Monday 9 May 1994

Premier's Council on Health, Wellbeing and Justice

Marilyn Knox, co-chair, children and youth project steering committee

Dr Dan Offord, co-chair, children and youth project steering committee

Zenia Wadhwani, project coordinator, Ontario Coalition for Children and Youth


*Chair / Président: Beer, Charles (York-Mackenzie L)

*Vice-Chair / Vice-Président: Eddy, Ron (Brant-Haldimand L)

*Carter, Jenny (Peterborough ND)

Cunningham, Dianne (London North/-Nord PC)

*Hope, Randy R. (Chatham-Kent ND)

*Martin, Tony (Sault Ste Marie ND)

McGuinty, Dalton (Ottawa South/-Sud L)

*O'Connor, Larry (Durham-York ND)

*O'Neill, Yvonne (Ottawa-Rideau L)

Owens, Stephen (Scarborough Centre ND)

*Rizzo, Tony (Oakwood ND)

Wilson, Jim (Simcoe West/-Ouest PC)

*In attendance / présents

Also taking part / Autres participants et participantes:

Jackson, Cameron (Burlington South/-Sud PC)

Clerk / Greffier: Arnott, Doug

Staff / Personnel: Gardner, Dr Bob, assistant director, Legislative Research Service

The committee met at 1536 in room 151.


Pursuant to standing order 108, consideration of the report of the Premier's Council on Health, Wellbeing and Social Justice.

The Chair (Mr Charles Beer): Just before calling our witnesses who will be appearing before us today, I'd like to note a couple of things. It is appropriate that we are going to be meeting with representatives from the Premier's Council on Health, Wellbeing and Social Justice. As members know, we begin next week a series of hearings under section 125 dealing with children at risk, and just for members of the committee, I'd like to ask Bob Gardner if he would review some materials that have been circulated.

Dr Bob Gardner: Members asked earlier on for the 1991 report that the committee did on children's mental health services, so we've included that. You didn't ask for anything else, but we brought some more background material anyway. Joanne put together a range of articles and excerpts from reports on the three issue areas that the committee will be looking at: the question of physical and sexual abuse, children in need of protection under the Child and Family Services Act, and then the broader issue of children and poverty. So you'll find in the package a range of articles and reports and so on.

The Chair: Thanks very much. Those hearings will begin next Monday here at 3:30.

We turn then to our order of business today. Under standing order 108 we have invited representatives from the Premier's Council to come and to go through with committee members the document they have today released and which was tabled in the House: Yours, Mine and Ours.

I invite Marilyn Knox and Dan Offord to come forward. Welcome to the committee. We are really delighted that we had a free day today and that you were able to stay longer. I think we all sense that this is a very important report, and this provides not only an opportunity for us to better understand it but, as we are here in the Amethyst Room with television, I think also to get the message out to a broader audience.

I wanted to say to you at the outset that we are very much in your hands in terms of how you would like to proceed. I know that there are some other people in the room today with you who have been involved in different aspects of this document as well as the youth document. I think I speak for committee members in saying that if at some point you'd like to invite others to the front to discuss some of that, that is fine and we'd be quite happy to do that as well. But you take us through as you feel is appropriate. At various points we may have a few questions and so on, and we'll just take it from there.

Perhaps at the outset you would also both be good enough, in terms of Hansard and the viewing audience, to just identify yourselves and how you came to be here this afternoon talking about this report.

Ms Marilyn Knox: Thank you very much for inviting us, and to you particularly, thank you for the remarks we heard from you today as well as the other parties. We appreciate the opportunity to sit and talk with you as this report is just hot off the press: what we did, what we're thinking about and what we've yet to do with this report. I'm Marilyn Knox. I co-chair this committee. I'm from the private sector.

Dr Dan Offord: I'm Dan Offord. I'm from McMaster University and I'm a child psychiatrist there. I co-chair the committee with Marilyn.

Ms Knox: There are some 17 of us who have been involved with this at the committee level, with Jane Fitzgerald behind us being the prime mover on the staff side, as well as her deputy, Tom -- did Tom leave? There he is -- and Malcolm, Chung and Zenia from the Ontario Coalition for Children and Youth. Malcolm works with them, and Dave. They may feel free to jump in at certain times as we go through this.

