Tuesday 15 January 1991

Children's Mental Health Services

Tikinagan Child and Family Services

Lakehead Regional Family Centre

Ontario Prevention Clearinghouse

Hospital for Sick Children

Jeanne Sauvé Centre

Simcoe County Children's Aid Society

Afternoon sitting

The Mary McGill Community Mental Health Centre

McMaster University

Ontario Association of Children's Aid Societies

Ontario Teachers' Federation

Waterloo County Board of Education

Ontario Public School Boards' Association

Earlscourt Child and Family Centre



Chair: Caplan, Elinor (Oriole L)

Vice-Chair: Cordiano. Joseph (Lawrence L)

Beer, Charles (York North L)

Haeck, Christel (St. Catharines-Brock NDP)

Hope, Randy R. (Chatham-Kent NDP)

Malkowski, Gary (York East NDP)

Martin, Tony (Sault Ste Marie NDP)

McLeod, Lyn (Fort William L)

Owens, Stephen (Scarborough Centre NDP)

Silipo, Tony (Dovercourt NDP)

Wilson, Jim (Simcoe West PC)

Witmer, Elizabeth (Waterloo North PC)


Jackson, Cameron (Burlington South PC) for Mr J. Wilson

Miclash, Frank (Kenora L) for Mrs Caplan

White, Drummond (Durham Centre NDP) for Mr Silipo

Clerk: Mellor, Lynn

Staff: Drummond, Alison, Research Officer, Legislative Research Service

The committee met at 0902 in committee room 2.


Resuming consideration of the designated matter of Children's Mental Health Services pursuant to standing order 123.


The Vice-Chair: Order, please. Our first presenters this morning are the Tikinagan Child and Family Services, Sioux Lookout. Charles Morris, the executive director, is presenting. Please come forward and take a seat. Would you also introduce the person who is with you.

Mr Morris: Good morning, ladies and gentlemen, members of the standing committee. Ruth Roulette is the co-ordinator of services for our child care agency. I am the newly hired executive director.

The Vice-Chair: Before you get under way, I just want to take this quick moment here to remind you -- I am doing this with all our presenters -- that we have to adhere to the strict rule of a half-hour for each presentation. You have a half-hour from this point on.

Mr Morris: I have a 12-page presentation. That will take about 25 minutes, I believe.

The Vice-Chair: That would leave you five minutes for questions by members of the committee. Usually most people who come before the committee would make their presentation and allow 10 or 15 minutes at the end of it, but whatever way you would like to split that up is your decision.

Mr Morris: I am pleased to have this opportunity to appear before the standing committee on social development. I am particularly gratified at this time that you have chosen to examine the issue of children's mental health services and to hear the views of our agency on this vital matter.

It is my understanding that your committee has convened to consider a number of pressing matters that affect children province-wide, such as pressures upon treatment placements and existing mental health centres, the growing numbers of difficult-to-serve children in educational institutions and the need for a co-ordinated policy approach to effect a more accessible and qualitative service delivery system.

While our communities share in these fundamental concerns, I must emphasize the degree to which these needs become amplified in the north, and moreover, considering the virtual void in services to on-reserve populations. In considering the statistics of youth suicide in the past two years, we can conclude that this growing trend of childhood apathy and despair is claiming our children's lives at the rate of one child per month. Further into my presentation, I will provide more detailed statistics on the suicide epidemic throughout the Nishnawbe-Aski Nation. I think you will agree with me that the picture I present is a disturbing one.

As the executive director of Tikinagan Child and Family Services, I am here to present our concerns as they relate specifically to the unique situation of native children's mental health needs and the limitations we have encountered in that area. Although our agency has assumed the primary mandate of child welfare for the 28 Nishnawbe-Aski Nation communities within our catchment area, we have only begun to scratch the surface in fulfilling the commitment to our people to promote and implement healing mechanisms that will reduce the dependency on protective services for children and families. I would like to provide you with some background on our organization and the unique features of the people and area we serve.

Tikinagan Child and Family Services was created as a result of the signing of a memorandum of agreement between the government of Ontario and the Nishnawbe-Aski Nation in August 1984. The memorandum provided for the takeover of child and family services by native people and therefore restored control over the care of our children and families to our people. This memorandum of agreement was signed by the Deputy Minister of Community and Social Services for the province of Ontario and by the Grand Chief of the Nishnawbe-Aski Nation and by six tribal council chairmen.

This agreement for the first time opened the door for us to begin to offer services to our communities. Under the legislation, namely, section 10 of the Child and Family Services Act, 1984, recognition was given to our unique approach of providing child and family services in the holistic manner envisioned by our people.

On 1 April 1986 Tikinagan became recognized as an approved agency under provincial guidelines. Tikinagan was approved to deliver community support and child care to its member communities. By 1 April 1987 Tikinagan was prepared to take over the child protection mandate and was subsequently designated as a children's aid society under the Ontario Child and Family Services Act. Tikinagan therefore is in the midst of its third year as a fully mandated child and family organization. It is one of the few organizations of its kind in Canada serving both a majority native population and a minority non-native population.

This majority is comprised primarily of some 12,000 Nishnawbe-Aski Nation members over geographic boundaries that span an area of 250,000 square miles. The cost of providing service to this expansive area where air travel is the exclusive means of transportation to all but two of our communities is by necessity very high, but remains a vital characteristic of our work.

Notwithstanding these physical challenges, as our people began taking over the responsibility of child and family services we saw that it would not be an easy task. We began to see that taking responsibility for our children meant delving deeper into the ills of years of systemic ineptitude inflicted upon what was once a vibrant and thriving people. This pathology more intensely affects the younger generation among our people.

In many of our communities we have struggled with community-wide breakdowns and crises. These have stemmed from intergenerational solvent and alcohol abuse, widespread incidents of child abuse, an epidemic outbreak of youth suicide and disturbing elements of cult-type behaviour in some of our youth.

These behaviours are symptoms of the destructive forces of dependency and powerlessness that are entrenched at a systemic level in our communities. On a larger scale this is the root cause of the tragedies we see among individuals. The problems of our communities must be addressed in this wider context with a commitment to lasting change.

Our leaders have thus committed their energies to bringing about self-government for our people and that struggle will continue until the objective has been attained. In the meantime, the struggle itself continues to take its toll in situational terms of personal losses and tragedies. We continue to witness a day-by-day phenomenon of people internalizing their powerlessness through destructive living. The most painful and bewildering of these acts has been the recent rash of suicides by young people in our area. Frighteningly, the statistics continue to increase and at the same time the average age of victims lowers.

The recently published Nishnawbe-Aski Nation report entitled To Sustain a Nation on mental health policy consultation cites: "In the two-year period, 1987 and 1988, there were 165 suicide attempts and 13 completed suicides. As of June 1990, there were 76 attempted suicides and as of September 5th, 1990, eight completed suicides. In 1987, most of the suicide victims were young men between the ages of 14 to 25 years. Between 1987 and 1989, the average age of the suicide victims dropped from 23 years to 17 years. In 1990, of the eight completed suicides, three were female victims, ranging in age from 13 years to 22 years in age."


Another serious problem we are facing in this field is the rising number of reported cases of child abuse to our agency. It is a widely held belief among our people that the abuse inflicted upon previous generations due to the old policy of removing Indian children from their homes to the residential school setting prior to the 1960's is one of the root causes contributing to today's lack of parenting skills, especially where neglect and abuse is an issue. In the area of child abuse we must begin to address preventive mechanisms such as community education, which would permit communities to deal with an issue that is both fearful and fraught with interfamilial dynamics among small and closely knit communities, especially in cases of sexual abuse and incest.

As a child welfare agency, we are steered towards dealing mainly with the investigative aspect of abuse and ensuring the protection of children rather than focusing on the healing aspect that is so critical to breaking the cycle of abuse.

In our experience as a child protection agency, we also become involved in issues where the health and the justice systems overlap, where gas sniffing among children is concerned. Time and time again in these cases we find major difficulties in serving these clients due to lack of treatment facilities that do not further alienate the child by lack of a focus on native children and geographic distances. We have failed to find suitable treatment placements for these children, as well as for those who suffer from long-standing abuse cases. This scenario is similar for those of our children who suffer from schizophrenia or who are otherwise socially maladjusted.

Presently our children are sent to urban centres where services can be accessed, but at a considerable cost both in financial and human terms. The wisdom of this practice is questionable, especially when front-line workers in these settings have confided in us their feeling that the services they provide may be inappropriate to our clientele and indeed detrimental to their mental health. We aptly recognize that children in our area are a high-risk group. However, due to this fact the existing services remain stymied at a crisis intervention level even when prevention remains part of this agency's mandate.

Other service providers in our area share in this sentiment in striving to provide service to children. The services which are provided tend to be fragmented, stemming from the lack of a clear mandate for any one body to assume responsibility for on-reserve-focused children's mental health and concurrently the lack of a strategy that would address other issues such as prevention, service coordination and the need for specialized training.

One of the key barriers to the provision of services is the jurisdictional question of who assumes responsibility for developing an on-reserve program delivery framework and a policy that would support the financial and statutory mechanism required.

Under subsection 92(27) of the Constitution Act it has been concluded that the provinces have jurisdiction for health, while subsection 91(24) of the Constitution Act and the National Health and Welfare Act of 1945 gives the federal government responsibility for ensuring that natives have access to health care.

Furthermore the 1965 welfare cost-sharing agreement in Ontario provides for the reimbursement of on-reserve services in Ontario by the federal government up to 95 cents on expended dollars for services such as child welfare, homemakers and general welfare. To this end, under the child welfare mandate, Tikinagan has been actively pursuing a strategy of accessing a number of children's services that would approximate the function of a community-based counselling unit specifically targeted for high-risk children and families. This strategy, although lacking a policy framework for children's mental health on-reserve per se, would serve to alleviate some of the pressures and limitations facing service providers in our area who are acutely aware of the gaps in the children's services field.

Although we are gratified that we have recently enlisted the co-operation of the Ministry of Community and Social Services in this strategy, it is to our dismay that this has only gained acceptance after three years since the original proposal was submitted. At the same time that this was going on we began hearing about the newly launched northern initiatives program, presently known as integrated services for children in northern communities. This program augments the existing northwestern Ontario service delivery to children with special needs through an interministerial approach of sharing resources. Among the services being offered will be mental health related expertise and services.

Again we find that what has been instituted is inappropriate for northern reserve needs. The program designers have told us in no uncertain terms that on-reserve communities are ineligible for professional services which are otherwise available to the rest of the population. This northern children's program has not strategically considered how it will offer service to remote native communities in northwestern Ontario. This omission in planning and the inherent jurisdictional questions associated with it has reaffirmed the necessity for our organizations to press for a comprehensive mental health policy that can meet a wide range of needs in a holistic fashion, serving both adults and children in a community-based setting for Indian people.

At present, service delivery, where it exists, occurs mainly on a reactionary crisis basis. We cannot help but think that in an ideal proactive climate the counselling unit which we are only beginning to set up in our agency could have played a role in preventing some of the losses in our communities if recognition was provided before the youth crisis in our area evolved to the proportions it is today.

We also speculate on the effects of our limited accessibility to community-based mental health programming. Some of this programming through the Patricia Centre for Children and Youth, a Sioux Lookout based children's mental health service, is available to our clients on a waiting list basis if we are willing to remove them from their home communities and families. Our workers must weigh the trauma upon the child of taking this action versus the decision of leaving families intact but without treatment services.

The lack of a mental health policy and program delivery framework will continue to perpetuate the conundrum of community services existing just beyond the reach of on-reserve populations. For those who access them, they will often find themselves alienated because services are ill-designed for serving Indian clients, and the federal government while maintaining responsibility for access to health care will point to funding considerations in maintaining small-scale and understaffed projects such as the Nodin Counselling Unit in Sioux Lookout.

It is our position, and one which is supported by the chiefs in our area, that a national policy on native mental health for on-reserve Indians must be developed and recognized. At the back of my presentation I have given you recommendations of the Nishnawbe-Aski Nation mental health policy consultation paper, so you will get that.


In considering the role of the province in this sphere I would like to highlight some of our specific and immediate concerns about the present state of children's services. I would ask that you consider the following concerns in the recommendations of this session:

1. Recognition and increased resources where required for measures such as family violence initiatives at the community level; the suicide crisis line presently being implemented in Wunnumin Lake for the NAN area; various initiatives arising from individual communities that are addressing the youth suicide issue through workshops and community education efforts;

2. Recognition of increased financial resources to service special needs children under Tikinagan Child and Family Services care at 50% to 100% higher levels than regular foster care levels; the cost of providing care to these children, many high risk, continues to place financial strain on our residential services budget despite the recovery mechanisms that we have enlisted from the Ministry of Community and Social Services;

3. The establishment of a treatment facility specifically for solvent abusers and particularly with a native youth component, as this is the main client group;

4. The establishment of specialized clinical treatment centres for native children that are equipped with trained native practitioners;

5. Development and implementation of programs for abusers and their families for rehabilitation and prevention purposes, such as Tikinagan's proposal for a male perpetrators of family violence treatment facility;

6. The need for increased collaboration among ministries and programs to fill gaps in service delivery and ensure efficiency to prevent duplication in services;

7. The immediate necessity of exploring more in-depth strategies aimed at improving the state of mental health and related services to Indian children on reserve.

In summary, I would like to once again emphasize the key role government must play in coming to grips with the crisis in mental health services for Indian children, in particular at the policy level. The type of policy I am speaking of must be consistent and comprehensive enough to address Indian mental health needs and requirements across Canada, but at the same time permit enough flexibility to be workable among other federal and provincial jurisdictions and regional and cultural diversities among first nations themselves. In this way, we will be able to sustain those structures we require in building a mental health infrastructure that is holistically based and therefore ensure cultural applicability. We especially see this action as critical for the children with whom we must entrust our future survival as a people.

The Vice-Chair: We have approximately 12 minutes left in the presentation. Mr Miclash.

Mr Miclash: Thank you, Chair. First of all, Charles, I would just like to thank the two of you for coming down to Toronto with your presentation, a very interesting one.

Something that I have had a bit to do with in the past three years is the program on solvent abuse. I am just wondering whether you are aware of the programs, through the Lake of the Woods District Hospital, offered to solvent abusers, first of all.

Mr Morris: Yes, we have taken advantage of that program and we have in fact sent our clients over to that centre.

Mr Miclash: What are your feelings on that program at the present time?

Mr Morris: Well, it is pretty hard for me to say. I have only been the acting director for two months. But the problem, in general, that we have is that our chiefs and our elders have told us to find alternative means of institutionalization, so that would exclude the program at the Lake of the Woods hospital. They want us to seek funds whereby we would be able to set up our own institutions that would provide relevant therapeutic care to our people.

The two cases that I am aware of where we have sent people to that place that you mentioned are cases where we have intervened and it has been a last-resort measure. I do not know if you got the impression from my presentation that there is a lot of work to be done. We need to educate our people and we especially need to do a lot of work on prevention.

Mr Miclash: The reason I asked the question is because it was my feeling that it was a movement out of the institution towards traditional means of healing and that it was one step in that direction. That is why I asked the question as to whether you were satisfied with that step in that direction or not.

Mrs Roulette: I think the other thing that we find, sending our children to Kenora, is that our children come from isolated communities and even Kenora, to them, is a big city and the adjustment there takes quite a while for them. So in terms of trying to treat a child for solvent abuse, you have to also look at the factor that they are homesick and they are lonely. You cannot treat a person who is homesick and lonely.

Mr White: Mr Morris, I am very impressed with your presentation and, of course, the time it took you to come down and to pull it together.

The holistic approach that you present, I think, is quite creditable. When I look at the kind of services that are delivered in urban communities, we tend to fragment our human selves so much that we lose any sense of continuity and context for our own services. I am certainly pleased to see that you are not willing to give up your whole sense of self and the community context, your native context.

You mentioned the Patricia Centre in Dryden. I believe that is their head office. They have a suboffice in Sioux Lookout, I think, with only one and a half staff people. I have two questions. One is, in what way do non-native supports interrelate with your program and, second, do you make any use of, or have other services like your own made use of, the native bachelor of social work program? I think that is at Laurentian University.

Mr Morris: This is what is so ironic about Tikinagan. I have been there for two months. It seems to be a native child care agency in name only. The native supports that you inquire about, I have not witnessed any of them. The work still has to be done in order to make a bona fide claim that Tikinagan is in fact a native child care agency.

At the local level, where we have our band family services workers, you have to recognize what they are. I do not know if you could even call them paraprofessionals, but they lack the training to do the work that is required of them and Tikinagan in no way has the resources or the capability to provide the training that is required in order to make the BFSWs an important linkage between the reserve level and our core office and so forth. So there is a lot of work that needs to be done. I do not know if Ruth would add to that.

Mrs Roulette: In terms of the Patricia Centre in Sioux Lookout, we do use the support system. However, Pat Centre does not service anyone north of Sioux Lookout, so we have to bring our children out and that has a tremendous effect on the children when we bring them out of the communities.

Mr Morris: We are just an intermediary. We purchase service from other institutions and from other groups, and that is all we are presently. That is the sad fact about this whole operation.

Mr Jackson: Really briefly then, Charles, thank you for your presentation. In the six years that I have been here I have listened to a lot of submissions from native bands in the social policy area and I keep coming back to the scary statistic that something in the order of 2% to 3% of the entire native population ever gets inside a university in this province. Perhaps that seems to hit on the point that the process of healing within your own community has to be done by native peoples and, as a result, if we are not providing the educational opportunities, then you are going to always be in a position to purchase service from outside your community, which is not part of the process of healing. I guess it is more a statement than a question, but I would like your response to it.

There are several reports from legislative committees identical to this one, which have investigated this issue and made some very clear and strong recommendations for native education, so that your resource pool is larger so that you can be empowered to deal with your own concerns. Would you please respond to that, because it seems to be part of the problem that you are struggling with?


Mr Morris: The problem lies to a large fact that when Canada was created the provinces and the federal government sat among themselves and totally excluded native people from any sort of empowerment, as he called it. So there is that jurisdictional problem. I think a lot could be solved, a lot could be done by native people if only they would receive more self-government powers from the two levels of government. That is to a large fact one of the main things that has stymied us time and time again. There are no policies in place. There is always the jurisdictional wrangle. There is always, always that jurisdictional void between the federal government and the province, so they keep passing the buck back and forth to each other, despite what our treaties say. The provincial government does not give a damn, the federal government does not give a damn. Until that attitude changes, nothing is going to improve for native people.

Mr Martin: It has been my experience over the years, having spent some time with native people, that we have a lot to learn from you in terms of how we deal with each other and with our children. I am particularly interested in the holistic concept. You also mentioned integrated services. Certainly it sounds, from some of the witnesses we have had here to date, as if we need a more comprehensive, co-operative approach to this whole thing. You mention they call it holistic. Perhaps from the native perspective, you might share a little bit more with us what you mean by holistic.

Mr Morris: Holistic, I do not know. I guess basically what it means is that native people be given more of a say, like the utilization of traditional means of resolving problems.

What I could say is that, with regard to treatment, the efficacy of treatment is directly related to the socialization that a person has been brought up in, that particular social environment that he or she has been brought up in. So we bring our kids out to a totally foreign setting where they get totally immersed in foreign norms, behaviours, traits. If we had our own native practitioners manning our institutions, I am sure the treatment would be much more successful. We have to develop our resources, we have to develop a framework, but the government, first and foremost, has to come up with the necessary policy and resources and the two levels of governments have also got to define their jurisdictional powers in relation to what it is that we want. That is what I see the holistic approach as being.

The Vice-Chair: We have run out of time. I would like to thank you for making this trip to come before the committee. You have come a long way.

Mr Owens: I am wondering if it would possible to obtain a copy of Mr Morris's presentation.

The Vice-Chair: Yes. I neglected to tell the committee members that we are trying to do that at this very moment and we will be distributing that as soon as it is available.


The Vice-Chair: I would like at this point to call our next set of presenters, the Lakehead Regional Family Centre from Thunder Bay: Dr Kevin Nugent, child and family psychiatrist, senior clinical consultant.

Welcome to the committee, Dr Nugent. We will just get settled down here and you can start your presentation. Again, I remind you, as I will do with each of the presenters, that you have half an hour for your presentation and it is your choice as to how you divide that. Your presentation can make up the entire time or you can allow for questions within that half-hour period.

Dr Nugent: Thank you, Mr Chairman. It is a pleasure and an honour to have the opportunity to address your group. This is as close to a political process as I have ever come and I really feel complimented to have been given the opportunity to make this presentation. I also am reassured that in these times when people are so cynical about political processes, the concerns about the children's mental health centre that had been brought forward over the past year or so are being listened to and are being attended to, and I assume this is part of the process in dealing with those problems.

In my presentation, I am going to assume that we are primarily at the level of trying to identify what the main concerns and underlying causes are in terms of problems in the children's mental health centre, rather than to be so presumptuous as to lay on solutions.

I also want to make it clear that I am speaking primarily as an individual and as such I would like to indulge by telling a little bit about my background. I am a child and family psychiatrist, which is to say that in addition to medical training and training in adult and general psychiatry, I have specialized in working with the mental health problems of children and adolescents and families. I have moved through the province, and so I have some sense of what the systems are like in other communities. I have worked in Kingston, I have worked at the Children's Hospital of Eastern Ontario in Ottawa. I have worked at McMaster and at Chedoke in Hamilton, and I am very pleased to see that one of my mentors, Dr Offord, will be addressing you this afternoon. I also finished off at the Hospital for Sick Children and another one of my mentors, Dr Bradley, is also on the program today.

I made a very explicit decision at the end of my training to strike out to the frontiers, to leave the health science centres, to leave southern Ontario and to go to northwestern Ontario, and up until very recently I have been the only child psychiatrist for the quarter million population in our area.

I have affiliated myself with the main children's mental health centre, the Lakehead Regional Family Centre, and I have functioned very much as a consultant to try and spread myself around there. So at the case level, at the team level, at the program level, at the agency level, where I work with our managers and even our board, and also at the organizational level across the area, I have tried to function as a consultant and work with our district health council. I am presently involved with a major project that is reviewing the way in which our regional services are offered across the entire mental health system. I am on the steering committee for that group. And finally, I am affiliated with the University of Western Ontario, which has set up a program -- it is called the extended campus division of the department of psychiatry -- trying to sponsor psychiatrists across the north. At the present time I stand as the only Canadian-trained psychiatrist within that group of psychiatrists across the north, and I will try and make some reference to that as I go on.

Again, I want to make it clear that while I have talked to a number of my colleagues, including some within our agency, this is mainly my own stance that I am presenting to you. I will move on to the paper. I believe that you will have copies of it, and I will move right to the section regarding quality. I am going to deal with the headings that you have talked about.

I see an apparent failure to value quality of service and programming in children's mental health, and I am afraid I trace a major change to the switch in 1977 to -- I am used to calling it Comsoc; maybe it is more polite to call it MCSS, but I am afraid I call it Comsoc throughout this -- Comsoc taking over care of child mental health centres. I see since that time a real devaluation of several areas, first in terms of clinical direction and expertise. Many child mental health centres have what I feel is an ill-advised lack of clinical leadership and direction to complement the administrative structure.


We are used to seeing in health and in adult mental health systems positions like a clinical director, a medical director, a psychiatrist-in-chief. While I would feel I have moved away a lot from a medical model in the sense that the psychiatrist has to be in charge, I believe very strongly that someone with expertise has to oversee the clinical direction of our child mental health centres. That is true in some centres, particularly the academic ones down south, but as you move away from that and into the smaller centres, I think that is often overlooked.

Subsequent to that, I think there is an inadequacy of skilled attention to clinical training, to program planning and development, to quality of service and to clinical research. In a meeting in our centre recently, the main unit of our centre, I found out, did not feel it was necessary for its staff to do assessments and treatment planning at the time of getting involved with their cases. That is the kind of situation that would never happen if there were stronger clinical direction. My role in our centre as a consultant means I do not have any formal authority or direction. I merely give my ideas as a consultant.

Next, I feel that the directives we have got from MCSS, such as Investing in Children in 1988 and in the north, Northern Directions for the Delivery of Services to Special Needs Children and Their Families, are naive, conflicting and seem to lack a sound expertise about the business, about clinical expertise and treatment and about what our present system of care is. I also see a profound failure of the CMHCs to offer adequate training, supervision and salary to a largely novice staff with the rare exposure to sound academic training in terms of their university training to child and family mental health issues.

I feel that, first, our universities are not doing a very good job of turning out graduates to be prepared to do good work in child mental health and, second, child mental health centres have become a training ground for our new grads. They come and work and we train them and then they go on to work in other sectors where they are better remunerated, and I will come to that.

I also see a real movement away from the idea of clinical assessment and treatment towards more of a care mentality as you see in the child welfare system or probation services. I feel that the Comsoc administration of CMHCs shows very little understanding about clinical concepts. I also strongly resent, and I know a number of my psychiatric colleagues have tried to speak about this, this idea of redefining what we do in child mental health as intervention or support to try and access the Canada assistance plan funding. This has been going on for a number of years and is even now in legislation, I understand.

I also see, and I do not know if this is only a northern phenomenon, a kind of amalgamation mania which has to do with joining programs to virtually everything in sight, which includes things like care and support programs, children's aid societies, and so on. I see a real blurring of boundaries and a confusion and this also ends up diluting the clinical strength of the programs. As I said, I do not know if this is only a northern phenomenon. I am particularly against the idea of amalgamating children's aid societies and child mental health centres, because I think there is a very real boundary there that is very confusing for our clients when those are merged.

Then I see Comsoc's unwillingness to pay appropriately for clinical expertise at the staff and program levels. At the staff level, recently our centre has lost two very good MA psychology people, psychometrists. One went to the health sector with a $6,000 raise; one went to the education sector with an $8,000 raise and the summers off. We cannot compete with other sectors on these kinds of circumstances.

At the program level, I would like to say something about our experience in Thunder Bay trying to procure a community-based treatment program for assessment and short-term treatment of adolescents. We have been proposing such a program for six years. We have undertaken two or three surveys. There is unanimous support across all sectors for such a program. We have customized our proposal to meet local need. We have rewritten our proposal two or three times. Basically we are being told that a clinical unit is too expensive.

About three years ago, the native child mental health centre in our area decided to go ahead on the budget that was being proposed. They have recently been reviewed and basically that review said: "This is a group home. This is not a clinical treatment centre." We have reappealed; we have scaled down our proposal on every possible opportunity that we can find.

This is at a time, incidentally, when at last count -- my director did a survey -- 75 adolescents from our region were sent to out-of-region residential treatment over a one-year period at a cost of hundreds of thousands of dollars. We are still told that our proposal is too expensive. Basically they want a group home; they do not want a clinical treatment centre for assessment and short-term treatment of adolescents.

Finally, I am concerned about the linkages to the health sector in this area of quality. I am talking about general hospital services, addiction services, adult mental health, paediatrics and family practice. I see a real lack of needed communication and co-operation. Recently in my centre, for example, a number of our managers argued with me about whether it was "worth the trouble" to update family physicians about our work with their patients. This shows an attitude of a major schism between us and the health sector. There is occasional duplication of services. We do not see that often in the north. Serious gaps in service result in many children and families falling through the cracks. This particularly happens with adolescents, I feel.

