relationship between learning disabilities and the causality of problems.

The Chair: We may be called for a vote any minute now from the looks of things. I want to thank you very much for coming forward, and hopefully as a result of the work of this committee and people like you being prepared to come before us and share your experience with us, we might be able to assist this government, and any other government, to come up with a program that will help or provide a haven where parents do not have to go through the agony I am sure you went through. We wish both of your children great success.

We stand adjourned until next week.

The committee adjourned at 1202.