What we thought would be useful is to give you an overview to start with of what's in the report, and we'd like it to be very informal. If at any time you want to jump in, please feel free to do that. Does that make sense?

The Chair: Absolutely, and because there will be people viewing this at different times over the next number of days, if people want to get a copy of the document -- it's something we always forget to do -- but could you indicate right now what they ought to do and can everyone remember, before we finish, that we do it again so people will have some idea? I'm assuming they can phone or write to the Premier's Council, but could you read out the address?

Ms Knox: Sure. Copies are free and they're available in English and in French from the Premier's Council on Health, Wellbeing and Social Justice, which is at 1 Dundas Street West, 25th Floor, Toronto, Ontario. The postal code is M7A 1Y7. They can call to 416-326-6754 or they can fax to 416-325-4261.

We have a report here that's two years in the making. It's called Yours, Mine and Ours: Ontario's Children and Youth. It is the first phase of a three-phase program, so the work is not finished yet. The report is there, but it will be followed by a community mobilization campaign and something we're calling the report card. We'll talk all about that as we go through this.

The two years in the making was not original thinking work, but it was rather taking the best of work that had been done by governments in the past, by researchers in the past, by community people in the past from all kinds of disciplines. It was really pulling together a huge amount of work that had already been done, taking discussions with children, youth, parents, grandparents, specialists, people who are volunteers, a huge number of people who gave us their views.

Very simply what we've done is a diagnosis on the situation of children and youth in Ontario today, developed a framework that's simple, that anyone can understand, on how to approach the problems and some ideas about what the solutions are and some ways to measure the results. In essence, that's what this report is all about.

Dr Offord: I'm going to start with a slide here. Let me just talk to this slide, because it provides a framework on which the report is based.

I'll begin at the bottom, healthy child development, and move up the left-hand side of this circle. What you hope for in Ontario is that children experience healthy child development. They become healthy children and adolescents and because of that, when they enter the workforce, the workforce itself is capable of innovation and is a competitive workforce. The result is a prosperous society. There's social stability. Because of these two things, there are resources to fund programs that foster healthy child development. That's the kind of circle that we hope happens.

What's bothersome in Ontario is that as you go up the left-hand side of this circle, there's a growing and growing group of children who are losing out early on in their childhood. These are children who experience early school failure and have behaviour problems beginning as mild anti-social behaviour and growing into severe anti-social behaviour, school dropout, alcohol and drug abuse.

There's a lot of money and resources being spent trying to reduce the scope and magnitude of this what might be called "casualty" class of children. Of course, when they grow up, in many instances they're not fully functioning members of society, so they can't contribute as much as they could otherwise do to the prosperity of society. The workforce is not as competitive, the place is not as prosperous, and there are very few funds left over to support these programs.

Now, this circle has two or three implications. The first is that the size of this group of kids who are losing out is so immense that the kind of work that I do clinically, seeing kids one at a time, attempting to help them, is unlikely to make a major impact in reducing the burden of suffering. The scope and magnitude is simply too large. One has to think of interventions that will affect groups of children.

The second thing is that this program is of such importance and size that it's not just people like all of us in the room concerned about kids today who are concerned, but almost all the sectors of society are concerned with this problem. It's interesting, in our experience on the Premier's Council, that some of our strongest advocates for this initiative have been from the business community, who are saying, in a sense, if you just put social justice to one side for a minute, unless we do something about this problem, it's not just those kids and those families who are going to have difficulty, but my kids, the whole next generation, who are going to have a lower life quality than we have.

The third implication to this is that one can argue that when times are tough, when things aren't going well, when a workforce is not leading to prosperity, one kind of program you don't want to cut is that which fosters healthy child development and programs that can contribute to reducing this casualty class. If you can do that, that appears to be one of the most hopeful ways of getting out of the recession, because in a way you have a much more prosperous and innovative workforce.

Ms Knox: As we went about looking at the situation that we find ourselves in today, families, time available, the economy all have gone through their own kind of restructuring and change. The institutions that support healthy child development have not gone through as much change as those other sides.

You see, of course, families are changing. You look at the percentage of women with children under six who are working; it's over 60% now. When you look at the social climate that has changed, what has now happened to the real income of families where the major breadwinner is 25 and under, versus 10 years ago, is that it's substantially less.

We believe there is a perception of increased violence. Whether there really is or not, we haven't measured it, but the perception would certainly be, if you look at downtown Toronto and other communities, that violence is on the upswing.