Next I will move on to the issue of accessibility. If you will indulge me in a mini-lecture, these are terms that may have come before this committee. These are quoted from one of the major textbooks in psychiatry. "Primary prevention aims to eliminate a disease or disordered state before it can occur." So this is true prevention. "The goal of secondary prevention is to shorten the course of illness by early identification and rapid intervention." Here we are talking about treatment or cure. "The goal of tertiary prevention is to reduce chronicity through the prevention of complications and through active rehabilitation." So here we are talking about maintenance, support, rehabilitation.

I would maintain that in Ontario, our child mental health centres typically pay lipservice to primary prevention and deflect or put on waiting lists many of our opportunities for secondary prevention of child and family mental health problems. If primary prevention is so important incidentally, why do we so devalue secondary prevention?

I also see an inordinate amount of our resources going to well-established and highly resistant presentations where we are essentially involved, by these definitions, in tertiary prevention. This list of presentations is really the main work that our centre appears to be doing at this time: children from abusive and neglectful homes, children from alcoholic and other kinds of serious dysfunctional families, incest victims, disturbed adolescents with conduct disorders and emerging personality disorders, children with autism.

It is not that I do not feel that we should be involved in the treating of these disorders. I do feel that by concentrating most of our resources on those, however, we are missing all kinds of opportunity for secondary prevention, for preventing children and families getting to some of these states of severe and entrenched disorder.

If I were to make a medical analogy, and I think you will be aghast, imagine you phoned your paediatrician and said: "I'm calling about the young one. He's running a temperature and he's got a terrible cough. It sounds like there is a bit of a wheeze." Imagine if your paediatrician said: "You know, we're awfully backed up with our ICU cases and our rehab cases. If he gets really sick bring him in, but otherwise he's just sick, so don't trouble us with it." That would not be acceptable: that would be a legislated impossibility. This is the kind of thing that is happening in child mental health, which really makes one wonder about what value we place on this area.

With the kinds of presentations which I see more in the area of tertiary prevention, we are often doomed to rather limited success, because we are looking at situations where there may be limited resources and motivation of the child and family, inadequate clinical skill of our staff -- remember we have a very young, green staff where training has not been emphasized. There is a lack of intensive treatment structures and settings.


A good example of this is in the area of sexual abuse, where we have a sense now of how we can properly treat families where incest has occurred, but it calls for a comprehensive, well-co-ordinated system that most child mental health centres are not able to provide.

Also, I see a weakness in our systems in contending with chronic conditions, situations and rehabilitations. We are dealing with chronic situations as if it is a matter of quick treatment and cure when oftentimes there may be a need for relatively long-term support and intervention.

I guess the one area that I would point to where this contrast is most striking is dealing with the contrast between the young offender sector, which at least in the north in my jurisdiction has received a major influx of funding over the last few years, and dealing with the kinds of kids who end up with young offenders earlier on, for example, children with attention deficit disorder and hyperactivity. As many as a third to half of those kids go on to have trouble with the law. Many of those kids end up in the young offender sector.

I have done lots of young offender assessments. Many of those kids had hyperactivity and attention problems that were not diagnosed, that were not well handled. In our centre, I have been trying for a number of years to get some designated resources to put in a program for children with hyperactivity, while we have a whole team dedicated to the young offender sector and, as I said, lots of other resources coming into the young offender sector. So we have no sense of a stitch in time here. We are putting major resources in at a point in time when it is well known that treatment of well-entrenched conduct disorders is a very frustrating and limited exercise.

I would also like to make a comment about the 10,000 or so cases awaiting child mental health services. I would ask, should not mental health assessment certainly, and at least perhaps treatment where indicated, be a legislated right in Ontario?

What of the opportunities for early identification and treatment that are being missed as families turn away bitterly from interminable waits? Should we wait for the entrenchment of presenting problems for suicide gestures, family breakdowns and so on, before our citizens have a right to mental health assessment assistance?

Next I would like to move to the issue of availability. I see a need to recognize that there should be a spectrum of services from basic services through to specialized services available according to the realities of population and the region. This has been well documented in many reports going back to the Heseltine report and others. Why are we not following our own guidelines in these areas?

Speaking on behalf of my area of northwestern Ontario, our critical needs would include skilled emergency assessment and short-term in-hospital treatment resources in at least one general hospital. Adolescents going into hospital in our community do not receive any kind of quality service on a reliable basis.

Second is the kind of community-based crisis and short-term treatment facility for adolescents I have talked about.

Third, and this is something that is kind of a new idea, is a pool of funds available to flexibly meet the needs for creative programming in special situations.

One of the youngsters that I have been involved with, for example, is about turning six. He has behavioural problems, and his mother was coming to keep an eye on him over lunch. She had an opportunity to return to the workforce and this boy was not able to manage through lunchtime. He was suspended three times and was on the verge of expulsion from kindergarten. A very small amount of money would have been able to provide some opportunity to supervise this child over the lunch hour. That is a small example of what I am talking about.

Finally, and I say this with little trepidation having talked about how money is flowed to the young offender sector, it is clear to me that there ought to be some kind of a prevention resource for intensive treatment of high-risk young offenders before the major offences that we are anticipating, before serious assault, before further sexual offences, and so on. When we call the supposedly designated centres in Thunder Bay, we are told they have not done that offence yet so we cannot get them into the treatment programs.

I would also like to suggest to you that a well-functioning child mental health system requires adequate backup from child psychiatry, from adult psychiatry and from the adult mental health system.

I would like to ask when the government of Ontario is going to contend with the drastic maldistribution of child and adult psychiatrists in the province. Why should we in northern Ontario with a population of 833,000 be struggling with a little over two dozen psychiatrists and three onsite child psychiatrists when at the other extreme Ottawa has well over 200 psychiatrists and well over three dozen child psychiatrists? When is this issue going to be confronted?

Regarding funding, I recognize that there is not likely to be a major influx of new dollars into CMHCs, although I do feel the sector is underfunded, but I do think some realities have to be faced. Our local Comsoc office continues to nickel and dime us on what are even very basic base budget issues, often coming from its own directives, the amalgamations it puts us through, pay equity and so on. This can only lead to cutbacks in service and training and a very real demoralization of our staff.

Second, in regard to the major salary discrepancies between CMHCs and virtually all other sectors, we are seeing a very real and rapid turnover of staff, a loss of experienced staff and again demoralization. Quality clinical expertise, treatment and programming cannot be purchased at rates that you would expect to pay for care and support and for group homes.

In conclusion in this area, I really feel society will get what it pays for. A continued failure to invest wisely in the mental health needs of children and families will only put increasing burdens on corrections and adult mental health services as our children grow up, and on education, child welfare and child mental health services for future generations.

The Vice-Chair: We have approximately 10 minutes for questions. I have on the list Mr Owens, Mrs McLeod, Mr Beer and Ms Haeck, in that order. Mr Owens is first.

Mr Owens: I would like to begin by thanking Dr Nugent for his presentation. I think you have delivered a fairly round and sound condemnation about the system as it exists now. I am wondering if you can present to the committee some specific recommendations that we can take into account as we go forward to bring recommendations to the government. I guess you are currently based somewhere between northern and southern Ontario, and what we heard from different presenters over the past day and a bit is that there are unique problems related to both sides. I am wondering if you could comment on that and also give us some sort of guidance as to what we should be looking for.

Dr Nugent: As I said, I was not certain that my vantage point and my definition of the problems coincided with the issues across the province, although I have some sense of those things. So I will make a couple of thoughts that I would see more as directions rather than solutions.

I think we really have to look at the decision we have made in terms of how the child mental health centres are administered. Is the MCSS the proper place to do it? Should it perhaps be Health? Should we look at the creation of a ministry for services for children and youth? I really feel that issue has to be struggled with. If we remain under the administration of MCSS, then we really need to get some people who have a knowledge of mental health and child mental health in positions of authority in MCSS.

I also feel very strongly, and it is an understandable bias, that the issue of clinical direction and expertise and informing of our programming and our training and so on has been undervalued and needs to be contended with on a centre-by-centre basis.

I feel some of the basic funding issues, as I mentioned in the summary, really need to be dealt with. One of the issues that is clearly an issue in the north has to do with recruitment and retention of professionals. The financial issue makes it that much more difficult to retain professionals, but we find it very difficult to recruit MSWs, MAs in psychology, PhDs. We have only a single graduate-level program in northwestern Ontario, which is an MA in psych program. They do not even have a course on child mental health. We really need to look at ways to improve that in terms of the situation in the north.

In our area, the native child mental health services are in a rather independent structure and function, so I am circumspect in what I have to say about that sector, but I tend to lean towards the idea that they really need to have culturally sensitive and appropriate services. The kinds of clinical offerings that I have been trained to give often do not jibe with where particularly native children and families from very traditional ways are coming from.

Those are some things in terms of solutions. Perhaps others will come up as we move through the discussion; there are a lot of questions here.


Mr Owens: In terms of the cultural sensitivity issue you raise in northern Ontario, how would you build that into the medical model that you seem to feel is the route we should be going?

Dr Nugent: Are you talking specifically about the native mental health sector? I feel very strongly that it is a situation of people with clinical expertise being available as consultants to native health providers, that we should be involved in training and supporting, consulting to them, raising their level of expertise and their knowledge of various aspects of technique of our area in terms of their being able to provide it to their own local people. A system of that kind of support to native mental health providers could quite easily be established. There is something comparable to that working out of Sioux Lookout but more broadly available across the north.

Mrs McLeod: I am not going to attempt to take the committee into the whole area of the special needs of northern Ontario. I was most anxious that we have representation from the north so we would begin to get a sense of what a huge area of need it is. I think we really need to focus on it in a very particular way and all we can do in these sessions is begin to get a sense of the enormity of it. Obviously, I am also very biased and not at all objective in dealing with the issue, so it is probably best that I not open it.

But I would point out from the opening comments Dr Nugent made that in his involvement across northwestern Ontario, one of the things I think he did not mention was that the only reason we now have a second child psychiatrist for the first time in my memory is because of the personal effort Dr Nugent makes to recruit people. That is also something which has been demanding of his time and personal commitment, and it is reflective of the acute need for trained people in northern Ontario that our clinicians would have to make such an effort at recruitment. It is also, incidentally, one of the factors we have to look at in terms of the high rate of burnout for professionals in northern Ontario.

Having made those comments, I will ask Dr Nugent to go into a more general area. The short-term crisis unit you mentioned is a long-standing need and one I am well aware of. I think the fact that has not materialized is not just a funding issue, although that is real, but also seems to reflect the other issue you have addressed in your report, which is a very basic difference in orientation between clinical and support models.

I do not know if you have had an opportunity to look at the Maloney report yet, which was tabled just before Christmas, looking at children's mental health services and recommending essentially that the school become a hub for service delivery. It may be unfair to ask the question before you have had a chance to look at the report, but I am wondering whether you think there is room for some of the primary-secondary interventions, as you have described it in your report, to be possible at that school level with a role still for a clinical referral model at a more centralized level.

Dr Nugent: I believe very strongly in that possibility. I think there is some good research that looks at primary prevention efforts based in the school that are non-stigmatizing, that are available to all children and that can make a very substantial impact. I am talking about Rutter's work in terms of primary prevention in schools in Britain. As to secondary prevention in terms of children and adolescents in school who are actually experiencing difficulties, I do not see why a support group kind of intervention, such as a support group for children whose parents have separated, could not be available based in the school. I am supportive of that as a direction to go.

Mrs McLeod: You are optimistic that clinical and social work models can work compatibly and provide a continuum, that we can get past this basic conflict in approach?

Dr Nugent: Oh, very much so. There is a clear need for a range of services. My difficulty is when the clinical ones are lopped off because they are too expensive or not valued and so on. We need the range, clearly, in my opinion.

Mrs Witmer: I am really pleased to see this very frank and honest report. Following up on what Mrs McLeod has just spoken to, the school being a central focus, would you also support the establishment of some sort of children's services planning advisory committee in each community to help co-ordinate children's services at the local level?

Dr Nugent: Certainly I would. I think it would facilitate the linkages between different sectors. We are making some initiatives in those directions both in the child mental health and the adult mental health sector in Thunder Bay. So far, we have been encouraged by what has been coming of that. Yes, I strongly support that as well.

The Vice-Chair: Thank you for your presentation.


The Vice-Chair: Our next set of presenters is the Ontario Prevention Clearinghouse; Bryan Hayday, executive director. Thank you for coming to the hearing. We have half an hour for your presentation, as I remind each of the presenters. We will stick to that time limit and you can divide that in whatever way you deem appropriate.

Mr Hayday: Thank you very much. The written presentation that has been distributed is not something I will read. I will not, however, introduce significantly different information but rather highlight it in the same sequence in which it is presented.

I would like to begin by making an introductory remark. It is important when we are thinking about the children of the province that we think about all of the children of the province and not just about those whom we are most aware of because of some specific current problems they may have, and recognize that any solutions which work for the few have to be in the context of all children. That is a theme I would like to pursue.

Our vantage point at the Clearinghouse is that as an organization we work with nonprofit organizations and social services, health and education across the province. So I think we have a rather unique perspective that reflects the interests of children across the province as well as other community concerns. The Clearinghouse has had a history of about five years and it is in that context that I will speak.

Children's mental health has expanded significantly in Ontario over the last 15 years. In some ways, it can be dated back to an experiment to bring together a children's division and solve some of the issues which are surfacing again a decade and a half later. During that same time period, there has been some significant research which we must pay attention to; it needs to be examined in a context of this question as well. That research is drawn in part from the Ontario Child Health Study conducted by the child epidemiology unit at McMaster. That study showed there was an incidence level of childhood psychiatric disorder that ran upwards of 16% of all children in the province between the ages of 4 to 12. Childhood psychiatric disorders are some of the concerns which children's mental centres pay attention to. If you keep in mind that figure of 16%, at the same time that 16% of all children in Ontario may have a psychiatric disorder we have a children's mental health system and children's and youth institutions and other organizations providing children's mental health support seeing maybe 2% of Ontario's children in any given year, with no guarantee that this 2% is drawn from the 16%. We have absolutely no way of being certain that those figures correspond. So even if you as a committee were to recommend an 800% increase in the resources providing treatment services for children with a psychiatric disorder in the province, there is no guarantee, the way we have currently organized our system, that those services, even increased eightfold, would address those children in most need. That is the first point I want to register with the committee.


I would also like to remind you that while we accept tacitly the importance of access to treatment, we do not demand at the other end of the spectrum any substantial evidence of the effectiveness of that treatment in adjusting the long-term life chances of those same children. There is a kind of lipservice paid to the importance of more access to treatment without equivalent efforts going into demanding evidence that this was useful and helpful for those same children in terms of changing their life chances and improving the quality of their lives.

There are some other disturbing findings that came out of the child health study which are buried in the detail, and this gets us back to the level of looking at the entire system for children. The child health study found that for those children living in families where the principal source of income was a welfare cheque, when you held that income constant and compared it with children living in the families of working poor, the same dollar value, the likelihood of childhood psychiatric disorder was substantially higher in those families where the dollars came from welfare rather than from earnings. Since we know that a substantial life improvement could be realized for those children by addressing that kind of system question, you have to wonder about the order of priority on which we are attacking some of these problems. The predictive negative impact of welfare dependence on life chances for children is enormous and substantiated by research.

More recently in Ontario we have two reports which asked us to look system-wide, and I would like to ask that you consider those in your deliberations. The Investing in Children report looked at some of these same problems in terms of access, availability and prevalence of problems for children with mental health concerns. One of the more recent reports, Children First, which has recently been released, says we do not have solutions available for children in piecemeal form; that we need models that work at community levels of which children's mental health centres would be partners but not the sole source of the solution; that schools are important; that recreation is important; that health is important; that corrections are important; that the co-ordination of our resources at the local level will yield potentially substantial benefit for those same children.

We have talked previously about the need for an agenda for children in the province. As the growing welfare rolls and waiting lists attest, some substantial difference, a different, fresh approach involving problem-solving at local community levels, fiscal allocation at local community levels, may hold some promise that we have not realized with our current attempts. Doing more of what we are doing now does not hold the promise for us that doing differently does.

Children's mental health centres have shown the potential to increase their community profile, their community presence and their preventive thrust to address problems at source rather than problems which are fully developed, full-blown, such that you have children in significant distress. They are not in distress one day and in massive distress the next. There is a period of development of the problem, within the family, within the community, within the context of understanding the child as a developing creature. There is a logic, there is research, there is an intuition which says we simply must invest our resources in prevention and early intervention as we have no substantial evidence that says we have either the resources or the expertise to deal with the volume of children who have treatment needs.

Children's mental health centres have an opportunity at this difficult time in the sense that they do not have a legal mandate to provide most of their services. They have resources which have an element of community discretion attached to them. They could be delivered differently without any required change in legislation. They could become the vanguard for some of the partnership required in some of these broader-based systemic solutions.

One of the examples of that kind of alternative way of working together at the community level is contained in a model known as Better Beginnings, Better Futures. It is an example of the kind of integrated child development model which has been under development in Ontario for the past three years. Better Beginnings, Better Futures brings together what we know from the research nationally and internationally about what works for children that makes for a better future for them. It is a model that we hope, we expect, will be launched in a number of Ontario communities very shortly. This community-wide model engages parents and children as partners, not as recipients of a service, with the various agencies that have a stake in the children's future and brings together again in an integrated manner, not in a sector-separate, discipline-divided manner, the best interests of the children's future. Together, this Better Beginnings partnership should be able to deliver the best of what we know about what can have a substantial long-term impact on children's development and change their life trajectory.

That kind of broad-based systemic approach holds some promise. Doing more of what we are doing now does not hold promise that is based on any substantial research. In fact, the research markers are pointing us in the direction of doing things differently.

Our service system for children in Ontario will always require areas of expertise for children most in need, but it requires a balance in that system. We should not be tinkering with one end or the other. That system needs a balance that puts an emphasis on prevention thrusts based on research, earliest intervention possible and treatment, where necessary, for those who have not benefited from those earlier interventions. But as a province, I think we need to organize our system in the interests of all those children so that we are emphasizing that end of the spectrum where we can have the most effect possible. Children's mental health services have demonstrated a potential to move in this direction. This should be applauded, supported and encouraged in the best interests of our children's future.

Thank you for the opportunity to make this presentation.

The Acting Chair (Mr Miclash): Thank you very much for your presentation as well. So far we have three people on the list for questioning. I will start with Mr Malkowski.

Mr Malkowski: I was very impressed with your presentation. I would just like to focus on the information related to the Ontario Child Health Study. It shows that 16% of children have mental health problems and only 2% receive the appropriate services. I am just wondering how you feel about some development within that area and the legal implications of these services being provided. Do you feel it is important for us to consider the development of legislation that would ensure that these services are being provided in the different areas, for example, children's mental health awareness, to help the parents and the education system become more aware and able to recognize these symptoms as early as possible; the second area, the children's mental health prevention program; the third area, children's mental health educational training programs? I was wondering which of these areas you feel might be the most important, which needs to be really most focused on and most immediately addressed, and where children can get the most appropriate health services through these sorts of issues.


Mr Hayday: I need to make notes, because the question is probing. I will take them in the order in which they were posed. The ministry with lead responsibility for children's mental health services is the Ministry of Community and Social Services. One of the areas of legislation which it attempted to bring forward -- did bring forward -- was the Child and Family Services Act. There are problems with that act in terms of what is being seen by the field as excessive litigation, a litigious attitude which is interfering with access to services and the quality of services.

There is a working group, of which I am a part, on strategic directions in children's services that is struggling with whether or not the solution lies in legislation or in alternative delivery systems that are not necessarily dependent upon legislation. Making it the law does not necessarily improve our capacity to deliver. That would be my quick overview of the Child and Family Services Act experience.

The second area: In terms of prevention program, I am aware that there is a prevention policy existing in near-completed form within the Ministry of Community and Social Services which has implications that cut across the ministries of Health and Education and which would have service delivery implications. I would urge the government to bring that policy forward and declare it and work through the delivery implications of it. I think that would be a substantial step in the right direction. Our training and education programs are not always well linked to best practice informed by research that shows the effect, size and value of that practice. I think it would be useful to have a continuing education capability that linked service practices to what is known in the research.

I think I covered the questions there. I may have missed part of one, if you would like to redirect me.

Mr Malkowski: No, that is fine. Thank you.

Mr Beer: I think it has not been by design, but I think it has been fascinating to have your presentation after that of Dr Nugent, not because I think the two of you would necessarily disagree. I think it would probably have been most useful for the committee to have both of you at the table right now as we deal with some of these questions.

What I think is important, as a committee, is that we recognize that there have been some approaches to this issue -- whether we want to oversimplify and say the medical model and the sort of social service model, regardless of what we may feel about that, the answer surely lies in a better integration of those and that the concerns that Dr Nugent raised are ones, whether children's mental health falls within the mandate of Comsoc or Health or some redesigned system -- clearly there are both of these areas. You made reference to Better Beginnings, Better Futures, which it seemed to me in a conceptual form was the way we wanted to go, which brought together the best of the clinical and treatment, the best of early intervention and the best of prevention and tried to approach it in, to use the term we are using, the holistic sense.

I think what I take is that you have identified and Dr Nugent identified real problems. Those are not imagined. They are real and they are there. In a sense for the government, for any government, how do we then organize ourselves to meet those needs?

I know you made reference to the report by Dr Maloney, Children First. I realize this is preliminary, but I wonder if you could share some of your thoughts in terms of how we put together structures both at the provincial level and at the local level to try to get around the various roadblocks that we have because of government structures, ministerial structures and all that sort of stuff, so that in fact the dollars that we have, which will always be limited__we will never have all the money we would like to have, but how can we best put that together? Then you will have done the committee's report and we will not have to --

Mr Hayday: In answering your question, I am reminded of the previous question that I missed so I will roll them together.

The governments of Ontario -- three different parties -- have toyed with models -- "toyed" is excessively derogatory -- have worked to find models at the local level of spending in an integrated and co-ordinated manner, resources that cross health, education, social service, fiscal budgets and delivery systems.

We have come close a couple of times. We came close with the children's services committee experiments of the late 1970s and early 1980s. We got right up to the decision point in terms of actually allocating budgets and fiscal authority and then we deep-sixed it because we were not quite ready to trust that people could make decisions locally, with all of the resources that were represented, in the best interests of children and services in a way which would not set legal precedents that would cause us inordinate difficulties, etc.

We have come close in terms of bringing together district health councils and local social planning bodies and giving them some kind of local fiscal decision-making capability. We have been within weeks of announcing experiments of that kind and have deep-sixed them.

It seems to me that the situation will eventually get so desperate that we will actually try it. We will actually try somewhere an experiment that makes available all of the dollars and resources, which we are spending in those communities anyway, in some integrated manner where it will not matter what the entry point was for the family with the child with the problem and the concern that they were worried about.

If they are more friendly with the public health nurse or the community health nurse or the children's mental health centre or the teacher, or they happen to know somebody, a pastor, who is on a local planning council, it will not matter what door they walked in because they will not become trapped in a service labyrinth thereafter. They will have walked into an integrated system where they will be able to get from the resources that are available a proportionate share that would enable them to improve their life circumstances.

There is a political will question here because of the three levels of government that fund, ultimately, services at local levels. But I do not know that our country is big enough to afford three parallel systems that do not work together, much less the ministries that fight with each other around fiscal economy. I think there is an issue of political will and a local community experiment is required.

Mrs Witmer: I appreciate your report and I appreciate the opportunity to become familiar with your organization. You talked about the delivery of service and the problems that we have and that there is no point in throwing more dollars at the system at the present time if we are going to deliver it as we have presently. You go on to speak about the Better Beginnings, Better Futures model. Following through on that model, do you then see the schools becoming a central focus for interagency needs assessment and service delivery?

Mr Hayday: In some communities that may make sense.

Mrs Witmer: What alternatives would you see, then?

Mr Hayday: I think that if we are going to pay more than lipservice to local decision-making, we may need some local forums to decide what the lead agency should be in certain communities, and it will not always be the school. Although the school is easily recognized and may be the dominant entry point for some, there may be some communities where there has been a relationship between the community and the school system that would make that a hostile relationship at this time.

If the system is genuinely going to be flexible, I think we need to be open to exception in Ontario. We have a tendency to want to design systems that work everywhere as though this province is made up of some kind of generic community where a single system will work in North Bay or Marathon or Cornwall or Hawkesbury or Kapuskasing or Scarborough. Our province is not organized like that. So to decree by caveat that it should always be thus, without a mechanism for local flexibility, does not seem to reflect the character of the province.

Mrs Witmer: What other agencies or groups would you then see becoming the central focus? You talk about the need for flexibility. What other suggestions would you have?

Mr Hayday: In some communities, a community mental health program may have an integrated child and adult program. A community health centre may be a local access point; the community health unit may be, and the school. It may be that someone is more familiar with the food bank. I am not recommending at this time that food banks exist in perpetuity, but whatever your service access point is, there needs to be some connection to the rest of the system.

Ms Haeck: Mr Hayday, I welcome your report very much. You definitely synthesize in an extremely articulate fashion a number of things that have been discussed, not only here but in my other lives as well, and I am glad you have done it as you have. But I also feel, because of my own experience out there in the real world beyond this building, that you will receive some criticism if we do not get on the record exactly who you are. We have heard from a whole lot of professionals, but according to what I have here I am not exactly sure what your --

Mr Hayday: Credentials are?

Ms Haeck: Exactly, because I am quite sure there will be slings and arrows visited upon you if you do not come up with 25 letters after your name, so would you be so kind as to legitimize yourself.

Mr Hayday: Sure. I am the founding executive director of the Ontario Prevention Clearinghouse, the directeur général du Centre ontarien d'information en prévention. I am the chair of the community subgroup of the Better Beginnings, Better Futures model and a member of the technical advisory group for that model. I am the chair of the Ontario social assistance reform committee network working to identify systemic solutions for some of the problems associated with social assistance reform in the province of Ontario. Prior to my work in those areas I worked as the director of prevention services for a children's mental health service, as the director of a school community consultation service for a children's mental health service and as the director of parent education for a children's health service, all in the same agency. I am also an ex officio outside-of-government representative on the prevention policy steering committee for the Ministry of Community and Social Services.

Ms Haeck: Excellent. I think you bring a wealth of knowledge to this committee. Not only have you put it forward in a very articulate fashion, but you obviously have a great deal of experience out there in the community which you have really brought forward very well today. Thank you very much for your presentation.

The Chair: We have time for one final question from Mr Hope, very briefly.

Mr Hope: Yes, it will be very brief. It is good that you brought up Better Beginnings, Better Futures. I am glad to see you brought that up. You also indicated about the legislation that we would have to do in order to make changes and you say there is no need, and I guess I have to agree with you because we seem to have already been doing a labelling of people.

In our own meetings here today we are labelling individuals of welfare who are going to potentially become killers or rapists or whatever, and I do not totally believe in that philosophy. But I think what this government has to do in the upcoming future of its mandate is to make sure that, number one, we look at social programs and helping families get out of that environment, with either housing or job development. I think that is really where the focus of this is coming from, because I believe that the service providers who are there do not want to sit there waiting until everybody starts flowing in. I think we have to address it, and addressing it at the beginning is where we have to start.

I really believe that the philosophy of our government -- hopefully in the mandate that is put forward by us, we will be able to take away from the waiting lists. As you deal with the waiting lists, we know there are two issues, prevention and dealing with the problems that are faced by the people of Ontario, and also to deal with the current issue that we have to address, the waiting list that is out there.

I am glad to see you brought up the legislative aspect. There are other areas of legislation that we have to address. I think that is what this committee has to look at, where the potential or where the people are who are coming from and into the program. We have to really concentrate our efforts on that and I want to thank you for bringing that up.

The Vice-Chair: I am afraid we have run out of time. I would like to thank you for coming before us. We will now adjourn for 10 minutes until 1045, until we are able to put together the slide presentation which our next presenter is going to be making.

The committee recessed at 1035.



The Vice-Chair: Our next presentation is from the Hospital for Sick Children, Dr Susan Bradley. I would like to point out that we have technical difficulties with the slide presentation that was supposed to take place, so we will put that to the side and we have a hard copy of your presentation. I think that will have to do. I apologize for that.

Dr Bradley: No problem.

The Vice-Chair: Please start your presentation.

Dr Bradley: Thank you. I appreciate being asked to come to address you. I would like to tell you that I have another hat and I think it is not just as psychiatrist-in-chief at Sick Kids that I have been invited to come here, but as head of the division of child psychiatry at the University of Toronto.

I think, in addition, I should simply tell you that I have been actively involved in a number of other groups oriented towards promoting and developing children's mental health services in Ontario, and these include the Sparrow Lake Alliance. I have been a member of the child welfare committee at the Ontario Medical Association for a number of years and am presently chairing the infant mental health promotion project for Metropolitan Toronto.

All of these activities tend to have a rather similar focus and some of what I am going to present to you is coming from that perspective. What I have chosen to do is to address the five topic areas which were part of your mandate. These may appear to have a certain redundancy, and I will try to limit that as we go along.

Under availability, I do not think I have to stress the fact that there are fairly significant limitations which have been pointed out quite clearly in the Ontario Child Health Study. The data indicating that there are roughly 18% of children with a diagnosable mental disorder and yet less than one sixth of those are actually receiving any form of treatment have caused us all to do some serious rethinking about whether or not we will ever meet the need with the present service system. Obviously, asking us to address some alternative type of service delivery system gets us clearly into issues of prevention and early intervention, but that is not the only avenue.

What I have chosen to do is to stress certain areas where I am aware that there are distinct resource gaps. I have chosen to do that in the three broad categories of age, diagnostic group and resources. There are two groups that stand out from an age perspective, one of which is infants, who have really not been recognized as having mental health problems until relatively recently.

I think those of us who have been working with families for a number of years are very much aware of the importance of early development and of infancy to the ultimate development of healthy individuals. At present, within our system there is no clear system of responsibility for infant services. They are spread broadly across at least three ministries.

Transitional-aged youth are again a group for whom there is no very well organized system of delivery of services. They fall neatly between the cracks. They do not fit neatly into the child and adolescent spectrum of services, nor do they fit very well into the adult spectrum of services. Constantly we are confronted with the fact that services, for example, for adolescents in crisis stop at the 18th birthday at Sick Children's Hospital, which is presently the only 24-hour emergency service available in Metro Toronto.

Most adolescents who are 18, who require crisis intervention services, are coming because of problems to do with their families. Those adolescents, by necessity, end up going to an adult facility, which does not really deal with families very adequately, so they end up having to get service from a system that is not well designed to meet their needs. This problem has been recognized in a number of reports, and I will not go on at length about that.

The diagnostic groups for which I am quite aware of deficiencies include the older conduct disorder group and particularly the young offenders, and the new Strategic Directions report is picking this up as a clear need, as has the Colin Maloney report. In addition, though, we are very much lacking programs for substance abusing and street youth. We have failed to deal with this issue effectively at all, and the university community is as lacking in this regard as is the broader medical community.

We are very much aware of the needs of sexually abused children and their families, but we have not succeeded in developing treatment programs that really meet those needs. There is a knowledge gap here. People who are writing in this area about children who have been traumatized will recommend that every single traumatized child should have individual psychotherapy.

Now that we know what the incidence of sexual abuse is in our society, and depending on what kind of abuse you are talking about, we are talking probably 10% of children at least. It is quite impossible to imagine providing individual psychotherapy for that number of kids. The issue becomes, are there other ways of intervening that really do address the needs of those children who have been abused and are as effective? We do not have the answers for that, but clearly we have got to get the answers for that.

Eating disorder is another issue in which there is no organized program. The great irony is that there is a very well organized program for eating disorders in adults. We all know that eating disorders begin in children; they do not start in the adult years. Yet efforts to develop eating disorder programs have met with very little positive response. I will get into some of the reasons why I think we are not getting anywhere in developing some of these programs when I talk about the lack of clear responsibility, but those are the obvious deficits in terms of diagnostic groups.

If we look more broadly at issues of resources, we are quite aware of the fact that we do not have enough long-term residential programs for seriously ill adolescents. We closed institutions and agencies like training schools, and in doing that we did not open up an alternative system of care. Many of the youngsters who in many ways were being looked after in some of those facilities in fact have been left without adequate facilities. Many of the children in need of long-term residential programs are going out of province, and this is causing a very significant drain on our resources, which should not be going out of province. It should be diverted into development of those programs here within Ontario.

There are clearly some problems with the legislation for the over-16-year-olds, and I do believe that has got to be addressed. However, assuming that can be fixed, we are left with the need for more resources in that area.

In addition to actual treatment-type programs for the chronically mentally ill, we need group homes with adequate structure and psychiatric backup. One of the difficulties is that there have been funds put into the system to develop group homes, but if they are not adequately backed up from a proper mental health point of view, these kids are not being adequately looked after.

A recent study looking at the severity of disorder in the group of children at Kinark Child and Family Services was very impressive to me because these are very seriously disturbed kids. These are not simply kids in need of housing or resourcing. These are kids with major mental disorders, and they are being looked after in a system that is not very well resourced. I think that is so throughout the system. If we are going to put these kids in these resources, we have got to provide ways of providing adequate consultative backup.

We are working in the area of prevention, and I think we all acknowledge the real importance of investing more of our energies in that area. I think we have got to work out ways of providing support to physicians, to schools, to programs for infant visiting and particularly in the area of parenting. This is an area which we have put very little resources into. When you consider the amount of effort that goes into educating kids in other areas, we provide very little hands-on teaching experience in the area of parenting, and yet everybody emerges and becomes a parent. We have very little real teaching or training in that area.

With respect to accessibility. I think it is quite clear that the groups which are most affected in this regard are the ethnically diverse and the low social class groups. They cannot access the system as well as somebody who has got the bucks to pay for private psychiatric treatment. That is an issue that will go on until we develop a better spectrum of services.

It is clear also that many children get lost because of lack of co-ordination between settings. This is particularly acute in the more seriously disturbed where they require a spectrum of services or transfer from one service system to another, and in that process we know that children get lost.

The adequacy issue is somewhat redundant because I think I have already touched that talking about availability. One of the things, though, that does need to be highlighted is the need to involve the academic community to develop treatment programs and to evaluate those. As I have indicated earlier, in issues like sexual abuse we do not have the knowledge base to tell us what is the most cost-efficient way to intervene in these disorders. We are using models of intervention which have not been well tested and the university has the capacity to do that. There has been very little collaboration between government and the university and that creates two separate systems which go their own way. I do not think that that is a good use of our resources.

With respect to quality, we clearly have some excellent programs in the province, and we have some very poor programs. A lot of it has to do with resources and consultative backup as well as access to training.

I think that one of the most critical issues is the funding issue and I see it as the fact that children's mental health is not seen to be a priority. I think until we can get it on the table as a priority, until people can become convinced that the only way that we are going to have a healthy society is to have healthy children, this is not going to become an issue that people really get invested in.

I think that we see this over and over again in a situation like a large hospital such as Sick Kids, where psychosocial resources are consistently less well funded than physical health resources. It happens in the community. You can get access to a doctor if you have got a sore throat, but you cannot always get access to a doctor or support if you have got trouble with your kids. Those are the kinds of things that I think we have to get into some balance. Sore throats go away without much treatment. Trouble parenting your kids does not go away.

Under needs, I can only stress how important I think it is that children must become a high priority and that children's mental health has to be seen as absolutely critical to the general health of our society.

We need a more clear definition of ministerial responsibility for children's mental health. This issue of Comsoc being the leading ministry has helped in many ways, but what it has done is create almost impossible barriers between those agencies which are more closely allied with the Ministry of Health and those which are allied with Comsoc in that if you attempt to create appropriate and logical systems of care, you have to have a gradation between the back end, which tends to be the psychiatric or backup end, and the front end, which is in the community. When you get two totally separate funding systems, one of which is very reluctant to give to the other, you cannot create that continuum of care. This has happened and been very perplexing for us in the area of things like eating disorders where we have tried to develop programs and cannot get the co-ordinated support to develop these kinds of initiatives.

I think that there have been lots of ideas floated around about what is the best way to go about it. There are many good ideas in the new Children First document, Colin Maloney's group. What is absolutely critical, though, is that somebody take responsibility for the whole spectrum of services, and that includes right from the very front end of schools and physicians to the backup end of treatment resources for the most seriously disturbed. We need to have a way of pulling those groups together.

It is critical that there be a planning process put in place to examine implementation of early intervention programs. It is fine to talk about it, but when this is left to each local community to develop on its own initiative, it does not work very well, and I am very leery about simply handing over responsibility along with funding to local communities unless there is clear direction from some central ministry to set up certain kinds of structures that are considered absolutely critical.


I have recently come from a consultation experience in Chile and what impressed me -- I went down there as the expert -- is that they have a system of care and they are in the midst of developing a mental health program for all of Chile and they obviously have given it high priority. They see that it has to be centralized. They are giving recognition to the needs that are different locally, but they have a central thrust. I think we cannot lose the concept of a central thrust and the notion of going to local committees. We have got to work out both ends of that.

We have to look at alternative systems. There has been a lot of discussion about school-based programs and physician support programs, and probably we need a mixture of all of these. We need expansion of programs and I have identified some of the areas which clearly come to my mind. I can only emphasize the importance of involving the academic community, in both the planning and the evaluation of any of these initiatives.

We need research. There are many things that we know about the initiation and development of children's mental health problems. We need more treatment evaluation. At times when we are faced with constraints, with economic constraints, we have got to find the best ways of using our money, and that means evaluation of intervention.

We do need to know more about factors which protect children and these include work in the areas of attachment which are already developing. Social and peer variables have become very important in terms of understanding how children deal with issues as they mature. There is some interesting new work looking at a concept which is sense of coherence. There are factors which make people able to cope with various adversities and we need to understand what those are more coherently. There is also some developing interest now in affect regulation as important overall in development of psychopathology. These are things that we are beginning to understand in terms of genetic and other mechanisms which are important. But we have got to work together; that is the bottom line.

The Vice-Chair: The time for questions is very limited. I have Mr Hope and then Mrs McLeod.

Mr Hope: Thank you for your presentation. I like the way you have presented it to us. It is in point form and it leaves us room to jot notes down, which is kind of nice.

First of all, I just wanted to touch base on the resource, and you are talking about the group homes, with the adequate structure of group homes now currently in place. By the way, I may be misinterpreting what you were saying. You were saying that we should keep the flow of the institutionalized setting and develop that institutionalized setting into more training practices as far as getting out into the communities to develop a --

Dr Bradley: We have got to figure out ways of linking up the major institutions like the universities and the teaching hospitals with the community. That is what is lacking at the moment. We have got to figure out a logical system of care which involves the people at the back end who can provide consultation and training to the people at the front end in the community who are actually delivering the service. That has not worked very well, because of the difficulty with the reporting responsibilities, in part. Most of the psychiatric and hospital-related community is reporting to the Ministry of Health. Most of the children's mental health community is reporting to Comsoc. They have not worked out the integration between those two groups.

Within the Ministry of Health, community mental health is not responsible for people who are under 16. It means that if you are trying to develop a logical system of care which involves the institutions at one end and the community at the other and you want to bring them all together, you have to work with several different groups within the ministry who do not talk to each other and do not work together. That means you cannot do it. Practically, that is what it means.

Mrs McLeod: I knew it was going to be tremendously frustrating, with each of the people coming to our committee, that we would have such a short time to learn so much from what you have to offer. So of a dozen question areas, I am going to focus on one. The Maloney report, as you know, looks towards a more integrated, more co-ordinated system, which obviously you would concur with, based on your remarks. I was concerned, in reading that report, that I very much like the school as a hub focus, but I am not sure that it does not neglect a little bit support for physicians, which you have identified, and perhaps the way in which complex treatment needs can be met.

I would like to focus on your background in education. I worry that in anything we have tried to do there tends to be an either/or type of approach in where the priorities should be, when in fact you just cannot afford an either/or approach for children's mental health services. Do you feel, in the university setting, whether it is faculties of education or family practice training, psychiatry training, psychology or social work training, that there tends to be an either/or focus, that it is one or the other, that one gets a priority? Does there need to be more integration of orientation at that level for us to be successful at the community level?

Dr Bradley: I think there is not, has not been at least -- I go back to my own experience in being trained and I think it has not changed dramatically -- a really clear understanding of the importance of children's mental health to ultimate outcomes. People are distressed about abused children and children who may have drug and alcohol problems or children who are being neglected. Issues like that are self-evident. But I do not think that at the broader level people understand how important it is for children to have stable, consistent relationships over time, how important it is that their needs get met in a variety of different ways. I think that kind of education has to become a part of what we teach children in public school, in high school, in all of our training programs, whether it be for physicians or social workers or anybody. I think there has to be more emphasis on how important children's mental health is and what the dimensions are and what you as an individual can do in your own professional practice to be alert to that.

Very few family practitioners are given real training in child development or in parenting problems or issues like those, and they see them all of the time. The ones who are particularly interested will seek out some more training, but the bulk of them feel frustrated, hope that they can find some resource in the community but oft-times do not do that. The ones who are tuned in to these issues are very aware that we have not addressed the issue because we have not addressed their need to be skilled in that area, in addition to which oftentimes some of them need things beyond what they could provide in their own practice.

There are lots of things. We could do a great deal more in terms of early intervention. Lots of general practitioners and pædiatricians pick up families at risk. They can tell in that first year that a mother is having difficulty. Yet, oftentimes they do not know what to do about it. The resources to turn to are not obvious. There are very few early intervention programs available unless you are so disturbed or distressed that you really need to go to the children's aid society or to the food bank or to something or other like that.

But for somebody who is really just having trouble parenting, where do you go? Those are the people who end up ultimately going into the system later on and costing us an awful lot of money.

The Vice-Chair: I would like to apologize. We are very pressed for time. We do have to move on. I would like to thank you for making your presentation. I hope you can understand and appreciate that we are very pressed for time, so we are going to move on. Thank you.


The Vice-Chair: Our next presentation is from the Jeanne Sauvé Centre, Kapuskasing, Yves Barbeau, executive director. Welcome to the committee.

Mr Barbeau: Thank you. It is certainly a pleasure to be here today.

The Vice-Chair: As I have indicated to other presenters, you have the half-hour. We will stick to that strict limit of your time there. Please commence.

Mr Barbeau: Okay. I understood that my presentation today would be bringing to you a perspective of a northern children's mental health centre with a specific component of francophones. My presentation will focus on some demographics about our area and then some specific issues that our centre is facing. Probably we are not the only ones facing those issues, but they are only applying to us as of now.

I think you all received the little document in front of you.

Demographics: In terms of being open since 1980, we changed our name in 1987 because development, with the new legislation, was reflecting on the services we were providing. Child and Youth Development Centre was our first name. The Child and Family Services Act, in terms of development services, did not quite reflect that.

We have a $1.4-million budget with about 30 staff. We cover approximately 225 kilometres from east to west, no road north and south in our place -- 65% francophone, about 30% anglophone and 5% native, and this is across the catchment area. In some places it is 100% francophone, in some others it is 95%. The basic concentration of anglophones is in Kapuskasing, which is about 12,000 population.


We offer six community-based programs and I mean by that family intervention, psychological assessment, family violence program, home intervention and one eight-bed residential francophone facility for 10- to 14-year-old children with emotional problems.

Of the specific issues we are facing in terms of availability and accessibility of services, I think I can start with continuum of services. I think it has been highlighted in the Investing in Children paper, the northern interaction paper as well. I want to talk about a whole range, and in our place we are offering six programs. Obviously we are missing quite a bit in that spectrum, and where it is going to go in the future I am not quite too sure, but being the only game in town, with one children's aid society, I think, whether we share the spectrum or we create another one for us, where it is only not there. We have a limited number of staff as well who are helping all those programs and it is a live-in staff in the community base. We offer, obviously, no prevention services at this point in time. We do not have time to do that.

We have three points of services as well across those 200 kilometres. Kapuskasing is located in the middle and you have to travel about an hour east and west where there is a satellite office. Four of those five community programs have one or two staff in them, which means, like a family violence program for example, there is only one staff member, who has to cover 225 kilometres and be bilingual as well. You have to provide services in at least two languages. We are not providing any native services at this point. Sometimes you are looking at the kind of population you have to serve. For a battered women's group, for example, you would be offering in three communities in two languages. You are already starting with six groups and you are alone in that program. It makes it quite a bit difficult.

In terms of waiting lists, I think our average length is about six to seven months at this point in time, 43 cases, and some of them have been on the waiting list for 14 months. Obviously, those ones are not the severe homicidal or suicidal cases.

In terms of adequacy and quality of service, "recruitment" and "retention" are big words in the north. In our place especially there has been staff turnover since 1980. There was not a year without losing staff, which was basically between 15% and 25%. This year we are about 20%. So out of 32 staff with contracts, we guess at between six and eight people every year.

All our clinical staff have less than four years of experience and once they get to be more experienced, they usually go down south or back to Quebec. The impact of this is, some communities would not have any services for six months for one program. For example, we have just been responding on a crisis basis and sending one of the staff just to look at the suicidal case and then come back to Kapuskasing and travel. Some clients would be seeing three clinicians in one year. That is a fact of life in our place.

I think the impact of Bill 8, as well, on bilingual staff -- I think it has been a great initiative. In Kapuskasing, however, it plays a bit the other way for us because now some agencies in the north will be recruiting some bilingual staff and I am pretty sure someone would rather be in North Bay than in Kapuskasing, which might not have been there before. I think in our place the problem is not recruiting francophones, I think it is anglophones. We do not have any anglophones at this point in time, out of 30 staff. So it is all basically bilingual. It is francophones who are offering the services. With all the shortage of staff everywhere in the province, an MSW anglophone would not be in Kapuskasing, I am pretty sure. He would find a job even here in Toronto.

Most of our staff are recruited in Quebec because of the masters level. Ottawa university was the last university to provide an MA in psychology from a francophone point of view. Now that Ottawa has closed that program, there is no place we can really recruit except there. And obviously those people are out from university, come to our place, get some experience, go back there. It is a cycle that perpetuates itself all the time.

I think salaries did not help us too much to recruit either. Like in 1988, 1989, they can just be called the master level. After five years of experience you are being paid $30,000 a year, starting at $27,000. That was two years ago. Add even 10%, it does not make much. So we have to upgrade them. I do not think we have much choice. We did not quite receive financial support on a permanent basis, but I think we are somewhat looking forward to it.

In terms of understaffed programs, I think there are two that strike us in the north. One is the day treatment, this kind of venture with the Ministry of Education and MCSS. Since I have been there, we have never had full- time child care workers in the classroom as it appears to be our mandate to do. The board of education would put a teacher in the classroom but with no staff to help him. So we are just providing consultation, whether an hour a week to them or a day a week to each teacher, depending.

I think a decision has to be made at some point in time if we are going to keep those classes open or we are just going to close them. We are not too sure if it is our end to take a serious look at it or to let the ministry say: "Is this venture working or not? Are we going to close the section 27?"

At the residence we do still have one night staff person per shift. I think since the tragedy that happened a year ago, there was a decision to staff all the residences with two night staff people, at least. I guess the bus stopped before reaching Kapuskasing, because probably the secure and open custody centres got the first shot at it, and then Kapuskasing. We are probably not the only one, but obviously we are the one at this point that does not have two night staff people.

In terms of professional development, being in Kapuskasing as well is a disadvantage. Travel costs: we do have some budget. Let's say people with $1,000 per staff a year is great. Well, it costs us $700 in travel to come to Toronto. It does not leave much to do other things. We use senior consultants on a surplus basis most of the time, and when the surplus is gone, so is the consultant.

In terms of funding, for us some issues are the ministry initiatives versus priorities of service plan. In the last year we had three new initiatives: northern integrated services was one; family violence was one; preparation for independence was another one. It was great to have those programs but they were not at the time a priority of the service plan because the expansion of some of the existing programs would be our first priority probably, because we do have limited staff in each of them. I am not sure how this is going to be negotiated in the future. Maybe it is a good thing for Toronto to get some of those initiatives, but in Kapuskasing I think we need to just consolidate and build on the existing programs we already have.

Are there funds available for new expansion of programs? I think it is always a question we have; probably everybody has that question. I think it would be at some point reassuring for our communities to know what we are going to do in the future and if there any funds, because with all the salaries that have been upgraded and the new rent we are paying, we are more likely going into reduction of services if we do not get funds to back us up. There is some impact of new legislation. I guess everybody is living through it, whether you be in the south or the north; pay equity and GST and Occupational Health and Safety Act and even Bill 8 to some extent.

In conclusion, just a few words of, not my wisdom, but it has been said before that it is doubtful that each of us individually will be able to meet the challenges of the future, as it is unrealistic to believe that injecting more funds into the system will solve all the problems. Even in Kapuskasing, we are aware that that principle of trust, partnership, collaboration, co-operation which has been referred to for a long time must now be embraced by all the players if the system wants to succeed.

That is something we have been working on in Kapuskasing as well, having shared board meetings with the children's aid societies, signing protocols with schools and with all the players in town, because that is probably the only way we can offer service, if we can get them; we might as well join if we can.


The Vice-Chair: I have Ms Haeck on the list first; Mrs Witmer, Mr Beer and then Mr White.

Ms Haeck: Mr Barbeau, it is interesting to get your perspective in comparison with some of the others we have received today. You indicate that at this point you are not providing any native services. Have you looked at hiring any native staff to possibly address this in the future?

Mr Barbeau: No.

Ms Haeck: Do you encounter any situations where you have a unilingual native person, where the language of that person does not happen to be English or French?

Mr Barbeau: It would make some sense to think along those lines. I think there are some new developments in the north with some other organization being created to service the native people; that is why we are not getting into that line. A new organization was just set this year to look at those reserves and native people, so they are already making some changes. The children's aid society, for example, was the one service in the native reserve in our place, with a prevention and protection worker. Now, this new organization is taking over all the prevention workers in the north.

Ms Haeck: What is the name of that organization?

Mr Barbeau: Kunumanimano.

Ms Haeck: That is fine. You can pass me a note and spell it for me.

Mr Barbeau: Maybe Mr Beer has heard about that one before.

Mrs Witmer: I would like to thank you for your presentation. It is obvious that you experience some frustration; your situation is certainly unique as compared with some of the others in this province. You mention that it is unrealistic to expect that the injection of more funds is going to solve the problem, and then you talk about partnership and co-operation. I wonder if you could expand. What type of service model would you see as contributing to some of the problems you face in the area you serve?

Mr Barbeau: I think the idea of integration has been extensively discussed in the north with the northern directions paper for northern children. I think integration means different things to different people. I do not see it as amalgamating different organizations under one board and one administration with different streams within that organization. I see it as all the players coming to the same table, in the same way as the integrated service for northern children sharing the service delivery for each child. Each service provides what it does best to the child but in a case management manner instead of just transferring the case from left to right. Whether this applies to the community or to the ministry in terms of integration -- is the ministry going to put all the funds for children's services under one ministry and then branch out to fund all the community agencies? I am not sure if it is the best solution at your level, but at our level I think it is just sitting with all the players; like Education and MCSS, for example, with section 27. I think it has to be discussed at the upper level and at the lower level.

Mrs Witmer: Do I hear you saying there would be some value in establishing at the local level some sort of a children's advisory committee?

Mr Barbeau: I have heard that concept before. Depending on which kind of mandate and power as well, whether it be financial or just recommending powers. It might be a good idea. I would not mind that.

Mr Beer: One of the things I always found interesting is that in the north -- I suppose, really, out of necessity -- you have probably moved in many ways a lot further down the road of working together because of the limited resources; people really have to make use of each other in terms of services. In the south we might learn from that.

Because we have a short period of time and because you are working in large part with the francophone population, I want to focus my question on Bill 8 and the development of French-language children's mental health services in the province. Are there perhaps two or three things you might want to recommend that we should be urging the government to focus on particularly in meeting the needs of francophone children? Are there particular things, as you have seen Bill 8 come in, as you try to develop your programs in the north, where there could be help? You mentioned, for example, the problem that the University of Ottawa now no longer has an MA program. One time when I was up in Kapuskasing you mentioned that you go to Laval each year to recruit. What are perhaps two or three things we are going to have to really look at if we are to ensure that the francophone population is properly served under Bill 8?

Mr Barbeau: It has to be in connection with the Ministry of Education as well in terms of providing graduate programs. It does not have to be in psychology; it can be in social work, it can be for child care workers, for example, some impact for the francophone population, which is not strictly based in Kapuskasing. There are some francophones in Timmins, in Kirkland Lake and across the north basically. There needs to be a link between the two for upgrading for education. I think some of the board members wish there was a Bill 8.5 to ensure anglophone services in Kap, because we just went through it. It would be any other easy day-to-day stuff; it would not have a big impact. It is kind of hard to say what kind of recommendations we can make other than to link with education, because it was not a big problem for us.

The Vice-Chair: I would like to thank you for making your presentation, for coming such a long way. I am sure it was enlightening for all the members of the committee. It will add to our base of knowledge we are acquiring for our research paper to be put together, tomorrow, actually, as we discuss this.

Mr Barbeau: It was my pleasure. I guess I will be flying back to Kapuskasing. There is not enough snow here to go back by dogsled.


The Vice-Chair: We will be moving right along to our next presentation, the Collingwood branch of the Simcoe County Children's Aid Society. Mike O'Brien is the director and Dave Myers is the director of placement services. I call them to make their presentation at this time. Welcome to the committee. You have half an hour. You are entitled to divide that time as you see fit. If you would like questions at the end of that time, allow yourselves some time for questions by members of the committee.

Mr O'Brien: My name is Mike O'Brien. I am a branch director with the Simcoe County Children's Aid Society. I will speak for part of the time and then Dave will speak as well. I will deal with the non-residential aspect of children's mental health and Dave will deal with some of the residential questions that have to do with children's mental health.

In the package that has been circulated to you, there is some information about a program I supervise called South Georgian Bay Child and Youth Services. It is an outpatient children's mental health program operated by the Simcoe County Children's Aid Society. I will spend a bit of time talking about that. There is also a paper entitled A Role for Children's Mental Health in Child Welfare. We will spend some time talking about that, the premise being that children's mental health is a very broad area and that the child welfare system is part and parcel of the package when you are looking at children's mental health.


First, with respect to South Georgian Bay Child and Youth Services, as I said, it is a child and family counselling service operated by the Simcoe County Children's Aid Society, which makes it very unique. That is very unusual. Very few children's aid societies in the province operate a child and family counselling service. One does not have to be a child welfare client to have access to this service.