You know, of course, that the role of women has changed.

There are some other things. The economy and indeed governments are undergoing restructuring. Lifelong learning has become extremely important. The other Premier's Council has talked about the need for that. But when you look, in companion to that, at the dropout rates from high school, the functional illiteracy rate in our society, those things don't bode well for a society that has decided that not only is lifelong learning important, but it looks like a majority of jobs down the road will require more than secondary education. Those things start to make us worry about what's going on: families are struggling harder to stay afloat financially, the time crunch we talked about, and increasing cultural diversity.


So what are the things we must do and where should we begin? We began with a set of beliefs -- and it's important to understand the starting point -- that we see children and youth as important for who they are today in addition to the investment they are in the future. They are an important part of our society. Healthy children and youth are absolutely beneficial. Dan's already discussed that. We're not trying to say that the primary responsibility for kids isn't their parents, but that those parents need support. We also are saying that children and youth, and that came through very strongly from the Ontario Coalition for Children and Youth, want an opportunity to participate. All children and youth must grow and develop free of violence, discrimination, abuse and inequity.

Those are the fundamental beliefs we share. Also, a stable and adequate economy is important, and when that falls apart, the kids are affected as well.

What did we hear? We went out and talked with a lot of people. First of all, we did focus groups, 22 of them around the province, talked to children from five years all the way up to parents and grandparents to the age of 85. In that age range, it was quite remarkable to see what happened. I think it was important to have started with the very young kids and not to forget the grandparents.

There are certain central themes. The kids from five to 10 were very straightforward; they told us exactly what they thought. After 10 years old, they started to tell you a little bit more about what they thought you wanted to hear, and also the cynicism started to come in.

But the sad part is when you really asked youth, "What are your dreams, what are your aspirations?" When we were younger, and I remember when our parents used to say that, it was perhaps to have the great travel adventure or the scientific discovery or the great art piece, but these kids said, "We want to have an income, we want to have good relationships with our families and friends, and we want a degree of freedom and independence." If you look at what the determinants of health are, those are very healthy answers, but have we taken their dreams away?

What the parents were concerned about was being able to provide for their families economically, and what that started to do was introduce even more of a time crunch.

What the grandparents said was: "Oh, don't worry so much about the money. Give them time. And what's more, we can help you with the time." But in reality, the way our society is organized at the moment, are the grandparents in the same place as the parents and the same place as where all those kids are? It's not quite as simple as that.

These were the things we heard when we did the focus groups at the very beginning.

We also asked the Ontario Coalition for Children and Youth to become involved. We sat around our table in the early days and said, "We should have our youth representatives on our committee." We tried very hard, we got a few representatives, and then they went on with their lives, things happened to them, and it was hard for us to get someone who was participating with the committee at all times.

Then we thought: "Is that really accomplishing what we're trying to do? Perhaps what we need to do is to figure out a way that is ongoing and get a huge input from children and youth, not a token input." That's when it was our good fortune to have discovered the Coalition for Children and Youth. They went out and conducted 21 sessions around the province, north, south, east, west, and in every kind of mixture you can think of. They came out with a whole lot of observations, some of them contradictory, definitely honest, some bold, some of them just very much what you'd expect, but they boiled it all down to four big recommendations.

-- First, ongoing involvement in meaningful decision-making in areas that involve them. This is a very important thing to think through. It's not a command that they have a seat on the board of everything. It is a very thoughtful request. If programming policies are thinking about children and youth, why not involve them in the thinking?

-- Second is to have a provincial network for children and youth, and they may want to speak to that.

-- Third, better preparation for the adult world, if you think about the life skills that are required to function, the number of careers that youth today will probably have down the road. There was another thoughtful recommendation about skill sets, for us to be better skilled at parenting. The skill set recommendation focused on them, but they had another thoughtful recommendation.

-- Finally, to be portrayed more realistically, by the media as well as politicians.

Did you want to add anything?

Ms Zenia Wadhwani: No, you did a nice job.

Ms Knox: So what do we know? We're going to go on and talk about the research.

Dr Offord: This research led us to some key assumptions. The first is multiple pathways for healthy human development.

The way to understand kids growing up in Ontario is that when they start off they're like on a train track. They go down that train track, and almost without exception some kids get off of it a bit, and then they get right back on again, they mature out of it. One doesn't have to explain why kids have some symptoms and some difficulties. The issue is that most of them get right back on it again, and there are different ways in which they get off and different ways in which they get on.

Ms Knox: What's an example?

Dr Offord: I think almost all kids in this province and all of us back in our childhoods did some anti-social behaviour. We always did. Everybody smiles and says, "Oh, I did some."

Ms Knox: It's hard to imagine that Charles did.

The Chair: We did.

Dr Offord: We did, sure. So you don't have to explain why kids do it, but why is it that some kids start off and don't stop? It's not under control.

Mr Cameron Jackson (Burlington South): They go into politics, the ultimate acting-out.

Dr Offord: Right, I got you.

The second thing is that development occurs within various environments. There's one inside of us, there's also the one in the family, but it's not just inside of us and the family. There are other contexts that we know are important for kids -- the schools, the community -- and a lot of these other contexts can make up for a lot of difficulties in the family, for instance. That's why it's so important for kids who are having difficulty in the families to have the best outside-the-home programs the province can provide in contexts such as recreation, schools etc.

The prenatal period and early childhood are crucial times, that's true. Earlier is probably better, but that has to be tempered with an understanding that there are different points at which one can intervene in the lives of kids that can make a difference. All of it doesn't have to be early on. Human development evolves in phases, and we're going to point out in a minute that there appear to be certain points in the growing up of children where one has a better chance of having success if one intervenes at those particular points.

And there are determinants, that is, factors that determine how successful kids are going to be in navigating these particular phases. What we did through the research papers was say, "Let's think of what criteria we'd apply if we were going to focus on certain determinants," because there are many things that influence how kids grow up. We applied certain criteria to narrow down the number of determinants or influences we wanted to consider.

First, we thought the determinants should be amenable to public policy.

Second, it should be a determinant that involves all children and youth, not just specialized or high-risk or particular groups of kids.

Third, one could envision that if one could do something about it, it could be done at reasonable cost. If you have unlimited funds, you can do a lot, particularly for small groups of kids, but if you're interested in raising the life quality of groups of kids, then one has to be very concerned about cost.

Fourth, there has to be a concern with measurable progress; that is to say, we want to know whether things have got better or got worse and whether we've had some success.

The last one is specific to the council, a determinant we thought: that by pressing for change, we could have some role in facilitating change.

As I mentioned, we focused on four points of transition, and these are period where one probably has a better chance of shifting the trajectory, the life course of kids.

The first is transition to life. It extends from the prenatal period through to the end of the first year. The second is transition to school. The influences include all the preschool years; the point of transition is between preschool and entering school. The third is transition to adolescence, and that corresponds generally with the change from senior public school to high school. The last is transition to family, the work roles and community. It's leaving high school, either to go to work or to go to some higher form of education.

This is the model we use. We say, let's focus down on determinants of successful navigation of these transitions, and then if we can identify a limited number of these determinants, we can, based on those, recommend some actions that could be carried out at the community level widely in Ontario.

Next, we want to be able to measure the effect of this: If these changes did take place, what are the measurable changes in the outcomes of kids?

Last, we want to put these outcomes together -- and I'm going to talk about this in a minute -- in terms of a report card, so that a community, the province, or different subgroups in the province would know how their kids are doing, from one year to the next and compared from one jurisdiction to the next.


Let me run briefly through these transitions.

First, the transition to life, the two major determinants of having healthy infants. The first is that you have healthy moms, and the second is that there's comprehensive care before, during and after pregnancy. Based on those determinants, we have two recommendations for that transition point.

The first is that we want to ensure that all women have access to good prenatal and postnatal care and support, so services to pregnant women and new mothers should be in a coordinated and accessible service network at the community level, and it has to contain a comprehensive range of services -- not just the usual health services, but social and parent support services.

The second recommendation is to promote a healthy and supportive birth experience for all women. To do that, communities should have a range of birthing options that provide equitable access to a choice of birthing services. Some young mothers want to have their babies in hospitals, some do not, and there has to be a range of possibilities that the expectant mother feels comfortable with.

Mr Jackson: Does that include high-risk births as well, the other end of that?

Dr Offord: Yes, it does include that. There what you would need is to have the specialized services needed for these particular subgroups of people. The community would have a wide range of services, but in the case of high-risk pregnancy, you'd certainly want the backup of specialized care.