I would like to talk to you about something you will probably have heard and will continue to hear about, but which I think is probably important to know about, that is, the whole question of availability of services in children's mental health. In Collingwood we have a service that serves Collingwood and area, which is about 40,000 people. We have two social workers who are available to provide that service. What that means is that people will often wait six months before they are able to see a social worker. That means that children who are in need of treatment, whether they have been sexually abused or whether they are suicidal, will often wait for six months when they have these very serious problems.

That is not unusual just to Collingwood. We have branch offices across the county and I can report that that is not unusual at all. In fact, I know of one service in the Barrie area where families and children will wait nine months for any type of counselling service. There have been, of course, numerous attempts to obtain extra funding for more staff over the last three years, but we have not met with any success in obtaining extra funding so the problem remains very serious.

As I said, the other area I wanted to talk with you about was the role of children's mental health in child welfare. The ability of the child welfare system to address the mental health needs of children is being seriously eroded and is being further eroded. In the child welfare system we see our mandate not only to protect children but once we ensure the immediate safety of a child to do something about the family situation so the family problems can improve to a point where the child will be safe. Unfortunately, more and more we are becoming social cops and not able to provide the vital counselling services that families require in order to remedy some of the problems.

The legislation gives us a mandate to provide guidance and counselling to our clients. There is a flexible services section of the Child and Family Services Act which talks about the possibility of providing funding from different areas to meet the needs of children, so we certainly feel we have the mandate to provide children's mental health services but simply do not have the funding to be able to do it.

At South Georgian Bay Child and Youth Services, we feel that one thing we have been able to do which a lot of child and family counselling services are not able to do is be very helpful to socioeconomically disadvantaged clients. It is important when you are looking at children's mental health that you look not so much at the traditional boundaries of who ought to serve whom, but at what types of services are best suited to meet the needs of the children we are talking about. In some cases the child welfare system is in a better position to meet the needs of children in families than some of the traditional child and family counselling services that are available. The reason for that and the experience I have had over the last three years with South Georgian Bay Child and Youth Services is that because we are operating in a children's aid society we have some unique abilities to work with socioeconomically disadvantaged families.

As you probably know, for the most part children's aid societies do deal with low-income families and develop a certain expertise in dealing with people from low-income families. Because of that, South Georgian Bay Child and Youth Services has been a kind of unique model in that in the 12 or so years I have been in the child welfare system I have never felt more positive about our ability to provide treatment services than I have over the last three years, because of the fact that within our children's aid society we can offer a treatment program to low-income families.

The traditional approach taken is that a child welfare agency does an investigation of some particular problem and then the agency refers the family on for services elsewhere; the child welfare agency cannot provide the treatment services to the family. In my experience, where we have this treatment service available within our agency, where we have already engaged a family and developed a relationship with them within the children's aid society, it is much easier for them to make use of a treatment service offered within the agency as opposed to going to some brand-new agency. Our child welfare clients feel very threatened by that. It takes a long time to develop a relationship with them. They are very resistant to making use of counselling services; that is why when one attempts to refer them to other agencies very often that is not successful. So, as I have said, I am very pleased by the fact that we have been able to offer a treatment service our clients can make use of. That does not usually happen.

What I would encourage is that when we look at different models for providing children's mental health services we continue to look at all sorts of possibilities and that we not ignore the very vital role that child welfare agencies should play in providing treatment to children with mental health problems. That concludes the comments I wanted to make.

Mr Myers: I want to give you some quick perspective on Simcoe county and the lack of services we have. We have no children or adolescent psychiatric units in any of the hospitals throughout the county. Basically, we have two child psychiatrists in Barrie. Naturally, they have extensive waiting lists and really cannot provide immediate service to children or families; they have an ongoing case load, obviously. What this means is that in crisis situations for a adolescent we might be able to secure treatment at Whitby or Youthdale or that kind of service outside our area, but within our community basically all we have are psychiatric wards for adults, or perhaps in certain situations a general practitioner will admit a young child to a paediatric ward, so obviously we have very much of a make-do situation in terms of just general psychiatric care to children and adolescents.


I think we who live in the county and have been there for some time, who are seeing the growth of Barrie and the southern part of the county, really continue to wonder how long this county can go on not having some sort of basic psychiatric service, at least in some part of the county. The fact that we are shipping kids out, as I say, to Whitby Psychiatric Hospital, Youthdale Psychiatric Crisis Service, etc, we just think is not adequate.

We do have some facilities that are funded by the Comsoc for adolescents and young children, so we cannot say we do not have services available for kids with behavioural problems or emotional disturbance. We have Blue Hills Farm, Robert Thompson Youth and Family Centre and Kinark. We have had some services available, so I do not think we can say that it has been doom and gloom in that sense.

Of course you all are probably aware of the Kinark tragedy last year, in Midland, in our county. Naturally we found that Kinark has been very restrictive in its admissions since that. We have traditionally, as an agency, looked to Kinark to provide treatment to young children; this would be eight and up. Over the last number of years they have preferred to work with that younger age group, but since this tragedy, naturally they are very cautious about what kind of child they will admit.

We recently had the unfortunate experience of realizing that they had a bed available for a nine-year-old boy whom they agreed was appropriate for their program due to his emotional problems and his aggressive behaviour and so on, but their staff are so frightened these days that they are actually now -- I hope I am not treading on Kinark's toes, because I am assuming they might speak to you at some point today also -- looking at the extended family, wanting to know who in that family might represent a risk to their treatment staff. In this case they discovered a common law partner who is presently in jail and they felt he potentially was a risk, so they turned the child down on the basis that this extended family member poses a risk, so as an agency we had to provide a specialized foster home for that boy.

Obviously, as I say, I do not want to be overly critical of Kinark because of the tragedy it has been through, but I would like to highlight to you that I think that kind of situation, I guess, represents a number of problems. We need more resources. We need more funding, obviously. Hopefully, in the future staff in that kind of situation are going to feel they can provide services to a nine-year-old boy who could otherwise be in deep trouble.

I want to highlight a couple of other areas just briefly. We are seeing quite a gap between what we would call crisis service and long-term treatment. As I mentioned, if a child is suicidal or homicidal, there is probably not a great deal of difficulty getting him admitted to Whitby or Youthdale, but that treatment or that crisis service is only going to last three weeks or a month, maximum, and then they are knocking on our door, saying, "Where's this child going to go next?"

If we are lucky, we might find a spot in a facility like Blue Hills Farm or Thompson centre in our own county, but if they have no beds we are really hard pressed. We have some group homes operating in the county -- some have closed -- but there really are not enough long-term beds that would have adequate staffing and adequate consultation and backup. I think the fact that we just do not have a basic psychiatric service in the county also really impacts on these other services that are operating, because if they take a child who is suicidal or overly aggressive or whatever, if they do not have adequate backup and consultation, they are very hard pressed to deal with these children.

There are the obvious sort of extraordinary situations. I remember about three years ago we had a boy who attacked someone with an axe, so therefore he met the criteria for secure treatment. We have a lawyer on staff and he was able to go through that court process and get that boy into Syl Apps Youth Centre for a period of secure treatment.

Again, I think it shows that we have this sort of all or nothing at all. At one end we have nothing. At the other end, if you meet this very rigid set of criteria, you might be able to get secure treatment through the court. But for this whole area in between we are really lacking in services.

Maybe you have questions. I think we need to try to highlight some of the areas that are in need in our county.

Mrs McLeod: Once again, it is hard to know exactly what area to focus on, but perhaps I will come back to the fact that this is a children's aid society with a difference, rather than touching on the whole gamut you have just raised about the gap in service, which I know is true in so many parts of the province. The fact that you are a children's aid society with a difference is of interest, both in terms of why it happened -- I gather that is related in large measure to the lack of service in a sense on the regional administration's part, that you were there as an agency and could perhaps step into an area of service delivery that other children's aid societies are not involved in. It would be interesting to look at the decisions about funding from global budgets and how that has been managed for you.

But perhaps if you deal specifically -- there is a sense that we heard previously on the committee that there needs to be a clear separation of treatment services and children's aid society child welfare and protection, that the families because of the clout the children's aid society has legally to literally remove children from the homes, to take legal action against parents -- that they are not in a good position to be able to provide the intervention and treatment and support. Do you feel that is a need from your experience? What I have gathered you are saying is that families not only accept it, but that it can be almost a preferable position. What happens then if you have to take the next steps and are they conscious that you can take legal action if they do not participate?

Mr O'Brien: I think you are quite right. I think that sort of an approach cannot always work, but the way we have our children's mental health service set up is such that we operate it as a distinct service and that if a client is making use of that service, that is their choice, whether or not they make use of that. They may be involved with the protective services of the children's aid society and be required to be involved, but the message that we give to them at South Georgian Bay is that this is your choice to be here and if the children's aid society says that you must be here, you may decide that you will follow that guidance, but we are not requiring you to be here.

In a lot of ways it is operated as a voluntary service. I think we have in some ways a two-tier system in this province in terms of children's mental health, that the middle class make use of the more traditional child and family counselling agencies and that the poor are dealt with by children's aid societies.

There are a number of reasons for that. I have mentioned one of them. I think there is a real sort of resistance and feeling threatened in making use of services. They are not people who reach out and who will make use of services perhaps quite as easily as the middle class. It is unfortunate because what we have with this two-tier system is that as children's aid societies become more and more social cops and do not have the manpower to provide counselling services to their clients, it means that with this two-tier system for the low-income people in our province, those children are not receiving the type of counselling services they need. That is one thing that I felt very good about with respect to this service. I think one third of the clients we service at South Georgian Bay would fall below the poverty line. We track goal achievements and 60% of them have made some really positive gains. I can assure you that is unusual, from my experience in the child welfare system, to see that kind of progress.

Mr Myers: Can I make a brief comment? We have been a progressive agency and I think we have every confidence that if we had more dollars we could organize more service and deliver it. But I want to tell you quickly about one program we have which we feel has really worked wonders. We have a teaching homemaker program, and as Mike was talking about a two-tier system, these are primarily women__there could be men also, but they are women who go into homes and really offer a hands-on kind of service with child management, household management, budgeting and a whole variety of practical day-to-day events.

We could double our staff in that period, because once we have made that connection, as Mike said, maybe the lower class is not as organized or does not have the ability to get to a traditional counselling kind of service, but if you can deliver a service in the home where it has immediate impact on the children and the way that household functions, we could service many more of those families. Yet the paradox of it is that we are having to fight with Comsoc now to continue funding that program, because under the rules of the game with Comsoc, they are saying, "That is not technically a child protection service and you are a child protection agency." We are having to battle like hell to get those dollars and yet every day I think that ministry office would agree that we are delivering a very viable and valuable service.


For every family that we can serve in that way, if we can prevent those children coming into care and make them a more functional family and those kids more successful at school, we could save a bundle of dollars, I know. But that is the dilemma. We are having to fight tooth and nail to get those basic dollars.

I think what we would argue is, why not enlarge the scope if you can prove a viable service? I mean, everything does not have to be a traditional counselling service. In fact, one might debate and say that this kind of service in a family is much more valuable than sending them off to see a psychiatrist or a social worker every two weeks, because it is artificial in a sense and does not really meet the needs. I think it is really a question of service delivery and can you offer a viable service.

Ms Haeck: I welcome your report and I have also had the privilege of having some discussions with my local children's aid society and have met with members of the Niagara Children's Services Committee, which is really a volunteer organization giving umbrella service and allowing some co-ordination and discussion around children's services areas. But despite the fact that they meet regularly and do have some discussions about what is needed in the Niagara Peninsula regarding child care and children's mental health, all of the issues, it has come to my attention -- which is something that you bring out as well and maybe you can come out to address how to correct the situation -- that the children's mental health centres that do exist are not only restrictive but really deal with success stories when they admit children. They do not deal with the youth.

I wanted to ask this question of Dr Bradley when she talked about transitional ages, what ages she was speaking to in the sense that we seem to be talking about, even in your situation, that Kinark is not talking about even allowing young adults into its programs, although that really would be part of its mandate. In our area it is extremely difficult to find placements for young adults, children 15 years and up. Do you see the same problem in your area and do you see any way of solving that particular problem?

Mr Myers: That is a complex problem, I would think. I think we face it also and part of the spirit of the act we are working under now was to move away from that idea that you send a lot of kids into group homes or put them into treatment, and then not have them do well and have them sort of bounce around and flounder around and eventually end up in the training schools. So we understand the spirit of the act, but there obviously are some very troubled kids out there who, if you give all these choices and liberties and then also arm them with a lawyer at family court, could successfully avoid being in placement of treatment.

Maybe the pendulum has to swing back a bit and maybe there needs to be a little bit more teeth at times in order to force a kid into a treatment situation. As it is now, if a kid says, "I am not doing it and I am not staying and I will run," it is very hard to compel him. Obviously it is a sensitive balance because we do not want to be in a situation where you are forcing kids and compelling them and locking them up. That is the other extreme, but maybe we have swung the pendulum too far in the sense of individual choice and liberty.

It is a sense of balance, but parents complain, "You're telling me I can't get my 15-year-old in treatment because he says, `No, I won't stay.'" That is the bottom line. We really cannot. Maybe we need to re-examine the legislation. I do not know. That is one area and obviously we need more resources too.

Mrs Witmer: You have pointed out to us again the problems we are experiencing on this problem, the lack of co-ordination, the fragmentation of services provided, and I would like to compliment you on your attempts to meet the void, the gaps in the service. I think you have done an excellent job.

I was particularly pleased to hear about two things that we were doing. We talk about the long waiting lists; we talk about the increased number of children who are requiring mental health treatment. I believe we do need to focus on prevention if we are going to reduce that list and I think you have indicated you are doing something that I am certainly supportive of.

I notice that you are doing something else as well. You mentioned the homemaker plan and you mentioned the parenting courses. Do you feel that there are at the present time in this province parents who lack parenting skills? Obviously you do, but what is the cause of this? Why has this happened? We have heard from Mr Morris this morning, for example, the reason for it happening in the native population, but what has happened to us?

Mr O'Brien: It is a very difficult question, but I would most certainly agree that lack of parenting skills is a serious problem. In fact, if you picked probably one of the five most serious problems that we would deal with at a children's aid society in terms of the difficulties the family has, lack of parenting skills is right up there in that top five. The ability to provide parenting education is extremely important in terms of prevention and to have the funds to be able to offer those types of courses.

As to the origins of the lack of parenting skills, I cannot really say why that would be the case. It certainly stands to reason that if parents themselves, and this is what we often see, have very limited parenting skills, they just do not prepare -- they cannot possibly, they are just not equipped to prepare -- their children for the types of life skills and problem-solving abilities that those children are going to need when they become parents. That is time and again what we see, that the children are just not being equipped at home because of the lack of parenting skills that their own parents have. So it is continuous from one generation to the next.

Mrs Witmer: Are you encouraging these people to come forward and participate in the parenting programs, or what method are you using to bring them out to the parenting courses? I would think some of them would be quite reluctant to acknowledge the fact that they are unable to parent effectively.

Mr O'Brien: We have not had too much difficulty actually. We have been running parenting courses out of the Collingwood branch now for about a year and there is never any difficulty getting enough people to come to the courses.

Mrs Witmer: So people are looking tor help then?

Mr O'Brien: Yes, very much so, and out of that, one thing we are doing is helping them establish self-help groups because, as you said, prevention is really an area that we have to move heavily into in this province, and I think self-help groups are one way of doing that. People learn that they can support each other and that they do not always have to resort to more and more services.

The Vice-Chair: Thank you very much. We have run out of time for this presentation. I apologize to those members who did not get their questions in, but we simply have to abide by these very stringent rules. Thank you for making your presentation.

Mr O'Brien: Thanks for your time. Most appreciated.

The Vice-Chair: On a point of order, Mr Malkowski?

Mr Malkowski: Yes. I would like to bring up a point of concern actually. The first thing: It seems to me when we look at the list of people for presentations, I am looking at the absence of mental health consumers. There does not appear to be anyone who will be making a presentation and it looks like a lack of consumer participation. I do have a concern that we are going to miss their perspective.


The Vice-Chair: The only thing I could comment on that is that we referred the matter of scheduling to the subcommittee prior to our meetings being held and each of the caucuses was given an opportunity to put forward in the agenda with respect to those groups who made presentations to us. The various presenters could have included those groups. I would refer that to the subcommittee.

Mr Beer wants to raise a point.

Mr Beer: Yes. I think Mr Martin yesterday and then again today raised the question of those who come before the committee. I think we need to recognize that, apart from perhaps just a couple of these sorts of 12-hour committee hearings, this is really a very new mechanism in the Legislature. I think I share with others that sense that we have to look at how, once the issue is brought forward -- and it is always brought forward by a particular party that says, "Look, we want to discuss that." They may well have thought through how they would like to see the question addressed and have some groups or individuals. I think we are going to need to fine-tune the process because there are some lacks.

Clearly in 12 hours, no matter how much we try to plan, we are never going to have everyone, but I would suggest that at the end of our two weeks there may be some observations around how this works that we want to provide to the House leaders. I suspect we may find similar sorts of issues that will arise at other committees which are doing this for the first time. Apart from the food bank issue, this is the first time that the social development committee has done these.

Perhaps we might then want to talk with our own caucus members and then at the end, in terms of the future process, try to have a system that will ensure that wherever possible we do not have some of the holes that may emerge.

The Vice-Chair: Mr White, I do not know if we want to get into a long debate about this, but I will entertain a few more comments.

Mr White: No. I think this is a very significant point that my colleagues bring out to Mr Beer's request. I think there are two points to that. One is that although we have only 12 hours, our report and recommendations will be significant. It is therefore incumbent upon us to mention that very significant lack in terms of these hearings. Essentially we heard from a great number of educators, some directors, service providers, psychiatrists, fine, outstanding, educated service providers, but none of the consumers.

It somewhat puts in question the committee's findings. I think it is incumbent upon us to note that in our report, but further that this particular and significant lack is also something which is a part of and endemic to the delivery system. There needs to be an effort, and perhaps that needs to be one of our recommendations, to enable groups to participate wholeheartedly from a grass-roots perspective and not simply from a professional perspective. That needs to be part of the information of our government.

The Vice-Chair: I am getting instructions from the clerk suggesting that those recommendations regarding procedure must be referred to a procedural affairs committee. It is not really appropriate to put that at the end of our report with respect to this subject. We might separate the two things and refer that to the appropriate place, whatever committee that is, and therefore proceed.

This is new, and as Mr Beer has pointed out, I think we all have to work through this process to find out what works best. I feel that we are in a hurry-up offence in the last minute of a football game.

I thank the members of the committee for their cooperation in trying to get through this, but we are restricted to the 12 hours and therefore we have to keep within those limits. That is something that is imposed upon us and we have a difficult time getting out of that.

Mrs Witmer, a last comment.

Mrs Witmer: I do not think it is appropriate that we engage in this debate at the present time. I think at the end we can. I just remind all concerned that, as has been pointed out, there was a subcommittee with representation from each party. In future, obviously, if individuals have concerns, they should be sharing them, in your case with Mr Owens, to make sure that the individuals and groups you feel should be recognized are placed on that agenda. I think what we try to do is give each person an opportunity to place an equal number there.

The Vice-Chair: Those concerns are duly noted. As I say, I think the suggestion has been made by the clerk that we put that forward to the appropriate place and try to make those recommendations count.

We are adjourned until 1:30 pm.

The committee recessed at 1205.


The committee resumed at 1330.


The Vice-Chair: We will call upon Mary Lou Moir, who is the co-ordinator of the Mary McGill Community Mental Health Centre in Alliston. Welcome to the committee. As I have been repeating this version of my gospel, we have a very strict time limit. You are entitled to half an hour, so you have the choice of dividing that up in whatever way you see fit. You can allow for questions at the end of your presentation if you desire to do so.

Ms Moir: Children's mental health: I am wondering how far Simcoe county has come as of January 1991 in terms of funding and services. On a scale of 0 to 5, I feel that we at the McGill centre are stalled at about 1.

I come today representing south Simcoe county as a service provider. I am the co-ordinator of the Mary McGill Community Mental Health Centre of Stevenson Memorial Hospital in Alliston. This is an adult mental health program funded by the Ministry of Health, community mental health branch. We also sponsor two youth programs; one is a life skills funded by the Ministry of Community and Social Services, and a youth employment centre which is funded by the Ministry of Education, as well as a child and family counselling intervention program. I am the director of these programs and speak to you today in my professional capacity.

South Simcoe county is situated just north of Toronto and is included in the central area of the Ministry of Community and Social Services administrative regions. My area office is in Barrie, 45 kilometres away. Up to 1 January 1991, Alliston was the centre of the southwest part of the county. It was at the hub of four townships and is bound to the east by Bradford. Recent amalgamation will change the structure of our region, but it is not going to change our catchment area. Stevenson Memorial Hospital is located in Alliston, as is the area's mental health services. It is a mixed rural and urban area, which has its distinct communities with individual needs. Growth in the 1980s has expanded the industrial base and thus increased urbanization. For example, Alliston has gone from a town of just under 4,000 in 1980 to its present population of 6,200. As Metropolitan Toronto has stretched northward, southwest Simcoe county is becoming more of a commuter community. That has brought with it young families requiring a lot of support and service. There are also other township restructurings that have occurred over the last decade. This has not changed our population base greatly, but it is an area to which families come because there is affordable housing.

How were our services developed in south Simcoe county? The Mary McGill Community Mental Health Centre was established in 1980 through the efforts of Mary McGill, a community member and health professional. She was aware of the lack of psychiatric services in Alliston and area. Until then, obtaining treatment in Barrie, Penetang, Toronto or Newmarket proved a hardship in terms of distance in an area where surveys had indicated a higher than average rate of suicide, alcoholism and marital breakdown. As soon as our doors were open in January 1980, it became apparent that not only were services needed for adults but for children and families as well. We offered these services to the community, stretching our mandate from adult mental health, that is, to persons over the age of 18, to serve their families as well. In 1984, interim funding for a children's worker was granted, I believe from surplus funding from the Ministry of Community and Social Services. We borrowed a worker from another agency in Barrie on a part-time basis, and as soon as he arrived his case load was filled with complex, severely disturbed children and their families. He could only carry a percentage of the families in need, and so the adult program counsellors were still carrying a case load of families who had children under the age of 18. In 1988, full funding was approved, which gave us our present staffing quota.

South Simcoe county, as you are all aware from this morning's presentation, is also the location of Thompson Centre in Cookstown and Blue Hills farm in Everett. As residential treatment centres, these facilities have been located nearby but took most of their clientele from our area. They, too, were funded in 1988 for in-home counselling and treatment services, and they divided the area between their two programs at Highway 27 in Cookstown. Our service is a traditional office-based one in which clients come to our facility, and we serve the whole of southwest Simcoe county.

By the time our ongoing funding was approved for one full-time counsellor, he had a full active case load brought over from the contractual interim funding. We targeted a maximum of 30 clients at any one time and hoped to serve 100 to 125 families annually. This projection of our capabilities was really optimistic. One worker could not carry the burden of 30 families, at least not of the severity that came through our doors. Length of stay was extended because of the complexity of the cases, and of course then our waiting list grew. Our base funding of $52,000 would not support expansion of services. The sponsoring agency also did not have surpluses to help out with any expansion. The parent program provides management and administrative services as well as office space and shares other operational costs with the children's program. Adult mental health also has waiting lists, is understaffed and is only meeting its budget.

In south Simcoe county we are the only service of its kind offering the traditional office-based assessment and treatment. We have a psychiatrist who consults to us on a regular basis. We offer groups and try to serve the mix of clients who come our way. Grossly underserviced are the severely psychiatrically disabled and those families at high risk due to family breakdown and being away from extended families. We are unable to address the issue of increasing recognition of sexual abuse.

The partnership with Blue Hills community program was not viable as the ministry had expected, as it too was at capacity and with waiting lists. We have turned families away by putting a freeze on our referrals. We have referred to other agencies in the county. We have approached the ministry for assistance and enlisted the support for doing this from the public and from our colleagues. Still, adequate funding is not available.

Our figures show a fluctuation in the volume of referrals over the last two-year period from a minimum of nine to a maximum of 45; this would take place in our quarterly. The waiting list has also fluctuated from a maximum of 47 to a minimum of eight. Part of this fluctuation is reflected in the freeze we have put on referrals and by the reluctance of the community to refer to us because of the extensive waiting period. At present, we have a six-month waiting list. A survey of the general practitioners in our catchment area has shown that they tend to refer elsewhere, usually to private practitioners, but many of these families cannot pay and this is not a viable alternative for them. Most physicians still refer to us, although some have decreased the referrals they send. When they do refer, they send the most difficult and severely identified problem families our way. Very few of the general practitioners in our area do any of their own family counselling.

When full, our centre has suggested alternatives including schools, doctors, private practitioners and other agencies. We try to offer services in Simcoe county, namely, in Barrie. This door is also shut to us as they too are stretched and do not accept referrals from outside their immediate catchment area. Families weather a crisis and it fades away for a while. Sometimes the families cope but many times the situation worsens until service is available. Also, so much more damage may be done and everyone has to work harder and longer to treat the family by the time they finally get to us. It becomes a rather revolving syndrome.

What has gone wrong? In 1988, when proposals were invited for a counselling service, I was so hopeful. There were only so many dollars for this area and I reasoned that our facility was eligible as we had been providing a service co-located with adult mental health. We had a competent counsellor in place and we were centrally located in the south part of the county. The other two agencies, that is, Blue Hills and the Thompson centre, also had an excellent plan, which could be funded partially from their existing facilities if surpluses were available. As it turned out, all three proposals were funded, not one larger program in the area. That limited, I believe, each one's growth potential. I would like to work on an evaluation of this kind of programming and funding. In the meantime, I feel that we at the Mary McGill Community Mental Health Centre are stifled in our growth despite attempts at seeking funding, and we have no surpluses with which to work.

What this means for our service is a treatment program which rushes people through. As manager, I literally nag the staff about length of stay. I push to have inactive cases discharged. I am quite rigid about meeting the demographic and age requirements and to do anything to admit the next person who is waiting to be seen. We have established groups to serve more people at one time. We have had parent meetings and used the telephone to offer interim assistance where possible.


The Ontario Child Health Study of 1989 states that in the central region, 18.4% of children suffer psychiatric disorders but only 4% use a mental health and social service. This indicates to me that we are grossly underservicing the region. The services in south Simcoe, though, are stretched. How many people are we not serving? The study is inconclusive and does not address whether services are available in any one area or not.

What has been suggested in planning strategies through the 1988 consultation paper Investing in Children is collaboration, a service spectrum, community and agency linkages, to name a few directions. Is this happening? I would hope that the collaboration between the Ministry of Health and the Ministry of Community and Social Services will continue. Also included in the collaborative process should be the ministries of Education, Correctional Services and even Housing. The schools in our area have cut back guidance services to exclude personal counselling to adolescents. There is also a lack of diagnostic services available. In the elementary school system, the behavioural personnel are not doing front-line work any more but only act as consultants to the teachers. I find these cutbacks undesirable. The education system has been a forum for identification of learning problems and correction of these problems that can lead to behavioural problems. One step in a positive direction is that a preschool screening program will include identification of high-risk families for psychological and behavioural problems, along with providing parenting skills and programs to those families that need them.