Then we have the outcomes: If that works, if you get those two in place, what would you expect changed? Well, we haven't worked out all these outcomes, but these are some initial attempts at these. The percentage of low-birth-weight babies could be reduced; and if we could find a measure -- we're working on it -- to measure the health of kids at one year of age, and that will include the type of attachment they have with their moms. The importance of such outcome measures does not just tell you something about the health of the one-year-old, but deviations at that age, of course, can put kids on different trajectories that have long-term influences.

The second transition is the transition to school. What are the two major determinants of successful transition to school? The first is that you've got to have high-quality care during the preschool. Second, you've got to find ways of preventing injuries to kids during the preschool era.

The first recommendation, the third of our overall group of recommendations, focuses on having work-friendly places for young mothers, young parents. This recommendation involves not just the usual child-caring sector but now brings in the business and employer sector. They'll have to find ways to make it possible for young mothers to feel comfortable working and looking after their kids, through things such as flex time, having time off to go to school conferences, having time off to stay with their kids when they are not feeling well.

The second recommendation is to ensure that all children receive good care and stimulation through the preschool years so that when they enter grade 1, they can master the work cognitively and they can master the environment behaviourally. What happens in this province, for instance, is that there are groups of kids who are very much behind when they enter grade 1. Some data suggest that some groups are one and two years behind in mathematical skills, basic number skills, so when they enter grade 1, of course they're in bad difficulty because the school offers a certain curriculum to them but these kids are unable to take advantage of it.

Ms Knox: And what happens to those kids if they don't get caught then?

Dr Offord: What happens is that in many cases they fail grade 1, they get turned off school, their parents feel alienated from the school environment, particularly if the kids themselves feel the school has treated them badly. And it's just not the failing of grade 1, but they're on a course now into special class and all that sort of stuff that puts them at much higher risk than they would be if they got off to a good start in school.

Mr Larry O'Connor (Durham-York): Would you find certain communities in which this was more of a problem, as the focus groups and everyone helped you develop towards this recommendation? Was this more common in certain communities, and what type of communities would they have been?

Dr Offord: There are not good data on this in all communities. That's number one. We'd like to know that; that's one of the things the report card will tell us. But information from Ontario and other places suggests, for instance, that children in public housing communities, these kids as a group -- it doesn't mean all of them, but as a group -- probably have severe difficulty accomplishing satisfactorily in first grade compared to other groups of kids.

Here is a major challenge in this province. What could you do to make it possible for these kids to get off to a better start in school? Clearly, part of the answer is that there's going to have to be a working together in those communities to ensure that these kids have a stimulating and stable environment during the preschool years. The other side of it is that schools are going to have to become very skilled at dealing with these kids who may make come into kindergarten and grade 1 with different prerequisites.

Mr O'Connor: I represent a rural riding. Would that be more of a problem there?

Dr Offord: That's a good question. The answer is that we don't know. We know from our work that rural teachers, teachers in rural schools, don't see high-risk kids as being as troublesome as they do in urban schools. They appear to be much more tolerant. This is back in the mid-1980s -- whether that holds today or not. Your point is well taken. To what extent the deficit occurs in rural communities compared to other areas in the province, I don't think we know. We'd like to know that and I'm sure you'd like to know too.

Mr Jackson: Did you look at all at differentiated entry points, because that's something that the select community on education examined. Richard Johnston was a member of that with me, as I believe Mr Beer was at one point, and we looked at that very seriously.

Dr Offord: We did not, in our overall; maybe in the subgroup, the task force, that was examined. I don't think we considered that in our discussions. Do you mean that different groups of kids would enter the formal school system differently?

Mr Jackson: The identification of children at risk is something we know we can do. It's just that no one has the responsibility to do it because the school board says, "It's our responsibility when we get the money from the province and the taxpayer to do it, but until we get that" --

Dr Offord: It's tricky. Let me tell you what I think the data show. You can identify kids who are going to do badly at the end of grade 2; you can identify them at age four and five. The problem is that to get all the kids who are going to do badly in grade 2, you're going to be wrong half the time, because your group has to be so big, if you see what I mean. The net has to be pretty wide.