It should be part also of every agency's mandate to address prevention and promotion. To do this, the public must be included and encouraged to join with the service providers to help each other. Use of non-professional volunteer services should be encouraged where possible. Why could we not use the energy and wisdom of our older citizens to develop community helpers?

Although we need a plan for the future of children's mental health, there is also great need now. Once we identify need and risk, we then ask people to wait for up to 12 months for treatment. The gap between need and service availability is a dilemma for us in all of Ontario that is not readily solvable by saying, "Give me more dollars." We must look carefully at how we can effectively use our communities. There needs to be a balance between the demands of the taxpayers and their ability to pay. I would like to see in south Simcoe county a child and family centre in its own right with clinicians, home workers, management and support staff. The linkage and collaboration would be there with informal networks, with physicians, adult mental health, schools and other community agencies.

Because of the overextension of the Mary McGill Community Mental Health Centre and the child and family services, I rated us at a 1 because of limitation in funding, staff and resources, all needed to plan and implement suggested programming. With the joint planning efforts of the district health council in our area and government ministries, I still have hope for the future.

I thank you for inviting me to give my input into the future of children's mental health. May we all work together towards our goals.

Mr Jackson: Thank you very much for an excellent presentation. I am fascinated by your comments on the last page, talking about the cutbacks in guidance services to exclude personal counselling to adolescents. I am quite familiar with high school programs and OSIS and all of that. Can you describe it in a little more detail? First, we are talking about the Simcoe board?

Ms Moir: I am talking about the Simcoe board, yes.

Mr Jackson: Public or separate?

Ms Moir: Public, mostly. I am most familiar, I must say, with Banting Memorial High School, which is the largest secondary school in Simcoe county with an enrolment of around 2,000 students. The guidance counsellors there had been providing counselling to troubled teenagers, using as a linkage and often as a backup. But through the director, from the board, they are to be delivering vocational counselling services only and not be doing personal counselling. We feel this is a great loss because I know, again speaking in our own area, that Banting has had some good people there.

Mr Jackson: I appreciate your clarifying that. I am familiar with some programs, but these programs are mostly evolved to respond to a growing need in the community or in direct response to a crisis which had great publicity. You are familiar with some of the suicide statistics which are shared internally professionally but not shared publicly. None the less, there is some reaction. It seems this is an area we should be trying to examine, to the extent that these programs are not formally entrenched by board policy nor funded specifically by the province through the Ministry of Education and reflected in their grants. I appreciate you bringing that to our attention. I know one of your area representatives, Jim Wilson, had brought this to our attention in our caucus. He has his staff here today, but he has a conflict in his schedule; he would have liked very much to have been here.

Ms Moir: Yes. I miss his face here today.

Mr Jackson: But he did share some of the points you raised in your presentation with our caucus and wanted you to know that.

Mr Beer: I am interested in your comments in terms of the local level and coming to a decision around the three programs. I am somewhat aware of the Blue Hills program, because they have a base in York region as well. How do we get at determining at the local level, whether it is Simcoe county, being that area, to make some of the decisions at times and to participate in the evaluation? I sense from your comments that your thinking is that for an area the size of Simcoe county it would be best, perhaps, to have one agency that had an overall responsibility for children's mental health. I know you have sat in and listened to some of the presentations and the Children First document that came forward that looks at how might we organize both locally and provincially.

What would you like to see at the local level if we bring together the providers of children's services so that some of these kinds of decisions would be made? Would you like to see some kind of body that could have some power over the distribution, allocation of dollars? How specific do we get here? This morning your counterparts from Simcoe County Children's Aid Society were talking about what they felt was an effective program they were doing within the children's mental health area. That may well be so, but there might none the less at some point be a decision made locally: "Let's bring all of this together." How do we go about making those decisions, where you, as part of that community, would feel, "All right, it may not be what I wanted, but there's been proper consultation and this is the way people feel we ought to go"?


Ms Moir: First, for all of us in south Simcoe, when we put this proposal together -- and I worked very closely with Blue Hills in our own presentation to the ministry -- I think we grossly underestimated the need despite studies; that is hindsight, unfortunately. We had hoped to have a closer working relationship with the home-based programs, such as Blue Hills was funded for, in ours, the traditional base. We do try to share cases back and forth. We have tried a joint management, but we cannot afford that, and we cannot afford -- we both have very extensive waiting lists.

I think that we have to look elsewhere, whether it is -- I have mentioned the Ministry of Education and how even the preschool screening program -- so I hark back to the idea of prevention and promotion and working together, with perhaps a central entry point. I think our district health council is actually looking at that in terms of mental health. I would have appreciated my visit here being the week after next. Next week the district health council is doing community consultations and coming to Alliston to hear from the providers and consumers there about mental health planning.

But I have heard other ideas in Collingwood, talking about using the children's aid society, using the Ministry of Education. I do not think it really matters. I think it has to be investigated in each area where we start, but I think it does need a central -- I kind of picture a wheel, the hub -- a centralized area where we can tap into informal and formal services and use the various ministries that fund us.

The Vice-Chair: Are there any other questions? If not, then I would like to thank you for making your presentation before us here today and wish you well.


The Vice-Chair: I would now like to call upon Dr Dan Offord, McMaster University. Welcome to the committee. I would also like to remind you, if you were not here earlier, that we have half an hour. If it is not used up entirely, it will put us further ahead, but do not concern yourself with our problems and predicaments. Use the entire half-hour in whatever way you would like to divide that up.

Dr Offord: Thank you. I have a handout that is being handed out here. I will just wait until everybody has a copy of it.

I am delighted to have the opportunity to present briefly to you some thoughts I have on the charge of the committee. The handout has the main points I am going to make, and I also have included attached to the handout two resource papers. They go into some detail about the points that are summarized in the handout.

I am going to begin with some pertinent findings from the Ontario Child Health Study, which was a community study which gathered data on a random sample of 3,000 children between the ages of 4 and 16 in the province. It investigated the mental health of these children, the physical health and the alcohol, drug and tobacco use, as well as risk factors and utilization of services and associated impairments.

From the Ontario Child Health Study it was found that the prevalence of one or more psychiatric disorders in Ontario children 4 to 16 years of age was 18.1%. So the first point to make about children's mental health problems is that a significant number of children in the province suffer from clinically important mental health problems. They are not rare.

The second point is that children with one psychiatric disorder are at increased risk for other psychiatric disorders. Further, children with psychiatric disorders are at increased risk for other morbidities or harmful outcomes, such as poor school performance, chronic health problems and alcohol, drug and tobacco use. Just think of all the things you do not want for your kids. They tend to pile up in a significant minority of children. Thus, children with lowered life quality in Ontario have a combination of disorders or conditions which are not the mandate of a single ministry.

Third, according to the study, children with one or more psychiatric disorders, compared to those with no psychiatric disorder, are four times more likely to receive specialized mental health or social services. The specialized services include places like where I work, Chedoke Child and Family Centre, other child mental health centres, children's aid, the courts, family service associations and private practitioners.

However, only one of six children with psychiatric disorders has received this specialized service in the past six months. Further, from our data, over half of the mental health/social services were being devoted to children without any of the four disorders measured on the Ontario Child Health Study. There may be other reasons, good reasons, why they were receiving those services. It could be that they have other disorders we did not measure, that there were other reasons to seek these services out except for psychiatric disorders in the children. However, it does raise the issue I will talk about later of the targeting of services.

Lastly, family doctors and pædiatricians in Ontario, with first-dollar universal health insurance, see almost 60% of the children every six months. The schools, of course, deal with all children of 5 to 16 on a regular basis.

What are the implications of these findings for the delivery of services?

First, it is clear because of the magnitude of the problem with children's mental health difficulties that specialized mental health social services can never adequately provide services for children with emotional and behavioural disorders.

Second, it is going to be extremely important that the specialized and expensive services be targeted to those children most in need of them and who can benefit from them.

Third, family doctors and paediatricians in the schools should be centrally involved in providing mental health services to children and their families because they see these kids on a regular basis.

Fourth, in addition to servicing identified children and their families one at a time, no matter how that is set up, there is the gnawing feeling in the field that it is going to be important to develop public health approaches which focus on populations of children at risk.

Examples of such programs include milestone programs where children at a particular stage in the developmental course are the focus. For instance, all children as they enter school in grade 1 could have certain programs in place. Second, there are high-risk programs. Groups of children at increased risk for emotional and behavioural problems are the population of interest. A major high-risk group in Ontario are the offspring of parents on social assistance. Third are community programs, children at increased risk living in a circumscribed geographic areas such as public housing projects. Over 120,000 children in Ontario live in these large, publicly supported housing complexes.

Fifth, services for children must be co-ordinated across ministries since the conditions that exist within children are not ministry-specific, and comprehensive cross-ministry programs are needed to deal effectively with these multiple morbidities.

As part of the charge, the issue of the waiting list of children for services of the children's mental health centres was pointed out, and I made some comments about short-term and longer-term steps.

First the short-term steps:

Gather systematic information on the children on the waiting list, including the types and seriousness of the problems they have, their family backgrounds and where they live.

Divide up the waiting list group into those who need immediate individual attention and those who do not.

Ensure that the former group receives immediate individual attention and provide the latter with less intensive group or community interventions.

Encourage children's mental health centres to review their case loads with a view to determining who does not need time-consuming, individually focused intervention but for whom the appropriate intervention is less intensive and perhaps not individually focused.


Second, longer-term steps:

Institute a uniform data collection procedure on all children and their families touched by the mental health/social service system. The number and characteristics of these children being served by the system are simply not known in any systematic way.

Use the data to determine the relative size of the populations of children with different types of problems and use this information to plan appropriate services.

Combine this information we would have on the children touched by the system or served by the system with the already good information we have on children in the community. Then we will be able to investigate the appropriateness of the population served by specialized mental health/social services. A prerequisite to do that means that you have two good data sets, those children being served and those children in the community. With that prerequisite in place, we can then make sure that the mental health/social services are targeted to populations most in need and most likely to benefit from the services.

Determine from the existing literature what interventions, whether they be individual, group and community, for children with mental health problems are known to do more good than harm for children with specific types of problems and, conversely, determine what interventions are known to do more harm than good or are ineffective for children with particular kinds of problems. Make sure that this information is widely available to the staffs of children's mental health centres so that their practice is based on the best available knowledge.

Institute a comprehensive research program to increase our knowledge about the effectiveness of prevention and treatment programs for children's mental health problems. Different delivery systems should be included in this enterprise: individual work by mental health and social service workers, family doctors, paediatricians, school staff. Different approaches should be investigated, individual, group and community, and the intervention programs should not be restricted to the mandate of one ministry but should involve multiple ministries.

The goal is to move towards a delivery system of children's mental health and social services which provides effective services at reasonable cost to all children and their families in need of them.

The Vice-Chair: We have Mr Malkowski first.

Mr Malkowski: I am very impressed with your presentation. There are two areas on which I would like to ask for your comments. One area is in the mental health training for children's specialized services. Do we have enough resources related to training in the non-traditional approaches in Ontario?

Dr Offord: Non-traditional meaning what?

Mr Malkowski: Traditionally we have used a medical approach to services and now we would like to take a more humanistic approach and provide non-traditional treatment. There are doctors or practitioners who still use the medical approach.

Dr Offord: I am not clear exactly what is known by the medical approach. What I would say is that I think there will always be a need for services which are delivered to identify kids and their families on a one-time basis. In those instances, it is important for the practitioners, whether they be medical doctors or non-traditional, whatever, to institute interventions that have been shown to do more good than harm so that ordinary clinical care, no matter who it is delivered by, is based on the best available evidence about what works.

Second, as I have indicated, it is clear that, even though that is done to the best of one's ability or system, there is going to be lots of room for other intervention efforts which will include, for instance, prevention programs for groups of children at risk, such as those in public housing, or high-risk groups, such as the offspring of mentally ill parents or the offspring of parents on social assistance.

I see that the delivery system for children's mental health problems will be a combination of those that are going to be done on an individual basis and those that will be delivered on a group basis.

Mr Malkowski: If we are looking at comprehensive research projects, would you plan to include the role of the consumers in this research project?

Dr Offord: Yes, absolutely. I think, for instance, if one is to do a research project in the community, that it is clear that one does not go in singlehandedly from a professional side and impose some program on the parents and children in that community, but the consumers, in that case the tenants or the parents and the children, are actively involved in determining what kind of program might be implemented and what the evaluation strategies might be. Clearly there is room for a lot of community development and participation by consumers in any comprehensive program to reduce the burden of suffering in children's mental health problems.

Mrs McLeod: I am very much supportive of the goals that you have outlined here and I think you would see them as being consistent with the Maloney report that has recently been tabled although, as I have said earlier in the committee, while it recognizes the support in the delivery through schools, I am not sure that it goes the further step of recognizing the importance of providing support close to doctors' offices.

I am becoming a little bit more concerned as our committee deliberations go on that we may almost see that decentralization in service delivery through the school as a hub as being an alternative to treatment provided in children's mental health centres. I wonder if you could help us a little bit. You talk here about the number of children with psychiatric disorders and I assume you are referring to some very specific syndromes of children who have some particular and often severe problems. Where do you see those children being treated? Can they be treated through the school intervention program? Is there a continuing role for the children's mental health centre?

Dr Offord: I think it is clear that the thing about children's mental health problems is they are diverse and include a wide spectrum of disorders, everything from kids who are chronically aggressive and lie to children who have serious and lifelong debilitating disorders such as autism.

I think the thing to remember about children's mental health problems is they are very diverse and a heavy burden of suffering, and the comprehensive program is going to have to include different elements. For instance, there is always going to be a place for individualized work that is done at the children's mental health centres because some kids need that. My plea there would be to make sure that the interventions are based on the best available evidence; not what people have been trained to do, what they want to do, but what appears to work.

Second, there are all sorts of other programs where the school could be central. There is good evidence, for instance, that what kids at risk need is the best outside-the-home programs this province can provide. What happens to economically disadvantaged children and children in public housing complexes is they tend to get the worst of those programs, whether they be recreation, summer camps etc.

There is beginning evidence to suggest that if you give these kids the best of the outside-the-home programs for groups of them, that can make a difference. We see again that there would be different elements of a program on a group basis that could be launched in a school that I think would be very helpful.

The third point I would make is about the school itself. It is clear that here you have an opportunity to work with groups of kids and the peer group, and there is beginning evidence that if you want to prevent antisocial behaviour, one of the most troublesome mental health problems in kids in Canada and Ontario, one of the ways to do it is to begin to pick these kids up early on. The thing about antisocial behaviour is it begins small and grows. Pick them up in kindergarten and grade 1 in school and do a combination of interventions, including teacher training, social skills training and academic remediation, which was launched in the schools and which may be able to reverse the course for these kids.

Mrs McLeod: Would you also believe that part of that school program would need to provide for family intervention, which would not be done by a classroom teacher and would therefore need some trained personnel based in schools?

Dr Offord: That is right. I think another interesting program that appears to be effective as far as we know is parent management training. If you offer the program, a lot of parents can gain skills which will help them deal with their kids. We need to do a lot more work. What happens, as you might expect, is the parents who need it the most are the ones who are easiest to engage in these programs. One has to do further work to see how to help these parents who are having more problems to stick with the program.

Clearly the program is going to be based in the schools, but the personnel would not all be school personnel involved in these programs. I would include family doctors and paediatricians. See these kids. Nobody knows what to do with those who have behavioural problems. No one has ever studied that. I would include recreation. It is a very big thing in Ontario and these kids who need it the most have the least of it.

Mrs Witmer: Thank you for your presentation, Dr Offord. You mentioned just briefly now again that there was a central role for the family doctor and the paediatrician to play along with the school, and then as well the need for recreation. What role do you see the doctor and the paediatrician playing?

Dr Offord: The data are clear that parents go to the family doctors and paediatricians, and our follow-up presented today suggest they talk all the time about the behaviour problems their kids are having. That is one of the places they go. I think what needs to be done is to train family doctors and paediatricians in what kind of interventions they can do on a short-term basis that will be effective for these people and what kinds of kids they see need to be referred for more intensive services. But here I think is a large cadre of people who see the kids and are clearly doing something for them for the complaints being brought. What I am putting in a plea for is to be able to upgrade their skills and to study the effectiveness of that vague delivery system.


Mr Owens: I guess my question is more of a statement. Since we began these hearings, we have been struggling with the issue of the massive waiting lists. I think you are the first presenter who has come forward with a reasonable method of dealing with that issue, and both your short-term and your long-term recommendations should be applauded. I guess my question is, when could we start to get these waiting lists down -- as we talked about earlier, even one child on a list is too many -- to get them into some sort of manageable proportions? Why has this not been done in the past? Why are we just accumulating kids on these lists instead of going after the strategies that you suggested in your paper?

Dr Offord: I do not know all the answers to that. I think that part of the time, with these kids and stuff like that, what happens in the children's mental health field is that you are so pressured to service kids that it is just like breaking down the door. What is needed I think, in addition to good people on the front lines, is people to take a look back a bit and see what the heck one might do on an overall basis. I am putting in a plug for that. I think this could be instituted fairly quickly.

I think we have to know who is on them, how badly off these kids are. If the kid on that waiting list is suicidal, clearly he has to be seen. That is dangerous. If there is a single-parent mom who is having some difficulties disciplining her young boy, the evidence as we know it now suggests that she can be helped most effectively by a group approach with other single moms, with parent management. So I think one should divide the waiting list into more homogeneous subgroups of kids all of whom would not need expensive individualized treatment, I would think.

Then again, I would put in a plug on the other side for children's mental health centres such as our own. Let us take a look at the case load and begin to see to what extent some of the kids already being seen, and their families, could be seen and benefit from a much more cost-effective approach. It might be defined groups. For instance, if all these kids are coming from one school, it makes sense not to see these kids individually. Go out to the school and see what can be done in the school. So I think this kind of thinking is involved in trying to get the waiting list down.

Mr Owens: Further to your point about checking the treatment these kids are receiving, is it actually being effective or are we just throwing kids into specialized programs, where they could perhaps be placed in a less intensive environment?

Dr Offord: Correct. If you had to say what the biggest need is in children's mental health, the biggest need is to find out what programs are effective, do more good than harm, for which kids. It is not that we do not want to do more good than harm, but I think in the majority of the clinical effort we do the best we can but we are not really sure to what extent we are doing more good than harm for the kids we are seeing.

Ms Haeck: In my role now as an MPP, I have been made aware quite tangibly on numerous occasions, although I have seen these things in the past much more in an observer status, that there is great concern about the psychiatric community, the delivery system. I know there are a number of members, much more in the medical area, who have received some negative comments from receivers of these services.

There is one thing that has been briefly touched on by a number of people this morning. I was just sort of looking at your comments and hoping to get some direction on professional renewal, education of professionals. What do you see would have to be done to keep things flowing in that area?

Dr Offord: There is not a simple answer to that. I think two things come to mind. One is that I think it is important for the field to know in Ontario what the state of knowledge is about the different interventions that are being commonly employed in mental health centres, and to be able to say to people on the front line, "Listen, these are the things that appear to work; these are the things that are not effective," and to bring their clinical practice in line with the kinds of things we know.

I think there are two things involved. One is that you have to get the information out. Someone has to know that stuff and write it up in a way that will be appealing to front-line workers. Second is to make sure that happens.

Another aspect of that is clearly for professional groups to make sure that they are trained. The problem, and I can speak for child psychiatry because I am a child psychiatrist, with child psychiatrists is that they tend to keep doing all their lives the things they have been trained to do. They are a product of their training and it varies depending on the centre. It used to be McMaster was big on family therapy and someone else was big on something else. The fact is the field has moved a lot from that. We know a lot of other things. I think it is clear that people should be brought up to date and be brought up to date concisely on these things so that clinical practice is in line with the best available knowledge. Now what happens, at least in settings that I am familiar with, is that people tend to do their own thing. That is simply not good enough. It is not the cheapest and it is not the most effective way.

Ms Haeck: I am with the Ministry of Colleges and Universities as the parliamentary assistant. Do you have any recommendations for that area as to what programs should be adjusted to fit the kinds of concerns you might have around staff development?

Dr Offord: It is again the same general theme. I am very much in favour in psychiatric training programs, the training of social workers etc, that their teachers do not teach them just what they were taught but that they are very concerned about critical appraisal, about effectiveness and cost of services. What we want to know is, how can you raise the life quality of kids with these problems in Ontario? There are large groups of them. That is going to take people who know, who have a critical appraisal of the literature and can employ it effectively.

Mr Jackson: Thank you, Dr Offord. It is the second time in a little over a year that you have been before the committee. Last time you were a lot more controversially received, but appreciated very much. At that time we were dealing with early childhood education, as you recall.

Maybe I am stating the obvious when I ask you this question, but I think we may be missing part of the point about access points to children at risk and their rights. I think one of the reasons there is that this infatuation with the school is partially because the law protects society because of its custodial role with the child in a school setting. The other opportunity, of course, is through a court referral where a judge specifically orders a child to receive treatment. You would be familiar with the recent report that was allowed to become public in the last four or five weeks which dealt with a child's right to reject service provision and support.

Perhaps you might just briefly comment on the significance of the school and the role it can play in terms of it having this custodial function, where a child can walk away from many settings where support and care is given, but it is harder to do that in a school setting. I think we missed that point and it has not really been touched upon, but there is a reason for this discussion around schools aside from their academic mandate.

Dr Offord: I think two points come to mind. The first one is that clearly you have to get a situation where the kid can stick with the intervention, where you have a chance to do something. Let me just tell you what the literature showed for years and what the big advance has been. You look back and say it is obvious.

If you get a kid who is kicking up and he is a real pain, I was taught that what you do is you take that kid aside and you try to help him. You make him into a better kid. Then you put him back into the peer group situation. What you find, and everybody finds the world over now, is that when you do that the fact is you make the kid better when he is by himself. You teach him all these skills. He knows how to get along and all that stuff. He goes back to the peer group and they do not think he has changed at all no matter what he does, so within 15 minutes or half a day he is behaving exactly the same way he did before.

The way to help that kid is to involve the whole peer group. That is obvious. When you do that you can help the kid. The point is that here you have an opportunity in the school to have a ready-made peer group to do something about it.

What happens and appears to be effective is you take the peer group aside and say: "Listen, kids have different kinds of problems. What do you think about kids who do not fit in? How can we help them?" You also have the kids come up with ideas. That kind of approach is very effective. So I think the schools are a very effective source of the kinds of things that can be done to raise the life quality of kids that cannot be done in other settings.

Mr Jackson: Post-suicidal it is almost critical. In some of the peer group incidents of attempted suicide following a successful suicide attempt, I have seen numbers in my own riding as high as 22 students in a school attempting it over the course of a year subsequent to a successful suicide. It just crystallizes that point almost too well.

Dr Offord: That is right, and I think suicide is one of these things that has a contagion effect. If one kids does it, it puts other kids at risk.

Mrs McLeod: It comes back to trained personnel.

Dr Offord: Absolutely, but there is no other setting that can provide this peer group intervention, even if you have the trained personnel. I cannot do it in my office. It does not do a darn thing. I would like to think I could do it. It does not do any good. It is a waste of time and money for me to try to do it. It is far better to do something with the peer group in the school.


Mr Beer: Briefly, I suppose that one of the things at the end of all this that we want to do is to put forward some recommendations that will move the yardsticks. Clearly in 12 hours we cannot become total experts. But one of the things that we have been wrestling with is the question of structure. Colin Maloney's report has suggested a way of looking at that both at the provincial level and at the local level.

I just wonder, from your experience -- you have met and talked with so many people working at the local level -- how structured do you think we have to become in terms of the delivery of children's services, the allocation of funds, the determining of who is going to do what to whom? How much of that can we really structure locally to make for a more effective system and what are some of the things that we have to be aware of? I am assuming that you have looked at a number of different approaches throughout the province. I think we can see how we might do that provincially, in dealing with a number of ministries in bringing that together, but how far can we go locally?

Dr Offord: Clearly it is going to vary from community to community, but I think the first thing is that if you are going to do something in the children's mental health area all the actors have to be on board. I think there is a lot to be said for local committees that include not just Education and Health and Community and Social Services, but include Housing and Tourism and Recreation. These people are together and then they begin to think about what are the big problems in the community.

The beauty of it is that these problems may vary from community to community. I think then they are going to perhaps need consultation -- perhaps it exists within -- to know what to do about these things. I think the advantage of the local stuff is that they can address local problems, provided all the actors are there.

The other thing I would say is that accountability has to be built in and so, for instance, the thing we are working on is recreation. Now the fact is that for poor kids nobody knows if they get even their share of recreation dollars, so if anyone is going to do recreation then I would want to know how many kids come out and exactly how much they learn. There has to be an accountability built in for everybody in there. I think that with the local work group on accountability that there are a lot of advantages to doing it on a local level.

The Vice-Chair: I see that you have obviously generated quite a number of questions. That is very good for this committee. We will be wrapping things up tomorrow with our report, so I would like to thank you for a stimulating discussion.

Dr Offord: Thank you for inviting me.


The Vice-Chair: Our next set of presenters are from the Ontario Association of Children's Aid Societies: Mary McConville, executive director, and Bruce Rivers, executive director of the Children's Aid Society of Metropolitan Toronto. Welcome to the committee. Again, I will repeat that you have a stringent time limit of a half-hour. Please commence.

Mrs McConville: I would like to thank you for the opportunity to appear before you today to discuss the important and troublesome matter of children's mental health services in Ontario and the need to improve these services. Although we wish to speak to you today primarily from a child welfare perspective, we would like to begin by making some general observations about the subject of children's mental health in Ontario.

The committee obviously is aware of the important epidemiological work in this area that was done by Dr Dan Offord, who has just preceded us. The study is a watershed document in our opinion that proposes, conservatively speaking, that at least 18% of our children suffer from a serious mental health disorder. In reality, if we consider a variety of other conditions which are well documented and which are not represented in that study, up to 30% of the youngsters in our communities are affected by mental health disorders during their childhood years.

These epidemiological indicators alone tell us two things. First, we will never have enough services to address a problem of this magnitude if services are viewed as the primary response to the problem. Second, the indicators also suggest that there are inequities in the health status of our citizens, especially children, which appear to be connected substantially to factors such as poverty, ethnicity and other factors such as public housing.

The relationship between poverty and health outcomes has been well documented. Children who live in poverty are 40% to 50% more likely to be of low birth weight, premature or with growth retardation and experience a 50% higher death rate from all causes. These children are also twice as likely to be afflicted with psychiatric disorders and poor school performances than non-welfare children.

These compelling facts, and there are many others which I am sure will be placed before this committee throughout its hearings, can only lead us to conclude that in addressing the mental health needs of children, we must think in a broader context than the adequacy of our services. We believe that the government must first and foremost concern itself with the necessity to promote the development of a better societal capacity to ensure the wellbeing of children in order to reduce the number of special needs cases that require the use of the safety net.

Simultaneously, we must attend to assessing the proper role of our specialized services in relation to that children's agenda, which does not exist in the province of Ontario, and as Dr Offord pointed out, the proper targeting of these resources. Within that context we can then properly assess the adequacy and the effectiveness of the services that are provided to vulnerable children and families.

The recently published document entitled Children First, a report of the Advisory Committee on Children's Services to the Ministry of Community and Social Services, is an excellent framework within which to consider the development of strategy to support the wellbeing of children, and also to improve the capacity and the impact of a variety of services that are applied to the problem of children's mental health.

The United Nations Convention on the Rights of the Child is also a useful document in assisting with the development of principles which should guide governments in forming social policy with regard to children.

Those principles are: Childhood is entitled to special care and assistance. The child, by reason of physical and mental immaturity, needs special safeguards and care before as well as after birth. The child, for the full and harmonious development of his or her personality, should grow up in a family environment and in an atmosphere of happiness, love and understanding. Children who live in exceptionally difficult conditions need special consideration.

There will always, then, be a need for a safety net that captures those children and families who are broken and who suffer from a variety of social, health and psychological problems. Child welfare services and children's mental health services are two of the cornerstones of specialized services in this province.

Children's aid societies in Ontario primarily service children within their families and their communities, providing service to over 152,000 families in 1989. We also provided substitute care to over 19,000 children during that calendar year. On any particular day in this province, there are approximately 10,200 children in the care of these societies; 53% of them are cared for in foster homes and the rest are cared for in a variety of paid or free institutions, group homes, etc.

Children's aid societies received more than 19,500 allegations of child abuse in 1990, an appalling increase of 2,300 allegations over 1989 and an increase of 100% since 1984. Although the numbers of abuse allegations and documented cases of abuse and neglect have skyrocketed, none the less the number of children in care has significantly decreased. This is partly because of the thrust of the new act which demands the least intrusive approach, but also because of improved methods of providing services to children and families at risk.

Having said that, there is a downside. Because societies are required to exhaust all possible measures by the courts before admitting a child into care, more and more children who are being admitted are being admitted in extremely damaged condition. Children's aid societies consequently are required to parent both on a short- and long-term basis many of the most damaged children in our society. It is essential that we have a variety of caretaking options, consequently, to ensure for the adequate care and treatment of these children.


The proclamation of the Child and Family Services Act, in our view, was a great leap forward in significantly reducing legislative barriers to service and treatment by virtue of the integration of a number of pieces of children's legislation. Some feel that moving the responsibility for children's mental health back to the Ministry of Health will improve things. We feel this will only create more fragmentation.

The government should rather consider more integration of ministry structures to better support children, because we also believe that co-ordination across ministries in and of itself is not sufficient. The service system in the province of Ontario, which is essentially a transfer payment one, despite integrated legislation, is none the less not supported by a clear vision of social policy and service delivery, or by adequate funding mechanisms, information systems or other systems management tools.

In short, service providers do a significant amount of good, given very limited resources, but we could do a much better job if we had basic support, such as the information system which Dr Offord just referred to, with which to plan and evaluate the impact of our services and effective mechanisms to ensure that children do not get caught in systems or are denied access to services.

There is no question that the problems of children's mental health go well beyond some of the inadequacies of the legislation or the waiting lists in various communities for services and we must be vigilant in our attempt to understand the problem so that we do not end up with simplistic answers that in the end are no solution.

Children's aid societies in the province, despite having responsibility for many of the most difficult children, are frequently unable to gain access to children's mental health centre beds, even in those communities where there is a wide spectrum of services and a large number of services. Many factors come into play here, the underfunding of some of those services that have beds but also insufficient staff, rigid eligibility criteria, the lack of innovative programming in some instances and the lack of planning in the use of residential beds.

At this point, I will just turn briefly to the director of the Metro society to give you a more specific feel of how that translates into the impact on children.

Mr Rivers: The placement problem for hard-to-serve children in residential facilities became so acute for Metro Toronto societies recently that they requested that the Ministry of Community and Social Services make a special attempt to deal with the local access crisis.

It is worth noting that the occupancy rate of local children's mental health centres in the Metro area is frequently as low as 74%, while local CAS occupancy rates at admission assessment residences have consistently exceeded 100%. It is also important to note that children's aid societies do not have the latitude to refuse service and develop waiting lists. The children's mental health centres' waiting lists are composed of families in the community as well as child welfare clients.

We believe much of what is creating the waiting list crisis is the reduction in available foster parents. For example, between 1982 and 1989, the child welfare sector experienced a 25% loss of foster parents. That percentage, by the way, is higher in Metro, closer to 50%.

When one looks at the number of children in mental health facilities who are wards of the societies, and the number is often remarkably low, there exists an all too frequent bias against accepting these children because they are considered too disturbed. It is a fact that many of the most disturbed children in the province languish in CAS-operated admission assessment facilities, frequently breaking down, and a large number of our children are placed out of sheer necessity to private group homes, often miles away from their local community, which is a terrible disservice to them and their families. Many are placed in foster homes or agency-created, staff-operated resources to fill the gap that is not being met by a residential resource system.

Children's aid societies themselves and the private group home sector have been forced to fill the gap left by the children's mental health centres in caring for highly disturbed children.

To give an illustration, one in three children referred by our agency to special placements required intensive long-term treatment, and by that I am referring to up to two years. In one year, 100 such children were referred to treatment facilities and only 33 were placed. The rest were not accepted because they were considered to be too disturbed. These children were eventually placed in foster care or in private group homes, often out of their home communities.

We recognize that many of the youngsters in children's aid society care, because of the severity of their problems and early deprivation, will not do well in residential treatment that in Ontario is, at best, a short-term resource. More long-term and crisis beds are required, but alternative methods of caring for these children must be supported, such as treatment foster homes and therapeutic foster care. Child management support in the home, group support for foster parents and higher per diems are all part of a spectrum of supports that must be available to caretakers. Foster care providers in the 1990s must be recognized as professionals who are expected to care for very disturbed children. They will require training, decent compensation and staff support, not only from child welfare professionals but from the mental health professionals in our children's mental health system who must be willing to apply their expertise in different ways, such as through case and program consultation.

We would like to refer you to an article in the Journal of the Ontario Association of Children's Aid Societies, which discusses the value of consultation between child welfare and children's mental health. It is item 4, and to help you, there is a summary at the end that I think will lead you to some practical solutions. I would also like to refer you to an OACAS fact sheet, which is green, inside the Journal, which indicates from our annual survey the very low rates of compensation for foster parents in child welfare. By the way, the average is anywhere from $15 to $18 per day, depending on the age of the child. Spending more on these kinds of essential supports and less on regulation, for example, would allow us to enrich a range of services. These are some of the practical solutions that we would suggest in getting the list down and expanding our foster care system.

Mrs McConville: It must also be said that children's mental health professionals and others are not clear about the mental health needs of discrete populations of children, although they know a considerable amount about the needs of individual types of cases. Consequently, professionals are not in a position, without more research, to define strategic ways to secure the level of resources required to address apparent needs.

More research is required to determine what kinds of children can best benefit from residential treatment and what kinds of children are best served through other methods of service delivery. We need to develop community strategies and service strategies for reducing risks for those at highest risk. Service providers themselves should not be able to define service responses in isolation of the clear articulation of community needs, as is presently the case. They should not be able to unilaterally control access to scarce and expensive resources such as children's mental health beds.

Accountability mechanisms must be put in place so that services relate to community needs, and we further need to create incentives to comply with regional plans and other policy requirements that emanate from the funders and local planning bodies and community groups.

In conclusion, we believe there are gaps in service. We no doubt could use more residential mental health beds, but some immediate relief or short-term solutions could be provided by doing a much more efficient job of allocating the resources we have, supporting alternatives to residential care for those children who need it and planning more carefully and in a targeted way for any expansion of the residential system. We have many examples throughout the province of the value of the collaborative efforts between child welfare and children's mental health professionals. For example, in the city of Toronto we have child-welfare and mental health professionals out of the specialized safety net working directly in schools, such as Ryerson Public School, with the sole purpose of supporting teachers so that they can identify risky and vulnerable kids and families much earlier and apply interventions, obviously at a stage when they are much more likely to work.

We, in addition, must expand these kinds of efforts, which do exist here and there throughout the province but in a very fragmented kind of way, and this expansion of alternatives can only be provided through ministry leadership and funding incentives. We must kickstart these efforts with an infusion of funds to keep services that are presently there afloat while we shift our structures to reflect another approach.

In the long term, a targeted reduction in the incidence of health inequities through strategies such as those put forth by the Social Assistance Review Board, which target poverty and early intervention and prevention strategies, is the only hope for changing the balance between the need for and the availability of specialized resources such as children's mental health services. Only a province-wide health strategy which promotes the wellbeing of all children will enable these strategies to develop and reach fruition. Specialized services, in the long run, should be in less demand in the future, but also should be restructured to reflect a wellbeing model of services and one that does not solely assign its expensive resources to individual case application.


The Vice-Chair: We will move right into questions. Mr Hope is first on the list.

Mr Hope: I welcome the information you have put forward. The one thing I have noticed is, when you stated about clear policy and direction and leadership of the ministry in itself -- and I think that is one of the key important things. I am sometimes wary of putting power into local communities, because, number one, we do not know what direction, and the best interests of the board level, who is on those boards. A lot of times in smaller communities in rural Ontario we have a hard time getting people to serve on these boards, so it is done by a minute group, which may not really see the whole picture of what is happening.

I have to agree with you that we need more direction from the government itself and from the ministry in implementing more direction and clear direction. I think there are a number of plans out there that we are trying to put forward and I think Better Futures, Better Beginnings, which was implemented by the previous government on the research part of it -- and he is a member of this committee and I have to commend him on putting that effort there, I think with that focus of starting to solve the problem at the earlier stage -- I am glad that you put some of this information about children's aid forward, because it is an issue and I think the community mentality of children's aid, education-wise, is not there. I think more people have to be aware of what the children's aid function is really all about, because in smaller communities I do not think they really know. I am glad you put this forward.

Mrs Witmer: Thank you very much for your presentation. I appreciated the information that you put forward. You mentioned on the final page that you feel the only hope for changing the balance between the need for and the availability of these specialized resources such as children's mental health services is through early intervention and prevention strategies. What strategies at the present time would you be recommending? What do you feel is working successfully and what should we be pursuing?

Mrs McConville: I think one of the most frustrating things for service providers -- and I am sure Dan Offord would agree with this; I do not know if he is still around -- is that there is already a good deal of information out there through good research which indicates that early intervention strategies work with individuals and families as well as with groups and vulnerable populations. I know that is what Better Futures, Better Beginnings is all about and I applaud the ministry's attempt to promote these broader prevention strategies with some significant money over a long period of years.

My frustration is that we have demonstrated many, many times on a local basis and in broader kinds of ways, and not just in the jurisdiction of Ontario, that working with vulnerable populations, for example, works; intervening earlier works. We know that in our own daily practice in the children's aid society. The problem is that we cannot express that experience by way of information that you can roll up in a global fashion so you can learn from it.

We do not do enough program evaluation. We have good professional experience that tells us what works and what does not, but the information is not available in such a way that professionals can learn from it and funders and social policymakers can learn from it. I think service providers at large in the province, and I would include many medical people in this, are doing a lot of good work and their experience is telling them that what they are doing is working, but we are not doing enough program evaluation and we are not doing enough research to document what works. Consequently, when you turn to the funders, they say, "Well, prove that what you do is effective," and we cannot.

Mr Rivers: If I could just also comment on that question, it is interesting to note that last year in Metropolitan Toronto we were funded privately to the tune of $1 million to experiment with primary prevention, but we were unable to convince the government that such an expenditure was necessary. It was the corporate community that in fact supported the program at Ryerson Public School and it was the corporate community that has supported programs for young moms to get out of their homes and to look at new and better ways of parenting. So there needs to be a look at the children's aid society's mandate as dictated under the Child and Family Services Act. You have to take a closer look at that prevention issue, because presently it is not getting the due attention that it requires.

Mr Beer: A bit in the same vein in terms of looking at some of the things that you have been doing, I was interested in your paper. I think this is the first time we have talked in some detail about foster parents and their role. I think it would be interesting for the committee if you might tell us a bit about the Home-builders program that you and your colleagues in Metro have been trying to develop. It seemed to me that had the promise down the road of providing a lot of help in this area. I wonder if you would just share that program in conceptual terms with us.

Mr Rivers: Home builders is an exciting program that could have a major impact on the waiting list that you are dealing with. Instead of a child being admitted to a residential program or into foster care, it would see the worker moving into the child's home for anywhere up to 20 or 24 hours a week so that the worker is there at the critical times that the stress is on the family.

This concept has been tried throughout the United States and has been demonstrated to be 80% successful in holding high-risk kids out of care. For the last year or so the Toronto agencies have had before the ministry a proposal for funding that is about $1 million to implement. That is the kind of kickstart that we are referring to when we say that there needs to be some risk here.

Presently, you will be interested to know that we have, as well, a couple of corporations that are prepared to back the project but cannot pick up the entire bill, so we have been able to convince people throughout Toronto that it is a good idea and we are just waiting to hear now about implementation.

Mrs McConville: I should also say that we did have in several societies throughout the province what we call family support programs, and there are many varieties of them, but the purpose of them is to assist families that are disorganized and have all sorts of problems in improving their parenting skills and reducing the crisis element of a family's functioning so that we can reduce the risk of bringing kids into care. We know these programs work and they have been a large part of reducing the numbers of kids in care by half over a 10-year period, and yet those programs today are vulnerable because, and this goes back to the mandate issue, as money gets tighter and tighter and the ministry tries to control the child welfare budget, which is difficult to control because we must in many instances provide service, it is starting to target the front-end programs, the early intervention programs in our specialized context that have enabled us to keep kids out of care who should not be coming into care, and obviously have, in the bigger sense of the term, reduced costs because it is a heck of a lot more expensive to bring kids into care than it is to service them in their community.

Mr White: I have worked both with the children's aid society in Metro Toronto and with a couple of children's mental health centres. What I am struck with, within the body of your report and certainly within my experience, has been that although we have two different services funded by the Ministry of Community and Social Services, there seems to be more than just a creative tension between these services. There is often a battle royal over a sector, where the wellbeing of the children involved should be the paramount issue. You refer here to the crisis in placements, situations where there were only, say, 74% of the residential beds in children's mental health centres occupied in Toronto. I understand that Metropolitan Toronto has fewer beds than does Hamilton. Some of these are startling statistics.

At a very practical level, what suggestions might you have in terms of how the Ministry of Community and Social Services might effect greater co-operation between two very valuable services working on children's behalf and in what ways the ministry presently may not be fulfilling its mandate to regulate children's mental health centres?


Mr Rivers: First of all, the battle royal you referred to is not as expressive as you might have experienced in the past. In fact, I would say the situation has improved. Part of the solution I am going to suggest to you is, I think, the reason why. Over the last two years, for example, in the Toronto area office there has been a concerted effort by Comsoc to leverage co-operation. When I say "leverage" co-operation, I think a number of children's mental health centres and children's aid societies realize that if they are going to be successful and focus effectively on the child, they have to collaborate. There is no better way to motivate people around that issue than to make funding contingent upon it.

Mrs McConville: I would also say, to further leverage local planning initiatives where they exist -- and of course they should exist everywhere -- has to be mandated. You do not ask people to collaborate and co-operate with one another. You tell them they are going to and they will, and they have done in the past.

Mr Martin: One of the questions I was going to ask you has already been touched on by Mr White. I certainly agree with you that leveraging and funding co-operative efforts is probably one of the ways to go in terms of getting those folks together who need to get together in communities so that resources can be more adequately used to meet the end of serving kids.

The question I have that you might want to comment on is a political one, in terms of ownership of the problem and the fact that children's aid societies are seen to service the poor in our communities more than the more-well-off who access mental health centres. Because of that, they do not get the high priority, perhaps, in terms of funding that they should. That is a problem you might want to comment on. It was raised this morning.

Mr Rivers: I would just like to speak to who our clients are, because your comments are quite accurate. The problem is that the most disadvantaged in our society, close to 60% of the parents we deal with, are single women. More than 50% of them are on welfare and about 48% live in public housing. All that constitutes the highest risk in our society, and we have been arguing long and strong to focus on those most in need. I think Dr Offord's comments previous to ours indicated that is one of the strategies that has to be undertaken.

Mrs McConville: I think your comment was very much worth making, because I do think this is a disenfranchised group of kids. There is no community ownership of their plight and the child welfare system ends up being their advocate and that is not good enough.

There is another element here that we try to get at in the presentation; that is, that we are not very good yet in terms of identifying those interventions that work with certain populations of kids. Of course, we have a population of very disturbed kids with a whole spectrum of difficulties. So I think there is another real resistance on the part of our most specialized institutions that has to do with the level of disturbance of the kids we are having to place. We know for a fact in child welfare that our most disturbed kids are far more often being taken care of by everything but the children's mental health system, because it cannot cope with it.

The Vice-Chair: We have run out of time. I thank you for your presentation.

Members of the committee, I think it is appropriate to take a five-minute break at this point, a seventh-inning stretch. We will reconvene at 3 pm.

The committee recessed at 1455.



The Vice-Chair: We have before us the Ontario Teachers' Federation: Guill Archambault, president; Margaret Wilson, secretary-treasurer; and Ruth Baumann is here as well. Welcome to the committee and please proceed with your presentation. You have half an hour -- the usual refrain. I have been repeating myself over and over again, but we are pressed for time so I hope you appreciate that.

Mr Archambault: The Ontario Teachers' Federation is pleased to have the opportunity to discuss with the committee today its concerns about the availability and co-ordination of children's mental health services in Ontario. As you know, OTF represents over 125,000 teachers in the publicly funded schools in the province and we provide education for almost two million students.

As teachers in the schools of Ontario, we have the opportunity both to witness first hand the increasing difficulties of children within our society and to be a part of the response to their needs.

The average child spends between 15,000 and 16,000 hours in school. Teachers spend more time with children than doctors, social workers, nurses or other service providers. For a significant number of children, more waking time is spent in school on a daily basis than with their parents and families. While teachers are not trained mental health professionals, the teaching profession must be an integral part of the delivery system for children's mental health.

School is an environment in which the ability to relate to others and a healthy self-concept are critical to successful learning. For some children, it is the first arena in which expectations for behaviour and outcomes are set by non-family members and in which they must learn to relate to the multiple needs and desires of a group. We would like to examine briefly some issues which we believe are related to the state of children's mental health in Ontario and to any discussion of the delivery system.

Let's talk about incidents of violent school behaviour. The Ontario Teachers' Federation, working with its five affiliated bodies, has conducted a provincial survey of the incidence of assault on teachers by pupils in Ontario schools. For those affiliates reporting, there was at least a doubling of major incidents of assaults by pupils over two school years. We define major incidents as assault with a weapon, threatening with a weapon, serious physical injury, serious verbal threats re teachers' physical safety, and constant bullying. Minor incidents were described as punching, scratching, biting, pushing, insubordination and serious verbal abuse. Minor incidents also increased dramatically. Many of the very serious incidents reported involved children as young as six years of age.

Comments provided by the schools indicated frequent frustration in the ability of the school to have the problem behaviour taken seriously by parents, social service providers and the justice system.

The relationship between school and mental health services: the present gap between educators and providers of mental health services exacerbates the difficulties experienced by children. While some school personnel may be involved in referral, the provision of mental health services is usually at another location and often does not involve the school community in the treatment plan. The school in turn defines problems in educational or disciplinary terms, partly because of its limited ability to access other resources on behalf of students.

When Ontario's special education legislation was developed, a deliberate decision was made to use an educational model rather than a medical model. This meant that for students whose acting-out behaviour required special intervention, the focus was not to name the psychiatric disorder but to identify the unacceptable learning-classroom behaviour and build an educational program which would attempt to modify that behaviour in a positive way. There are times, however, when the difficulties are rooted outside the school environment and the school is unable to do more than address the student's needs within the school itself.

Teachers are often uncomfortable dealing with students whose behaviour is unusual or threatening because they have not had any training in doing so and feel isolated in their attempts to intervene. In those facilities where education programs are funded under section 27 of the general legislative grants, there is often interdisciplinary co-operation between educators, health care providers and social services personnel that allows an integrated approach and the opportunity to share strategies and resources. More active collaboration between the professions on an ongoing basis in the community school would do much to enhance both the skills and the understanding of the various professions involved.

Confidentiality is an issue that frequently touches the school. Many parents are reluctant to identify their children's mental health needs to the school for fear that the child will be labelled. The lack of an ongoing interdisciplinary approach to the needs of children in the school in turn makes the negative effects of sharing information more likely. However, it also puts children at risk.

Consider the case of an adolescent with a history of suicide attempts and subsequent hospitalization and treatment who is enrolled in a large secondary school for the first time. The parents instruct the health care providers not to share any information with the school because they are concerned about the stigma. Without any information about the student's history or the source of the anxieties, it is impossible for the school to respond to his or her individual needs at all.

The balance between the need to know and the right to privacy can be maintained much more effectively if the working relationships among and between the various professionals are sound and trusting. A further advantage of ongoing collaborative relationships among the professional communities would be that the improved working climate would be of general benefit to the mental health of children in classrooms and not just to those who have been identified.

Then we have the changing family context. As the one social institution that touches all children, the school has been left with the major responsibility for coping with the changes in family life which society has experienced over the past 20 years. The majority of child care centres are now located in schools and more and more school systems have recognized the need for some kind of before- and after-school programming for school-age children of working parents. Unfortunately, while services offered under the Day Nurseries Act for young children are subject to clear standards, those services provided for school-age children are only occasionally provided under the auspices of the Day Nurseries Act and are widely variant in the quality of programming, staffing ratios and available resources. Many children are on their own before and after school for significant stretches of time.


Beyond the number of changes in the number of working parents and single parents, another significant change in the family context is the loss of the assumption by children of their unconditional acceptance by their families. The growing number of adolescents living on their own is testament both to their willingness to leave and to the willingness of some families to have them leave. Perceptions of student welfare within the community have shifted from a view of welfare as a last-resort solution to very difficult situations to a view of student welfare as the alternative of least resistance to family conflict. This too becomes a significant issue for the mental health of children. If the support of the family for the child is tenuous, what resources can teachers or health providers call on? We did not take time either to discuss the whole matter of family violence, sexual abuse and all that.

It is time for government to make clear statements regarding our collective expectations of families and the support required by children and adolescents and to support these expectations with a service network and an infrastructure that meets the needs of Ontario families.

We will not reiterate some statistics, but I quote from Children First, the Report of the Advisory Committee on Children's Services. They say:

"We therefore believe that it is in the best interest of children to maintain them within their school wherever possible. The system must minimize the disruption that comes from removing children from their classrooms or schools as a result of disruptive behaviours, exceptional needs or required interventions from young offender, child welfare, or treatment services. To enable the school to accomplish its significant tasks, teachers must receive the required resources to enable them to maintain the child within the classroom."

In conclusion, the Ontario Teachers' Federation shares the grave concerns expressed by the Ontario Association of Children's Mental Health Centres regarding the needs of Ontario children and the state of the mental health delivery system for those children.

When children are experiencing difficulties, there is a need for rapid access to appropriate services. Teachers and schools frequently find themselves attempting to manage and serve children with mental health problems without access to appropriate mental health and social service resources. There is a need for much greater collaboration between the mental health and social service providers and the education system in order to meet the needs of children. Ongoing collaboration and in-service for educators can strengthen the support network available and enhance preventive efforts.

Any discussion of children's mental health must also include a discussion of the environment in which our children live. Access to appropriate child care, access to protective services and access for families to a fundamental economic entitlement are necessary for a climate in which mental health is achievable.

As educators who care deeply about the children we teach, the Ontario Teachers' Federation declares its interest in being a partner in the provision of a healthy learning and living environment for children.

Mrs Witmer: On page 6 you make reference to the fact that the majority of child care centres are now located in the schools. I was wondering what type of data you have to support that. I was rather surprised to see that statement.

Mrs Baumann: I think that came from Children First. If you give me a moment I will try to track it down.

Mrs Witmer: I know that there are many child care centres in schools but I was not aware of the fact that the majority of them are now located there.

Mrs Baumann: They are not operated by schools, but the statement that I believe is in here, and I will try to pin down, is that the majority of child care centres are operated by non-profit operators within school buildings in Ontario.

Mrs Witmer: I appreciate that clarification.

Mrs McLeod: You indicate on page 5 that teachers are often uncomfortable because of lack of training and feeling isolated when dealing with students whose behaviour is unusual or threatening, and I can appreciate that sentiment. Would you say that is true even for children with the supposedly mild or moderate behaviour problems that are, in the current designation, seen as being within the mandate of the education system to deal with, as well as the more perhaps seriously troubled children?

Mrs Baumann: I think there are a lot of students who are falling under the rubric that we have assumed would be mild who in fact are kids with quite serious difficulties, but because the education system, in identifying those youngsters, really has limited access -- and if you go back and look at the specific process the schools use through the identification, placement and review process, it is board personnel who by and large do the assessment of the child.

It is quite possible to have the youngster who may be experiencing even more serious difficulties outside of home get through that system and be identified on the basis of what appeared to be in-school difficulties with an in-school solution and to miss the kind of cross-referencing that probably should be occurring, either to health care providers or social service providers.

Mrs Wilson: We were surprised at the survey results because, particularly in the elementary panel, they identified quite clearly that a large part of the increase in incidents which were serious enough to concern teachers were tied to children who had been labelled behavioural. Normally the assumptions that we would have made are the assumptions you are making, that the disorders would be minor and that the teacher would be able to cope.

We are going to go back and try to pin down exactly what is happening. We asked the schools to identify over a period of time how things had changed and we are startled at the change over a short period of time and that they could identify the children who were involved in saying they had been through the IPRC system. Something is askew and we are quite sure, regardless of what we go back and find out, that there is inadequate assistance being given to both the children and the teachers.

Mrs Baumann: I think the one other comment I would make about that may tie into some comments that were made by the previous presenters. The spaces that are available for students who are not in the normal behavioural program within the special education context in the school system are spaces that are in mental health facilities, so if there are youngsters who have not been able to access spaces in group homes or agencies which would have a school component, they are in the schools and where they end up is often in the behavioural programs.

Mrs McLeod: I was even looking beyond the children who would be IPRC, because there is a clearly identified problem of some sort that requires special assistance and identification and placement. I am looking at those children who would not even go that route, with whom the teachers are coping in a classroom. I guess in the work that I did briefly I had a sense that teachers were often frustrated because the root of some of the relatively mild behaviour problems was in the home and they had no access to the home to deal with family stresses.

I also quite honestly found learning problems that were missed because kids were inaccurately picked up as just mild discipline problems. That leads me to say that the direction of the Maloney report sounds as though it has a lot to recommend it, provided the resources can be put in place. They have been around long enough to see the school system has to take on a lot of new tasks without being given adequate resources. Are you worried about it?

Mrs Baumann: Yes.

Mrs Wilson: Yes.

Mr Malkowski: I was very impressed with your presentation. It had quite an impact. We are aware of the changing world and how quickly it changes. Those changes influence family life and then of course influence the educational system.

But we are wondering, on the management of daily problems, looking at the teacher-student ratio and the children who come from different backgrounds, from dysfunctional families, or refugees from other countries who have suffered abuse, how teachers can manage all those problems. I am also wondering, from your experiences with the availability of counselling services within the educational system, does there not seem to be enough staff support who can make the referrals to outside agencies?


Mr Archambault: This is true. For a long time we have asked for more guidance at the elementary school and more guidance at the secondary school, because it is surely a lack of a number of personnel. There are not enough to go around.