It's important to think about identifying high-risk groups, but also to keep in mind that it's not an exact thing and that you're going to be wrong a lot of the time. One of the things this report emphasizes is to say, are there some interventions that could be applied on a community-wide basis that would cut down, in the first place, the number of kids at risk and not wait for these kids to become at risk before trying to do something about them? It's an area we're particularly interested in, but it's very difficult to predict the behaviour of kids. To get the group you want, you've got to make the net pretty wide. There are a lot of false positives there.

Ms Knox: When you get to the point of looking at the outcomes that we want to measure in transition 2, in a community, let's say, if you were looking at certain markers on an annual basis of what's happening about your kids in your community being really ready for grade 1, it would start to tell you, "If you're off the mark compared to other communities, in your community you may want to focus on that and the entry into junior kindergarten programs, the quality of child care and so on, the training that people get who are looking after children, whether it be parents or people in the home, in addition to child care licensed people." Those things will start to tell you what you need to do in your community to make things better.

Do you want to talk about the Operation Headstart results for a minute?


Dr Offord: Headstart's an interesting program. The evidence is clear that if you have the money, you can raise the IQs of poor kids, economically disadvantaged kids, and get them off to a better start in school. The data were discouraging to the extent that if you follow those kids up until grade 4, you find that the initial advantage the kids had compared to the comparison group that didn't have the preschool washed out. By grade 4, these kids could not be distinguished from the kids who never had preschool in the first place. That was very discouraging to people and they said, "Jeez, we're giving these kids something and it doesn't seem to last," and that's not surprising, because these kids need it.

Then the oddest finding came up. If you follow those kids up until age 19 -- now they're followed up to age 27, actually -- you find that the kids who were in preschool were at some advantage over the other kids at age 19, in the following ways: They were less likely to be antisocial, were doing better in school, were less likely to drop out and were more likely to have a good work history, and that's continued up into the mid-20s.

There's something nuts here because you've got an intervention at ages three to five, the effects pass out by the age of eight or nine, and then there are the long-term effects.

The way to understand those: First of all, are they lying? Is it the truth? Apparently, it's true. They understand that by always considering the concept of pathways, that it's not just what you do for a kid at the time but it's the kind of pathway you put a kid on.

What happened to these preschool kids are two things. We understand more about the first than the second. The first is that what the preschool did was that it got the kids off to a much better start. They never went into special class early on. They were doing so well in the first three grades of school that the teacher never thought of putting them into a learning disorder class or a behavioral class or whatever. Once you get in those kinds of classes, it's a different trajectory.

The second thing these preschools did for these parents was that they became empowered about taking on the school system. They felt very comfortable going to the teacher and fighting for their kids. They were less likely to be, in a sense, pushed to one side by the school system.

The importance of this finding is that it illustrates that it's not just what you do for a kid at the time, but you always want to think of what the possible pathways you've opened up to the kids might be, and it's through those pathways and understanding those trajectories that one can understand the long-term effects of an early intervention.

Mr Jackson: It also tells us something about the junior division in our school system, which is lacking, that you won't find in our primary division, in terms of PTR, in terms of resources, in terms of training. There's this gap and then it gets all stimulated again in the intermediate division on your way to high school. There's sort of a gap in there, and this lull is probably what's occurring there, in my view. Forgive me for interrupting.

Dr Offord: No, that's fine.

Ms Knox: There's the parent relationship with the school.

Dr Offord: That's the other thing we were discussing at the press conference, the parent relationship with the school. It's a fascinating thing. I'd be interested in knowing your experience in rural areas.

In some schools, and we've gone to 60 of them as part of this big project, the parents feel very comfortable going to the school. It's a very friendly place. We were trying to set up parent training courses. We'd say, "Where would you like to have them?" Some parents would usually say: "Have them in the school. Everybody loves going there." In other communities, the parents and the school would say, "For heaven's sake, don't have them here; parents hate it here," and the parents felt very uncomfortable coming to the school.

There's beginning work to suggest that when you have this lack of communication and an adversarial relationship between the home and the school, you're in trouble. One has to think of ways to make sure that parents, particularly parents of kids who are at increased risk, feel very comfortable coming to the school and talking with the teachers about their kids etc.