Mrs Wilson: The regulations state that schools must have guidance personnel in the secondary schools. The regulations do not insist on guidance personnel in the elementary schools. In fact, it would be quite unusual to have any significant time allocated to guidance in the elementary schools. This is a serious problem, one that we have been addressing ourselves for years. It leaves the onus in terms of finding assistance for children to already overloaded teachers, vice-principals, principals -- the vice-principal if there is one. In many of our elementary schools the principal is a principal-teacher and teaches as well.

As Lyn said, if we are going to try to improve things for children without putting one more load, another straw on the camel's back I guess, we have to look at the infrastructure in the educational part of the system as well to make sure there are people there who can make the connections. I will not even address myself to the guidance ratio in the secondary schools. It is not terrific.

Mr Malkowski: Do you feel that it is important to expand the guidance counselling services and that they should happen in the elementary schools? Do you think that will help to reduce the problems that would be then faced at a high school level, and maybe if we give the guidance at the elementary level it will provide the students with better coping skills?

Mr Archambault: We have been asking for guidance personnel at the elementary school for some years now, and even though guidance personnel are added to the elementary school, I think we will have to put some more guidance counsellors into the secondary schools also.

Mr Jackson: I want to build on Mr Malkowski's questions. It was the area I wanted to get into. First of all, let me say that I have asked that the recommendations in two reports of the select education committee be shared with this committee, since you are now the fifth presenter who has been before both committees on similar themes. The numbers just seemed to get worse since last year when you were before us. Those recommendations contain areas that deal with education specifically and guidance generally.

I have a concern and I would like you to react to it. We have not been fair to the OSIS document, which I know calls for more guidance support but we are not providing it. I want to ask you to react as line professionals who comment on education but are impacted by educational decisions by trustees. Trustees will be up in a moment and you will be able to talk to them. They sometimes make policy decisions based on ministry direction and what is in vogue or what is the going thing. They also protect certain program areas, such as French language, which we know is coming at great expense -- immersion, I should say -- and yet we are not getting this priority for children's behavioural problems.

I want to ask you a couple of very specific questions -- Margaret perhaps from her OSSTF background -- with respect to the OSIS document and proper supports, and perhaps a general question about whether the ministry should be giving more specific guidelines with respect to boards that are protecting some program over another program. Obviously these children are not learning, and therefore, in protecting one set of programs, the will of the board might not be as appropriate as supporting these kinds of linkage programs for outside agency support.

I should tell you that earlier today we received a report about a specific board which has withdrawn to a degree some of its personalized support services. This is not the general guidance, this is the personalized support services. I am sorry, I am getting into a delicate area here.

Mrs Wilson: I think I should clarify one thing for the committee. I was on the steering committee of the secondary education review project, which was the mother or father of OSIS. That really is what Cam is referring to. One of the recommendations that project made when it was dealing with essentially grade 7 through what was then grade 13 was that there be a significant improvement in guidance services. I think part of the focus of that report was on trying to improve career guidance services, because that committee felt that guidance services had drifted almost entirely to personal counselling. I want to make that clear.

That report also suggested that there should be -- I feel as if I am here reinventing the wheel -- better integration and that in fact some of the personal counselling services should be provided in the school setting by other agencies and that the school guidance department should be able to tap with ease into other agencies that would go into a school facility and provide assistance to students. I think when some school boards are in part withdrawing right now, they are looking at limited money and saying that other agencies should be doing this, but we do not have an infrastructure that enables us to interconnect with them.

At the same time, when we were working on that project, what was absolutely evident was that a number of what secondary school people would call problems that we had identified were problems that did not begin when the kid hit grade 9. They in fact were sometimes learning problems, sometimes family problems, sometimes personal psychological problems, and they required assistance very early in the child's educational career since it was the school that was the venue where they had been identified.

I think even then all of us felt very strongly that the whole area of guidance, to a mild degree career and to a large degree personal, in the elementary school needed really serious examination and that also in the elementary school we had to develop an infrastructure that brought the expert outside professionals into the school and into a better interplay with teachers who know about teaching reading but might not be trained in how to overcome, let's say, an emotional disorder that is preventing a kid from learning how to read, which is possible, and might not know what is happening in a child's family that is creating the blockage.

I was very happy when I heard that this committee was going to look at that particular area, but this is, I hope, the end of a long debate in Ontario about how we proceed on this.

The Vice-Chair: I have Mr Beer next for a very brief question. We are quickly running out of time for this segment.

Mr Beer: Because we are running out of time, I would simply say that the last comment, Margaret, that you make is critical, that this is the beginning of a public discussion.

When I look at the Children First document, which provides the basis for a very meaningful and necessary debate but we know raises a lot of issues around structures, I think that the question we cannot go into fully here is how exactly, if the school is to be the hub, it is to be the hub, and what the role of individual classroom teachers and principals as they interface with the other sections of the children's services sector is.

I would take it from that last comment that, if there is a recommendation that somehow helps the government go on with more focused public discussion over a reasonably short period of time, that is very necessary in your view so that the educational world can have a clearer idea of what would be expected from it in any major changes as to how we deal with children's mental health.

Mrs Baumann: I think it would be safe to say that we would like to see a lot of discussion about how to integrate those services. We have tried to say in the submission that you have today that we think the case has been made for a long, long time about the fact that they need to be integrated and that we no longer need to talk about the need for integration but the mechanisms.

Mr Archambault: I would like to have a few seconds to respond to Cam's second question on the protection of some programs. I think the trustees do whatever they can with the funding that they get and in the last few years other programs have been coming in without additional funding so we can see why some programs are being protected at the expense of others and it becomes a political choice for them.

The Vice-Chair: Thank you for your presentation.


The Vice-Chair: Members of the committee, I have a request by the Ontario Teachers' Federation to make a correction. I will read it into the record:

"The statement on page 6 of the submission of the Ontario Teachers' Federation to the standing committee on social development which reads, `The majority of child care centres is now located in schools' is an error and should read `According to Children First, one third of all child care centres are now located in schools.' The Ontario Teachers' Federation would like to apologize for the error."



The Vice-Chair: We will move quickly to our next set of presenters, the Waterloo County Board of Education, represented here today by Susan Sanderson and Bill Otto, respectively the chairperson and the vice-chairperson, and anyone else who I am not aware of may identify themselves. Please begin, and welcome to the committee.

Mrs Sanderson: Thank you, Chairperson, members of the standing committee. We welcome this opportunity on behalf of the Waterloo County Board of Education to share some of our experiences and perceptions with regard to mental health services for children that are provided within the region of Waterloo and across the province of Ontario.

I would like to take this opportunity to introduce to you the people who have accompanied me this afternoon. Mr Otto, our vice-chairperson, is in the audience. John Monteith is to my right. He is a trustee and as well chairperson of the special education advisory committee. This, as you may know, is a legislated committee comprised of community members with an interest in special education. Dr Steve Chris is also in the audience. He is co-ordinator of student services and a psychologist with our board. Vic Graham, also in the audience, is executive officer with the chairperson's and director's office, and on my left is Gord Backenhauer, superintendent of special education with our board. I extend regrets from our director, Ray Ward, who is unable to be here today because of illness.

I would like to refer you to the document before you and spend a few moments to highlight some specific concepts that form the base for the recommendations that we shall put before you, and at the conclusion we will be pleased to entertain questions.

If we turn to the first page, the first part of our presentation is simply background on public education within Waterloo county.

"Co-operative working relationships-past and present:

"The Waterloo County Board of Education has a long tradition of working co-operatively with the local agencies within our community. However, because of individual mandates and budget restrictions, `territoriality' is sometimes seen as a factor in creating gaps in service delivery for students with social, emotional and behavioural needs.

"Schools have assumed an ever-expanding responsibility to respond to a broadened range of needs of children, regardless of exceptionality....As we have worked on studying student needs and taking a look at gaps in service delivery, we can see that good interagency resource interaction can best provide for the needs of students. We can also see that the school can be a focus for service delivery models that are initiated from the multiagency viewpoint. This does not, however, negate the needs for the provision of existing services by hospitals, treatment centres, children's aid societies and others."

Under "Directions for integrated service delivery," the Graham report does promote an integrated, collaborative approach to planning and service delivery.

On to page 3, "The school as the focus:

"The school system must be a key partner in the development, implementation and evaluation of service delivery models....There must be a commitment at the provincial as well as the local level to use existing and expanded budgets in a flexible way to design and implement co-operative ventures."

Pursuing the funding, "There will still be a need for the availability of additional designated funding by each of the ministries to meet the broad range of children's mental health needs."

Under "Summary," we say:

"If agencies are to work co-operatively as a multifaceted response mechanism, then they must have the mandate to do so and must be accountable in a way that will provide consumers, family members and the service units themselves an opportunity to help to plan, implement and evaluate what is happening. Funding must then, by mandate or by legislation, if necessary, facilitate these directions."

In our "Specific Recommendations," we say:

"The partners, especially Education, Health, Community and Social Services and Corrections, should be mandated, both provincially and locally to legislate the development of `Children's Services Planning/Advisory Authorities' to assist in the co-ordination of children's services at the local and provincial levels; to work co-operatively in planning for and implementing changes and new directions; to fund services that are planned co-operatively; to enable schools to become a central focus for interagency needs assessments and service delivery; to support a continuum of services by the ministries of Education Community and Social Services, Health and Corrections."

Once again, we thank you for the opportunity to be here today.

The Vice-Chair: We have a fairly lengthy period for questions, so I will be begin with Mrs Witmer, and there are several others on the list.

Mrs Witmer: I would certainly like to extend my appreciation to the staff and the board. Having been a former trustee on that board, it is a pleasure to know that the presentations are still excellent and that once again a tremendous amount of research has gone into your presentation. I guess the one thing I personally appreciate are the very specific recommendations that you have made to this committee. That is certainly something that we were looking for.

You talk in this report about co-operation, the need to work with all of the ministries, the need to work with local agencies. I wonder if you can give us a little more information about the joint early identification/early intervention school-based program that has been initiated in your school board area.

Mrs Sanderson: Thank you, Mrs Witmer. I would turn that over to Mr Backenhauer, who certainly has been instrumental in that program.

Mr Backenhauer: For the last couple of years we have been involved with the ministries of Community and Social Services and Health and the separate school board in a joint venture, taking a look at children at the kindergarten to grade 3 level who are exhibiting behavioural, emotional and social needs within some of the schools within our county.

We were able, through that joint effort, to develop a co-operation among those four bodies and, ultimately, in getting resources from the boards of education, getting extended resources from Health in the form of public health nurse involvement in expanded school-based teams and actually receiving a dollar allotment from the Ministry of Community and Social Services to hire intervention workers in the schools, we were able to begin the project. It is under way at present time. We are going to build in an evaluative process to it. We are going to call it program evaluation, as opposed to research, because feel that we want to know what is going on in the program. Hopefully, it will emphasize the co-operative nature that has happened among the four agencies and the community.

I will tell you up front that when we began that there was a lot of territoriality and people were saying, "What can I bring to this and what can I get out of it?" I think we have come a long way, as we need to, in the whole attitudinal direction in working together. I guess I would use that as a last point to state that if there is to be a mandate that should come from the provincial government, it should be two agencies to have the mandate to work together in order to provide this type of co-operative venture. I may get an opportunity to expand upon that.

Ms Haeck: I really do appreciate your being here today because you allow me to put forward a question centred around a particular project that our Lincoln County Board of Education would like to put forward. I think it is very innovative because ultimately what it will end up seeing result is that teenage mothers are able to have their children looked after while they are also in school.

My question centres around the funding issue, because in fact the regional municipality of Niagara will be funding the day care component. How do you see yourselves, or school boards in general, working with regional governments on issues like this? Basically, it is a primary preventive area.


Mr Backenhauer: If I may respond to that, as we suggested in our recommendations to you, and I think this would apply to Lincoln county as well, I think the provincial government has to mandate local agencies to work together. I guess when you take it to the local base, you have to give some degree of flexibility for local people to meet local needs, whatever those needs are, and to deal with issues such as the one you are talking about.

I would suggest that the mandate should come down to existing political and staff bodies that presently exist within regions at this time to put that forward as an issue and then to say to those people, "Can you develop a structure that will satisfy the needs within your own community to do that?"

One of the second points is that if you are going to do that, there has to be some flexibility in the ability to fund, and that then may mean that additional dollars, at least in the interim, have to flow provincially and might be earmarked, but along with that, a direction within that mandate to say, "You need to work together in order to provide those types of directions."

Mr Beer: I would just note, Christel, there is a project like that which the York Region Board of Education and the region of York and the province have started that sounds very similar. It is a pilot project but one that we have a lot of hope for.

I wonder if I could ask you one of the questions around governance and structure that arises from the Children First report. You are, I think, our first board of education and I know you will not have had a chance as a board to discuss it, but perhaps just some of your preliminary thoughts. I should note that we were chatting earlier about this, but I think it would be useful for the committee.

In the Children First report there was a suggestion that there be some kind of elected body that would be looking at the provision of children's services. We have had the structure of the school boards in the way that we have had them for some time, and I think the purpose of its being in the report was not so much that this is the only way to go, but to try to get a public discussion going about how are we delivering children's services at the local level, where we have one institution, the school board, which is very large and has a large budget and a large mandate, and then a whole series of other people who are busily at work and whose work takes them into the schools, or certainly working with the kids who are in the schools.

As we go forward with this, I notice in your presentation to us you talked at the end, under "Specific Recommendations," about having these children's services planning/advisory authorities to assist in the co-ordination. Do you think we can do it that way or is there a sense that we are going to have to have a body with some sort of power, in effect -- some elected clout, if you like -- in order to make the kinds of changes that are going to deal with the problems that everybody has been describing for us? What are some of your initial thoughts on that?

Mr Monteith: I can speak to that. Initially I have a bit of difficulty with the concept of an elected body at the local level dealing with this, the reason being that if this is going to work, it is the workers in the field who have to co-operate and collaborate to make it effective.

I would rather see a structure somewhat parallel, if you like, to the way special education advisory committees are structured, where various agencies in the community appoint and elect -- delegates elect -- individuals to act on a committee. This way, I think we would tend to get people who have interests in the specific areas that they represent rather than leaving it to chance that the various interests would be represented through a general election.

I think also it would encourage appointment of perhaps staff personnel to act on this committee who are the people who ultimately have to work together in the end anyway. I know I worked for a number of years in a situation, in a provincial institution, where Community and Social Services and Education not only worked together but within that, the disciplines worked together. I worked at Midwestern Regional Centre and under that structure we had psychology, we had medicine, we had the chaplaincy, recreation, residential setting, social workers, teachers, all working together on committees at case conferences for the children's mental health care and at other sessions related to their needs. That was very effective. The people who were working with the individuals worked together in the planning, worked together in developing the procedures and so on, and it was exceptionally effective. I would like to see that same type of situation applied to what we are talking about here.

Mr Beer: If we were to follow that sort of outline, that kind of children's advisory group or council or however called, ought it to have some authority or power over the allocation of dollars, whether they came from Education, Comsoc, Health, Recreation? I am trying to get a sense at the local level of how much authority we want to vest and how much accountability in a new structure we might put there. Again, I am not going to quote you a year from now, but we need some direction.

Mrs McLeod: Hansard will, though.

Mr Backenhauer: I think within Waterloo county we have met on an ongoing basis, and we did last Friday morning as a matter of fact, at the latest with people representing Health, children's aid societies, some of the treatment agencies and so on. One of the questions that comes up is exactly the one that you raise. I think that people see local political structures -- eg, the district health council, the social resources council, the boards of education -- as having a political mandate, if they get together, to be able to direct these services.

We have talked about the funding aspect of it. I think there is a twofold opinion on that. One is that if you give dollars to an advisory body of that nature, then it gives it more clout and consequently it will be able to direct. There are other people from other agencies, at our level at least, who are saying, "Hey, we don't want that because that takes away from the planning advisory aspect of it."

I think it is something that is going to have to be weighed very carefully. Just to put in a plug for Waterloo county, I think we are just about ready to take the next step if those political bodies were given the mandate to do so. I think we would be able to take the next step and it would be interesting, as a pilot direction at least, to say what would happen if some degree of funding were given to that group in a co-operative planning way, for example our early identification/early intervention type of program and saying, "You have a mandate to begin." We will carry out a program evaluation and we will then have a responsibility to report back to whomever to say, "Does that type of co-operation really work?" We think it will.

Mr Monteith: Just to add to that, while there may be funds necessary, I think the other thing happens when you get people who actually work with the children working together in a model. But I suggest that my previous experience was that, where it was determined that a particular discipline should provide a particular activity, service, whatever, to an individual -- for instance if it was decided that I as the educator should perform a certain service and needed a certain piece of equipment, if during the course of the case conference I said, "Well, yes, I agree completely but I don't have the money for the equipment," it was very common for someone from the other ministry to say: "Look, I have a few extra bucks in my budget. I can spring for it this time." Next year it might be the other way around. There tended to be a sharing of budget across this fund and even between a few ministries in that setting. I think with the extra funding, plus getting people working together at the root level, money is spent more efficiently as well.

Mr Hope: As we are seeing the indication in school boards and your interest in getting involved, and I am proud that you are, in voicing your concerns about the children, because yes, you do spend a lot of time with our children as we have shift workers who have seen what is going on with the economic stages. But I guess my question pertains to the time frame between when that child is born and he enters the school system.

I have heard the reference of the school board being the hub of the situation, and I am now wondering if we are not trying to put a Band-Aid on the sore after the sore has been there, wondering about that time period when we should be addressing the need, when we can develop the change. Are we going to devise two mechanisms now, an earlier stage between the birth and entering the school system, and then we are going to have another system after? I guess that is the question: How do we get to them at the earlier stage, when we can get to the parent and get to straightening out the problems initially, not waiting till later on?


Mr Backenhauer: I think you can have two systems as long as the systems work together and communicate with each other as to what is going on. As an example, one of the directions that is going to be taken by regional health and public health nurses is taking a look at the three- to four-year-olds who are in our region at this time and those who exhibit needs, and then very carefully building up communication directions to us in the education system so we know before the youngster comes into the situation some things that have been tried, some directions that have been taken, so we can be in that dialogue process before the child actually comes into school.

Another thing in our early identification, early intervention program is that the hours of the workers who have been assigned are going to be extremely flexible, because some parents are not available during the day, particularly single moms who are working. We are setting up a system where meetings take place in the home at the times when parents are available, and even reinforcing the fact of recreation opportunities and that meetings might take place in a town house grouping and so on. These types of things need to be brought together, and only through the type of planning advisory body we are talking about do I think all of those things could come into some type of focus.

Mr Hope: We have already indicated the category of people in need of this service; we have labelled these people as welfare people. I imagine there are some here who have had a few years of service in the school system. Has the school system, in its calculations -- is there a differential between the time frame of the early 1980s, when a recessionary period was on, and the time frame we are dealing with now, those two time frames? Are we maybe missing something in our education system and are not fully informing our younger adults -- I am talking from grade 9 to grade 12 or whatever -- about the real facts of life, that everything may not be peaches and cream and coping with the realities of what may happen? Have we even done a study between those time frames, between the recessionary time of the early 1980s to the recessionary time now?

Mr Monteith: I will take a shot at part of what I think you are asking. One of the situations you run into with time frames is not necessarily preparing children for the reality of the situation they are going to face when they get out there, but dealing with the reality of now, especially now with the freedom of information act in fact protecting a lot of information -- and even before with the degree of confidentiality that existed and so on.

In the past, quite often what would happen is we would get an agency dealing with a child on some particular aspect. The child could have benefited from a multiagency approach in that the child had other needs, but somewhere down the road, because the child has only received support in a particular area, all hell breaks loose and all of a sudden somebody else says: "Look, why didn't you call me five years ago or three years ago? I could have done something. It's too late now."

If we are concerned about time and the time factor, I think it is even more important that we get these agencies together under some form of mandate or legislation, because, if I remember the freedom of information act, one section provides that where a body is mandated or legislated -- I forget the exact wording -- they can then share information. If we get working with these children, getting all the agencies that need to be involved, at an early enough age to develop appropriate attitudes towards education, appropriate mental health, appropriate attitudes towards life, the children can then benefit from education relating to changing times and the things that schools are trying to do.

Too often what happens is that you get a situation like the early 1980s, where a child has a problem and one agency deals with it. We get into better times, and because times are better the problem diminishes. We hit another recession and boom: because the problem has never been solved it is now major.

Mr Jackson: I would like to concur with Mr Monteith's observation about the elected board. I have not dwelled on that issue, but I have a real concern about people competing to be elected to that board. Even Colin Maloney made brief reference to its relationship to something that is happening in the Ministry of Health, which is the whole elected nature and shift of accountability with respect to district health councils, which also deal with children's mental health services and delivery mechanisms. We have not even got into this whole conflict that exists between those two bodies and government policy in those areas. I, for one, would not abide any system which sets up a blockage between the kids who need the service and us here at Queen's Park. In other words, we have some board we can offer it to and say, "Will you set the priorities in Waterloo county and you iron it out and argue with the people in Waterloo and then come to Queen's Park and prioritize your 10 needs down to 2?" I am really not interested in developing systems like that in this province. You are spot on, and I commend you for being so clear on it.

My question has to do with the select committee on education reports and concern for transfer of funding. We have heard from every group about funding. We have heard from everyone about financial incentives to get off projects and move into consistent program delivery. For that reason, the Tories and the NDP have strongly objected to the move to take special education funding and roll it into general grant. This has a devastating effect in terms of accountability from us at the province to school boards in terms of special education delivery. We recommended in the select education report that that system be stopped and that we go back to identified special education funding, as well as tearing down the elementary and secondary funding panels which we have had traditionally. That recommendation is outstanding. We have heard nothing from the new government. Would you recommend to this committee that we reinstate that so we have at least an accountability mechanism for special education funding instead of, on bended knee, competing for these pilot projects that everybody loves but we know we are not going to get the funding for -- even the successful ones may not get the funding? That is not a leading question. Take that anywhere you would like to take it.

The Vice-Chair: I would like to leave time for a response, Mr Jackson.

Mr Jackson: A yes answer is what I am looking for.

Mr Monteith: And that was my answer. I cannot be any briefer. Yes.

The Vice-Chair: You have put it clearly on the record. We have run out of time, unfortunately. I would like to thank you for your presentation. Obviously, it stimulated a great deal of discussion, but we will have to move on.



The Vice-Chair: We must move on, pressing ahead with our next group of presenters, the Ontario Public School Boards' Association. I call upon Ruth Lafarga, past president, Penny Moss, executive director; Rhea Springsted, I am informed, is also here. Welcome to the committee. As I try to impress upon all the presenters, we have a strict limit of half an hour for your presentation. You may divide it in whatever way you deem most appropriate.

Mrs Lafarga: Thank you very much. I am very pleased that you made time for us today. We really do appreciate the opportunity to present.

The Ontario Public School Boards' Association represents 94 public school boards in the province and some 1.5 million students, the majority of whom are very healthy, well-adjusted students, and I think we should keep that in mind. Nevertheless, our concern is for those students who do need some extra help.

Our presentation reflects very much the presentation we made to the Advisory Committee on Children's Services. We do not have a set of recommendations or really a magic way in which we can address the changing needs of vulnerable children. We do not have any structures for the delivery of services, but we do want to focus on the concern. I am sure you are very familiar with some of the statistics of the Ontario Child Health Study, which has identified that some 40,000 children are identified with antisocial behaviour. In listening to the previous presentations, I would like to reinforce what we hear in the school system, that that is increasing at quite an alarming rate. I think the reasons for that are very complex. You cannot point a single finger at them, but nevertheless they are causing a great deal of concern in the school system.

It is also true that the traits we find in antisocial children are more often identified in needy children and those who are poorly housed and nourished, children of single parents and parents who have ineffective parenting skills. The superintendent of special services with our board stated that he believes we are starting to see an underclass -- the same term which has been used for a lot of years in the United States -- that is more or less perpetuating itself with problems.

I think what we see in the school system is that in the early years children come into the school system, whether it be junior kindergarten or kindergarten, with irritability, discipline problems, inattentiveness. That is a forerunner to low academic achievement, because they have low academic preparedness, they are just not ready.

Over the years, you discuss this with teachers and they increasingly tell you about the sorts of students they are trying to deal with. In the mid-years, with many of the same students, we see they become aggressive and disruptive. Quite often, they are rejected by their peers. Ofttimes, they are rejected by their parents. They are possibly rejected by their teachers, because they are the problem makers. We are all very familiar with that. Or they may be excessively compliant and withdrawn from their peers, too, and create problems in terms of their achievement from that. Whatever the manifestation, it results in poor school achievement. Then, of course, in adolescence we see this further alienation from the mainstream and they withdraw from their peers and eventually get in with what we call the wrong group and we see adolescent delinquency forming.

Through all of these various stages, of course, they cause problems for adults and ultimately for their own quality of life, which is lowered as a result of these problems. They have problems with relationships. They have problems with academic performance and, ultimately, psychosocial problems with alcohol, drug abuse, criminality and poor parenting skills, so the cycle is repeated.

Many of the programs currently in place address adult mental health problems. They are expensive and there has been very little success with those various problems. What we would like to see is that the intervention and prevention should be in the early years for these children, with the focus particularly in the school system.

One of the things we have to realize is that the school is the only common element in all children's lives. It is a safe haven for many children. In some of our schools, you will find that some children are reluctant to go on overnight excursions because they are not sure what the home life will be when they return there. This is the extreme for many children, of course, but this is a reality for them. I think the focus of the school cannot be overestimated. It is the common area for them.

For the majority of students, it is compulsory for them to be there from 6 to 16, except those who go through our SALEP committees, supervised alternative learning for excused pupils. Where we have JK and where we have day cares in our schools, that is lowered. What teachers ask is: "How do we teach children who come to our schools angry, hostile, ill-fed, ill-clothed and distressed by what is happening in their personal life?" They are indeed very vulnerable children.

When we have other agencies we have the problem of the lack of services available and the lack of resources within the school system. I have heard some of the questions earlier, and I think, too, there is still an ongoing debate in some boards about the extent to which the school system should have to pick up this problem. But in many boards they have done it because they recognize the children simply cannot be taught if in fact they have all these social problems. We have to deal with the social problem. You cannot attempt to teach a child who is very, very unhappy.

In our presentation you will see a list of programs -- as usual, I never have the presentation quite in front of me -- on page 3 that are not universal to all boards but are examples of various programs that boards have moved into. It is not a complete list, because there are in some boards programs for pregnant teens; there are other programs we are always introducing because we see the need. I think there is very much the recognition that the school system has to deal with these issues.

We make the point because we see that the problem is increasing and because we recognize, as I have mentioned, that the schools are the only thing common to all children. The setting is usually where the first identification is made for children when they come in for their early identification. This is where these social and emotional problems may be first identified.

Very often the parents, because of their own experiences, may not feel really that ready to come into a school setting. Nevertheless, with their child they will come in and through programs that have been made available, they can be helped with the parenting of their children. Schools, too, provide a setting for group intervention with many of these children; that is being tried in a number of areas across the province. If poor school performance contributes to increased antisocial behaviour. the deficit we hope can be remedied within the schools and, as I said, the parent concept of the school as a place that will help their child.

Obviously, you have heard over and over again about the need for improved availability of treatment services if prevention is to be successful. When I go into my own schools, which I do on a regular basis, and hear of the problems, what I am told, even in schools where we have social workers, is that there simply is not the availability of services for these children. Even when you identify the problem and know where you want to go, the services are simply overwhelmed. We need to improve the availability of the treatment services.

You have heard, too, and we want to reinforce, that the mandates re children's mental health through Comsoc, Health and Education have to be more closely defined and the policy level has to be addressed. We need to break down the territorial barriers between these areas. People working in this field are very, very frustrated about the talking about this that goes on. People say they have been working in this area for years and they keep talking about breaking down the barriers but it just does not happen.

I want to reiterate how important we think the work of this committee is and how hopeful we are that some positive results will come out of it, and to really emphasize that as the Ontario Public School Boards' Association we want to be involved in the discussions that take place, because so many of our boards are already working in this area.


Mrs McLeod: I am in complete agreement about the importance of developing a more integrated co-ordinated approach and sympathetic to those who have expressed frustration at the number of times we have come close to trying to create a model and not been successful. I am going to direct my question very specifically to one of the toughest parts of implementation, following up on what Mr Beer asked the Waterloo county board. It may be premature to ask for a response, but I am going to raise the question quite specifically anyway.

The Maloney report suggests elected children's services bodies at a local level. The Waterloo county board, in responding to Mr Beer's question about structure, described something which it thought would work which sounded like a much more modified version: a multiagency with professional staff, maybe community representatives, that would do the planning for programs with a centrally targeted funding from the province. At least I hope I am doing justice to the suggestion they made.

I would like to ask you whether you think there is room for something larger, for local authorities that would have global budgets which they would then have to allocate according to priority. If you think there is room for that, do you think it should be elected or not elected, and if not elected, should only school boards have access to the tax base? I am making the assumption that you cannot access the tax base without elected representation. How would school boards then determine what were traditional school activities that should be served with local tax dollars?

Mrs Lafarga: I am going to ask our executive director, Penny Moss. Give her the difficult questions.

Mrs Moss: So that I can say we do not have a position on it, and hopefully we will not. Maybe I can suggest why. I would like to hope at this point in time that the recommendation of the Maloney report plants a very big seed and says there are some serious issues of governance, accountability and funding that need to be resolved, and if we can accept that is what the report says, then look at how to do that.

I suspect that in an ideal world, being Ontario, the model that would be appropriate to ensure the needs of children are met may differ community to community. If that is the case, one other way of looking at this is to ask what range of services ought to be available to communities in Ontario if our desire is to raise healthy children, healthy in terms of school achievement, of mental health issues and physical health issues, social and emotional. What is the range of services, who is doing what and who is not doing what, and what are the provincial policy expectations for those services? At the local level, let lead jurisdictions that already exist, for example, have a bash at working out structures that would deliver those.

There are some quite wonderful examples. In Ontario, for example, there are municipalities that fund to the maximum infant child care spaces for the parents in high schools. There are other municipalities that refuse to make that a priority. In other words, teen parents in one jurisdiction have access to high-quality child care with parent support services and school and very similar teenagers somewhere else do not.

I think if we clarified the expectation of that service to be available, it helps at a local level if people say, "That is not within our mandate." I think what we want to do over the next little while is to work with key other partners in this area to start to define some of the models in ways that are sensitive to governance issues but that do not divert any more money than is necessary to the creation of more management and bureaucratic structures when the cry everywhere is for direct services to children.

I think there is a longer-term agenda and an immediate short-term one, and can we use the short-term to develop the models for perhaps more long-term implication.

We cannot separate, as a last point, this policy discussion from the question of reforming education finance in terms of the need to define education's mandate, let alone everybody else's. I think it is an exciting time for the province but it is hard to imagine those big questions being dealt with in an either/or manner and not in an evolutionary manner.

Mrs McLeod: I guess I raised the questions because I am concerned that the conceptual model will break down when we get to the equalities or inequalities in the partnerships and the role of provincial versus local funding.

Mrs Moss: Could I just have one minute? To be really radical about it, what would happen? Local municipalities and local education are creatures of the province at this point in time. What would happen if government said to "de-elect" these bodies that they already have? "Tell us your plan for the delivering of this range of services and what might be the mandates and the provincial-local split." If they cannot do it, then perhaps it is that bigger solution. But the health care councils have not solved those problems themselves. That is possibly one of the models we have got. There are some models in the training area as well, but none of them actually do what Maloney asks to be done.

Mrs Lafarga: I would just like to add that there are a number of pilot programs, of course, now through Dr Offord that are taking place -- I am sure you are aware of those -- where you have, with local boards bringing in various agents, representatives of various groups. While they are just in their infancy, I think that the results of those pilot projects and the various ways that they work out in different areas of the province will give us a good handle on perhaps what the model should look like.

Mr Martin: It may be just a regurgitation of what we have just gone through; however, I would like to chase it a little further. I have given the history of the discussions between various agencies and bureaucracies that have grown up over the years in Education and Health and the Ministry of Community and Social Services. The suggestion that you have here, after speaking of the Children First report by Mr Maloney -- he used a term that I like but none of us in North America, and particularly in my experience in Ontario, are very good at, and that is the building of consensus among all interested parties. Do you think that is possible?

Mrs Moss: I do, but I am an optimist -- I do not know.

Mrs Lafarga: I think you have touched on something that is quite interesting, because I think it is a new mode of operation to build consensus. It is probably true that many of us do not have the skills in that particular area, so we do have to learn what consensus is and probably never more than we see in the world today. We realize the importance of that. I think we are starting to see people who have these skills coming into leadership roles. I think that is something we have to continue to work at.

Mr Martin: I suggest to you, as you have suggested to us, that that will be key in any successful --

Mrs Lafarga: I recognize this is the problem and it has been tried before. I think there probably needs to be some direction from the government in terms of encouraging that, whether that be financial or in organization ways. But we do need some structure down because we are getting all the projects around but we need something to say --

Mr Martin: We used the term earlier, "levering," a little reminder to just sort of move it along a little bit.

Mrs Moss: Yes. That always helps, but while everybody says incentive funding and pilot projects to test out models in education, we have growing concern about the development of models in individual locations which in fact do not get transferred. The Ministry of Community and Social Services itself a few years ago engaged in quite an innovative program on the development of prevention models for high-risk children. Some of those were really innovative, but it is interesting to look now and see which of those projects still exist.

I do not know if I am quite up to date, but by and large, the ones that exist still are the ones that used prevention money, as it was called in those days, to develop models that would feed into the existing funding structures. Those who used the money for operations had a real problem if the government did not continue to fund them in an extraordinary mode. I think that has to be watched for.

Mrs Lafarga: Very often, that sort of funding comes away from your main funding and people become increasingly hostile about it. That is really a danger.


Mrs Witmer: I certainly appreciated the opportunity to hear your very thoughtful and thought-provoking presentation. You made some reference to the Maloney report. What other recommendations do you feel are contained in that report that we should be pursuing and taking a look at?

Mrs Moss: It is new and it is out of print so our association has not had committees and suchlike look at it yet. My own view is that the section on entitlements raises some interesting questions about the possibility of creation of a model, if you like. This is our vision of entitlements for healthy children, healthy again in the broadest sense of what the implications of that are for the provision of services in local communities. I still maintain that they have different implications in different communities.

Mr Owens: One of the things we have not heard a lot about in the last couple of days is kids who are faced with multiple challenges, perhaps having a mental illness but as well being physically challenged or deaf. How are these kids identified and how are they serviced, or are they serviced, within the school system? The last paragraph in your "New Directions" section talks about wanting to make the school system a key partner in this process. I am just wondering how that process takes place now and how the assessment is done. Do we lose kids as a result of the overlap of problems, and what kind of resources would you see yourselves, as persons involved in education, needing to carry out that kind of work?

Mrs Lafarga: Are you talking about multihandicapped children?

Mr Owens: Yes,

Mrs Lafarga: They are of course identified very early, the first six months, but they are in the school system and they are fairly well serviced by the school system, I believe. I do not see that the problem is with the multihandicapped children. I think in terms of our services for those children, we are spending quite large resources on them. I believe it is in terms of dealing with children with emotional problems that we are having more problem.

Mr Owens: That is what I am referring to, the overlap where a person has a physical disability of some description and also an emotional illness, How is that dealt with at this point?

Mrs Lafarga: I am not sure.

Mrs Moss: In a variety of ways. At the level of the school boards we do not have intimate knowledge of the individual circumstances and approaches, but I think it is fair to say in most jurisdictions the multiply handicapped children in school have, as Mrs Lafarga said, been identified really early, and it is in some respects people's experience that they find it easier to access further services for some families already well connected with the caring profession.

There is always an issue throughout Ontario about the size of local resources, so that you will find that the sophistication and variety of services available in some centres in schools is dramatically different than other communities. Some school boards still have managed to retain, for example, qualified child psychiatrists on staff. Other school systems have not been able to afford social workers or a child psychologist, so I say it is mixed. In some respects, access for kids already being served may be greater than the new entries to the system.

The Vice-Chair: Mr Hope for a brief question.

Mr Hope: Through today's presentations, and yesterday, it was indicated that a lot of the people who do not receive services are either going to end up becoming murderers or being thrown in jail. Hearing what you were expressing yourself today, you are saying most of them cause self-infliction of trying to commit suicide.

I just want some clarity, because we seem to be losing sight of it and I would just like to know: There are those who may attempt to commit suicide under frustrations, but the thought that may be being put out there is that if they do not get these services, they are either going to go to jail or commit suicide, and I just want some clarity on that.

Mrs Lafarga: I think we made the point that they will have behaviour that is socially not accepted, whether it is alcoholism or drug use or something like that. We are seeing more problems certainly with suicide attempts with young students as a result of various stresses in their lives, and I can attest to that.

I do not know if that is because that has become an issue we are learning more about or if that is the reason, but there certainly are children who are very stressed and we have parents coming into the school system asking for help. In many cases, because the resources are not available in the community, the schools are very stressed and they find that they have to try to adapt their programming for the child and that they really need more expert programming in other areas.

The Vice-Chair: Thank you for making your presentation.

Mrs Lafarga: I would just like to reiterate that we had to work with two partners in this process.

The Vice-Chair: We certainly appreciate the time you have taken to present before the committee,


The Vice-Chair: We have, last but not least on our list, the Earlscourt Child and Family Centre. I would call on them and Kenneth Goldberg to make a presentation before us. Please identify yourselves for the purposes of Hansard.

Mr Goldberg: I am Kenneth Goldberg, executive director of Earlscourt Child and Family Centre. To my left is our distinguished past president of the board, Paul Schroeder. I am also pleased to indicate in the audience two members of our board, Jinni Morton and Jane Shapiro.

Earlscourt Child and Family Centre is a non-profit children's mental health centre serving predominantly the cities of Toronto and York and governed by a 16-member voluntary board of directors. We are committed to improving the life circumstances of aggressive children and their families. We believe that children and their families are affected by their social environments and that services must be client-driven and delivered in the context which is most relevant to them. We provide children and families opportunities to improve their life chances through services which are based on the most advanced psychosocial treatments.

Our goals are these: To provide effective programs for aggressive children, ages 6 to 12, and their families; to facilitate the development of social and self-control skills in the children and child management skills in their parents; to conduct evaluative research; to improve program delivery and enhance our understanding of childhood aggression, and to ensure that all staff receive the best possible training and appropriate supports.

We operate a range of programs that I will just describe very briefly to give you an idea of what is going on. Our residential treatment unit for eight children will serve about 20 children annually, for approximately 8 to 10 months, for mostly stabilization purposes. Our family services department serves about 80 families annually. Most of the interviews are conducted in children's homes after regular office hours. Treatment there lasts roughly 6 to 8 months and is delivered by a small department of four family workers, one of whom is Portuguese-speaking.

Our under-12 outreach project was established in 1985 in conjunction with the Metropolitan Toronto Police Force in response to the Young Offenders Act. This program serves about 70 children a year and offers a multifaceted program, including transformer clubs, where the children learn self-control and problem-solving skills; individual befriending, which is done by both professional staff and volunteers; tutors; parent education groups; family crisis intervention and school advocacy.

We operate a school-based program in St Paul's and St Martin's Catholic schools in the Regent Park area. This program involves teachers in classrooms, social skills instruction, identifying particularly aggressive children for specialized withdrawal groups, individual coaching and involving parents wherever possible. This program once served 16 schools. With underfunding it currently serves two. That will be a recurring theme.


Our school liaison programs at Huron Street, which is a contract program until the end of June, and at Lord Dufferin assist about 100 transient children in these schools to integrate into regular classrooms while staying with their mothers in emergency shelters.

With mostly private funding, we also operate a highly successful therapeutic summer day camp, called Camp Wimodausis, which serves about 48 children each summer whose behavioural problems would have prevented them from any other organized summer activity.

Earlscourt is known in the community as specializing in the treatment of aggressive, non-compliant children, typically from impoverished families. We have excellent working relationships with schools, child welfare societies and other agencies, and our clients are overwhelmingly satisfied with our services.

Research carried out by investigators at Earlscourt has identified the special treatment needs of children from Portuguese-speaking families and the special needs of children who witness family violence, as examples. Our studies have demonstrated reason to be cautiously optimistic about the outcome of our treatment programs.

Over the past decade Earlscourt has been active in the area of program evaluation and research. With minimal core funding and external grants we have demonstrated that some children do benefit from treatment and that in programs like our outreach project gains are sustained at six months and one year following treatment.

Earlscourt is at the cutting edge of program development and applied research, but we require significant increases in funding for programs and research in order to meet the demands for service and to ensure that programs are effective.

I want now to focus on the current crisis in the children's mental health sector, which was the focus of these discussions from the beginning. I have three major points.

The first is that aggressive children are different. There is a growing body of literature that suggests that aggressive children differ from their peers along several dimensions. They value aggression. They typically are suffering from another psychiatric disorder, such as depression and hyperactivity. They are less likely to attend to academic tasks than their peers. Many have learning disabilities and are underachieving in school. Many are actively rejected by their peers.

These children are difficult to raise and their lifetime prospects are grim. They require more attention and closer supervision from their parents than normal children, and yet these children's high rates of whining and demanding behaviour, stubbornness and unresponsiveness to requests make them highly aversive to be around. Their parents are frequently under considerable stress, alienated from the mainstream of society and disfranchised.

At school these children are defiant of authority, destructive, disrespectful and disruptive. Their teachers and principals are frequently frustrated and overwhelmed by their behaviours. Often by the time a case is referred to Earlscourt the child's school feels it has tried everything and the working relationship between the school and the parent has reached rock bottom. These children are frequently suspended, threatened with suspension and placed on home instruction. They are at considerable risk of early school dropout, juvenile delinquency, adult criminality and adult psychopathology.

I regret to have to inform you that services in Metropolitan Toronto are shrinking. Due to consistent provincial underfunding of children's mental health services over the last 15 years, many services have been gradually cut back or discontinued altogether.

Let me describe some of the cumulative effects of this underfunding in Metro. Twenty years ago there were about 100 residential treatment beds for latency age children, children aged six to 12, in the Metropolitan Toronto area. Today in Metropolitan Toronto there are 24 such beds, fewer such beds than in Hamilton. Day treatment classrooms are decreasing and outpatient services have also been under siege.

As I listen to discussions around co-ordination, I am thinking that if you just wait long enough co-ordination will become easier, because there will be fewer and fewer services to co-ordinate.

We regret that by downsizing, for example, the catchment area in our family services department in order to offer immediate response to requests for help, we have simply become unavailable to certain children needing help who live beyond our service area and for whom other comparable services do not exist.

It is incumbent upon a caring government which is committed to children to ensure that resources are in place to allow centres like Earlscourt to help those children that other child-related sectors have given up on. We perceive a trend in government that seems to protect mandatory services at the expense of voluntary services. Consequently we are concerned that with no legislative guarantee of access to service, children with mental health needs who are not already receiving mandatory services will languish without the help they so desperately need. Children should be given the same legislative guarantee of reasonable access to mental health services as they currently have for physical health care and protection services.

Workers in children's mental health centres are underpaid. In transfer payment agencies like Earlscourt, salaries lag miserably behind salaries paid in directly operated Ontario government facilities, such as Thistletown. This leads to resentment, low morale and high staff turnovers in our centres. The annual staff turnover in Earlscourt's residence, for example, is well over 50%. In the fall of 1988, over a three-month period of time, we experienced a 75% turnover. An immediate redress of the historical inequity in salaries in comparison with directly operated Ontario government facilities calls out for action.

Child care workers and social workers -- female predominant professions -- have traditionally been underpaid as a reflection of society's undervaluing of work with children. Recent union and pay equity settlements in directly operated Ontario government facilities have knocked the salaries in transfer payment agencies well out of the marketplace. This disparity is an injustice to our workers who certainly deserve and are entitled to salary equity within our sector. It is also an injustice to the children and families we are unable to serve because we cannot attract and keep experienced child care workers at our centres. There is an urgent need to achieve equity with wages paid to employees in the Ministry of Community and Social Services.

This human resource crisis is particularly acute, we feel, in the greater Toronto area where our workers experience a higher cost of living than anywhere else in the province. The combination of low salaries, the high cost of living in the GTA and our inability to compete with other sectors such as health and education have resulted in an intolerable situation.

As a result of numerous human resource and service crises in the greater Toronto area, 26 local children's mental health centres joined together to conduct a salary survey. We actually have a committee called the salary equity committee and I would just like to introduce members of that committee who are here and who helped with the report. We have John Spekkens from Dellcrest, Tony Deniz from the West End Crèche and Humphrey Mitchell from the Peel children's centre.

The attached charts I think clearly illustrate our desperate situation. We surveyed child care worker 1s, 2s, 3s and social worker 2s. These are the people who are working on the line with the children daily, often on a 24-hour basis.

If you look at the second chart, where we look at salaries in children's mental health settings. In this chart we are comparing mid-range salaries. The mid-range salary for a child care worker 1 in a transfer payment children's mental health centre in the GTA in comparison with the locally operated Ontario government facility is a whopping 41%. For child care worker 2, it is 30%. For child care workers 3s it is 21%, and for the social work staff it is 9%.

The child care worker 1s comprise -- we are looking at 230 employees in the greater Toronto area in these agencies. For child care worker 2s, we are looking at 303: for child care worker 3s, 138; and for social worker 2s, 175.

The salary committee of the central region has met with representatives of the Ministry of Community and Social Services as recently as 2 o'clock this afternoon about this pressing issue. The ministry has acknowledged the seriousness of the problem. What is required now is the political will to address it.


The Vice-Chair: The chair wants to ask a question. I am going to invoke my prerogative.

Mr Beer: Shocking.

Mr Owens: Resign.

The Vice-Chair: It has been a long day, I know.

Very briefly. I just want to comment on the report and also say that actually I am interested in the work that you do with culture-sensitive groups. You are located in downtown Toronto and I am obviously familiar with downtown Toronto, having grown up there, and also with the kinds of groups that are presently in downtown Toronto. It is a real catchment area. You must encounter a great number of recently arrived Canadians in that area, a large number of immigrants.

I am particularly interested in the work that you do with the Portuguese community because I know that as a result of their large number, in Toronto particularly, a great many problems are associated with children in the Portuguese community going through the educational system. I know that you have one worker on staff, as you pointed out in your brief. I think that is certainly inadequate and I am going to support your views on that and just simply say that there are not that many agencies dealing with the kinds of problems for those culture-sensitive groups. I do not know what we should do at this point other than to say that other agencies must look at that.

I am making a plea for that to occur within your own agency. I know that you will come back and say, "Well, we need more money," and there is certainly that to be concerned about. But there is just a horrendous problem with culture-sensitive groups. It is different because of that factor and the problems are multiplied and exacerbated because of the barriers that are faced, not only with language but really it comes down to culture, something that is a little more stressful.

That is my Chairman's prerogative.

Mr Malkowski: On a point of order, Mr Chairman: I am just wondering, is the Chairperson allowed to make comments or discussion during the committees?

The Vice-Chair: I believe that I am allowed to ask a question and I was trying to formulate a question out of all that.

Ms Haeck: Actually, I think I will be asking the same --

The Vice-Chair: Okay.

Mr Owens: Where is Steve Mahoney when you need him?

The Vice-Chair: We will proceed with Ms Haeck.

Ms Haeck: I flagged it for myself as you were going through it, about the issue relating to Portuguese-speaking families. I was interested that you used that one particular ethnic group as opposed to knowing, I do believe -- Penny Moss is not here, but those people who were involved, say, with the Metro area school boards -- that there are at least 80 languages taught in its heritage language programs. We know that there are a vast array of ethnic groups situated in this four-million-population area that is called the greater Toronto area, so why the focus on this particular one as opposed to Vietnamese or whomever?

Mr Goldberg: There are certainly far more Portuguese children in this area than there are Vietnamese. There may be 80 or more ethnic groups, many in the city of Toronto and in the city of York, but there are more Portuguese in this area than any others, so I think the demographic data support our focusing on that. We gave up a long time ago trying to be all things to all people, and in fact the designated Portuguese language position we have was developed out of a demonstrated demand for service and essentially cut back an English-speaking position in order to do that.

Numerous times we have asked government for funding to increase that capacity but have received no positive response. The whole issue of the delivery of services in a multicultural society and town is a complex one and requires further discussion. I am proud of the fact that we have a designated Portuguese position. When I have to say that our services are in English and Portuguese, I cannot apologize for that, because in fact attempts to broaden that have fallen on deaf provincial ears.

Ms Haeck: My reason for bringing it up was that you focused on that one ethnic group and you have substantiated why you have done that. Being an immigrant myself, I was sort of interested in seeing why you particularly focused on that group maybe other than somewhere else.

Mrs McLeod: Obviously one of the frustrations that all of the people who have appeared before us have is the inadequacy of resources to do all that they know needs to be done in their field. I guess one of the problems that creates is that there is often a competition for resources between people with similar kinds of concerns. I think it would be unfortunate to need to be pitting one against the other, although I know in reality that tends to happen.

I just wanted to get a little bit of clarification about a seeming tension between this presentation you have just made and the one that was made by the children's aid society a little earlier. You indicated that you felt as though mandatory services had received funding almost preferentially to voluntary service. Yet, the children's aid society earlier -- you may have been here -- suggested that the occupancy rate of children's mental health centres in the metropolitan area might be frequently as low as 73.9%, while the CAS occupancy rates, demand rates, would be higher than 100%. Again, I do not want to be seeming to exacerbate the tension by pitting one against another, but could you help us get a sense of why there seems to be that different perspective?

Mr Goldberg: I wish I could do it informally over coffee perhaps.

Mrs McLeod: Maybe we could substitute that.

Mr Goldberg: Perhaps another time. When I say "mandatory," I mean in the context that if a child is seen in need of protection, it is expected that the child will receive it, such as education. All children are entitled to an education. In the sense that the children's mental health sector has been withering on the vine, as has been stated before, we do see mandatory services protected.

I want to try to address the point. I am sorry that I missed the OACAS presentation. If there are children's mental health centres that are in the perception of any local children's aid society not adequately or fully being responsive to the needs of their children, I would encourage them to have dialogue with their local children's mental health centres and to have dialogues that involve perhaps the area office where they are located. I cannot help but think that with a little dialoguing and a spirit of co-operation, changes could occur.

Mrs McLeod: The vacancy rate then is not a reality for you?

Mr Goldberg: We are at 100% occupancy, one child receiving specialized one-to-one funding in order to provide him with 24-hour care.


Mr White: I am very impressed with the evaluative research component that you mentioned. Earlier this afternoon we were informed that was not something which occurred regularly in children's mental centres and that as a result those services were often trying old methods, which may or may not be effective or may or may not be more good and bad, as I recall the phrase was.

In using that evaluative research in relation to the residential component, and you mentioned specifically the aggressive children which your centre services -- I imagine those are most likely to be the kind of children who would be using the residential services -- what does that research tell you about the need for that kind of a service as a core, perhaps, of children's mental health centres?

Mr Goldberg: I guess it is our really firm conviction that residential treatment ought to be on a continuum of less intrusive, less intensive services. There is a valid role for it. The current trend would be to decrease, actually, funding for non-residential services in order to maintain the few residential beds that we do have in Metro Toronto. As indicated, there are fewer in Metro Toronto than there are in Hamilton.

I would like to clarify, and it relates to Ms McLeod's point as well, that we have eight beds; four of those are designated for children's aid societies and in fact the other beds are also available to them. The use of those beds and the use of beds in the other two agencies in Metro providing residential treatment to latency-age kids, Dellcrest Youth Services and Aisling Centre for Children and Families, meet monthly with the ministry rep and the children's aid societies to co-ordinate the most effective use of those very limited beds that are there. So there is very close collaboration that way.

I would say that residential treatment is very important, but the non-residential services in terms of secondary prevention are very, very important as well.

Mr Owens: First of all, I would like to congratulate you on your report and to take on this issue of pay equity and wage disparity that we have in the helping professions. As a person who comes from a hospital setting, I can tell you that the expectation is that people do not work in these jobs solely for money but for, I guess, a personal sense of satisfaction, and that sometimes is used as a hammer over their heads when it comes to, I guess in your situation, contract negotiations with the unions.

It is my sense that this government will not shy away from trying to close up some of those discrepancies, as we have heard from several presenters and again from yourself, with an acuity that is astounding, that we will try to address those kinds of problems so that we do not have issues of burnout and 75% turnover rates. I find that is appalling and it certainly does not help the children in any way, shape or form and it does not give the workers any sense of self-worth in their own professions.

The Vice-Chair: I think we have come to the end of our session, unless there are any further questions. If not, I would like to thank you for your presentation, for taking the time to come before us.

To members of the committee, I need direction from you with respect to our meeting tomorrow. We can meet in camera if that is the wish of the committee, or shall we continue to meet open to the public? What direction can you give me on that? Is there a desire to meet in camera, or shall we just continue the way we have been? We can do it either way.

Mr Martin: Continue the way we have.

The Vice-Chair: Consensus on that? Yes, okay, fine. We will meet at 2 o'clock tomorrow afternoon, Wednesday 16 January.

Let me just thank members of the committee for their co-operation in this most pressing and difficult endeavour of keeping on time. Thank you very much.

Mr White: I was wondering about the arrangement of the tables here.

The Vice-Chair: Rearrangement.

Mr White: Rearrangement. I am wondering if that could be changed back the way it was. I understand there is only one member of the Legislature to whom we should be extending our backs.

The Vice-Chair: The clerk would like to address that.

Clerk of the Committee: The reason for the change in the setup is twofold. Number one, and most important, if you have another member of your caucus who wants to come in or if any other members of any other caucuses come in, in the other setup there is absolutely no way of accommodating them. That is the main reason. The other reason is this room is very small, as you saw over the last couple of days, and we were not able to get the audience seating in here that we needed yesterday. Those are the two reasons.

The Vice-Chair: The truth is I almost broke my knee.

Mr White: They can be rearranged.

Clerk of the Committee: What about other members of your caucus who may come in and cannot be accommodated?

Mr White: In the event that occurs, I am sure we would be willing to give up our seats for them or make arrangements.

The Vice-Chair: Do we need a ruling on this?

Clerk of the Committee: No.

The Vice-Chair: I do not think so. Can you talk to the clerk further about it? Do you want me to debate this? I would like to adjourn the committee.

Mr White: Why do we not rearrange the tables?

The Vice-Chair: Okay, we will talk about it later.

The committee adjourned at 1657.