I mentioned there's a research project in Oregon. One of the things that teachers in Ontario complain about all the time is that there's no phones in the school. They can't phone home. Kids don't like it and they all complain about it. This guy in Oregon got a really smart idea. He had research funds in the States, and as part of his intervention he got money to put a phone in every classroom. Every day the teacher leaves a taped message -- this is a very high-risk, inner-city area -- for the parents on what's been going on in school that day, what the social skill of the day is, what they're covering in school and how they can help out.

Of course they've monitored it and almost all the parents call daily to find out what the news is from the school. Not only that, I think it's about 80% of the parents leave a message every day for the teacher about how their kid's doing. I think this is a creative, innovative way of trying to find ways of bringing the home and school together, but these are two major contexts in kids' lives, and the more they can be brought together, the better off the kids appear to be.

This is the outcomes at the end for transition 2, showing that they're ready to learn in grade 1 and have an age-appropriate set of social skills. We're going to have to operationalize that outcome better. We've got a lot of work to do in this area. This is just our first attempt.

Moving on to adolescence, the major determinants are to have supportive environments for these kids and to give them some control over decisions and choices. Most of the impetus to try to help teenagers is to try to stop them from doing things: stop drinking, stop this, stop that. The overwhelming evidence of that stuff is that it does not work, and in some cases it may promote the activity. So one has to think of different ways of approaching the kinds of difficulties these kids potentially can get into.

Our first recommendation here is "to create supportive environments for children and youth, improve their ability to participate effectively, and enhance their sense of belonging," and really to turn elementary schools and senior public schools into what we could call community schools.

This is really a very exciting possibility that's happening in some communities, where the school becomes the centre of community activities for not only the kids but the parents. I've talked about the development of partnerships between the school and the community. The school doesn't close at 4; it's not closed on the weekends; it's open. There's community participation in the schools, and learning life skills is part of the school experience. You can see how important the public school or the elementary school principal is, because some principals and staff enable the whole school to be opened up, where the community participates and things go on with the school at the centre.

The second recommendation for this age group is "to increase opportunities for supportive relationships for children and youth." What these kids need, of course, is a chance to talk things over with some adult -- it doesn't have to be a teacher, but some adult; it could be a senior citizen, it could be somebody in the business community -- who has a mentoring relationship, somebody who could check with the kid about how things are going, what possibilities there are for him or her and what choices there are and how they could be helped along.

A lot of this happens informally anyway, particularly for kids who have everything else going for them. What's needed is to think of a way that this kind of thing could be delivered for populations of children, really adolescents now.

For the outcomes here, we've thought of some. These are kids entering grade 9. Level of academic achievement: You would hope that there would be a reduction in violent incidents and expulsions and that the kids would have a lower rate of absenteeism.

The last transition is the transition to work roles, community and family. What's needed here is family support and some very solid, supportive relationships or links between the education network and the workplace.

Our first recommendation for transition 4 is to give the youth a lot of opportunities to contribute to the community. There's good evidence to suggest that for those of us who volunteer as adults, almost without exception that began in childhood. So the volunteering pathway begins in childhood and in adolescence, and we want to have some way of making sure that adolescents have the opportunity to contribute back to their community.

What we're suggesting for this transition is that there could be a way in which youth could get together, and maybe Zenia and Chung can talk about this, a youth mobilization program where they would have their own ideas as to how that could be brought about at the provincial level. We think it important to have a community service credit in all secondary schools so that when kids do something for the community, they get credit for it.

There's some evidence that peer mentoring works; that is to say, older kids in secondary school mentoring younger kids appears to have beneficial effects. The unanswered question is whether this really extends beyond kids that have everything else going for them anyway. Does it really get at kids who are having difficulties? We're also suggesting that youth representation on the governing boards of agencies and other community bodies would be another way in which they would feel part of the community.

The other recommendation for transition 4 is "to ensure that youth have the capacity to adapt and learn over their lifetime and to close the gap between work roles and education." Again, we're making the pitch here, the plea here, that the schools, colleges and universities become centres of lifelong learning.

I don't know what it's like for you, but for me I had one career. That's about it for my generation, and that's going to be it for me, I can tell you that. But most people in the next generation are probably going to switch jobs two or three times. As to my peers who did that, I thought they were nuts. They quit one and they're forced to do something else. It was like they were deviant. Not true now. My kids are probably going to have two or three different careers.


As part of this we thought it would be important to have a new professional work role counsellor so that they could help students, from the beginning of high school, plan how they're going to go through the transition from high school into the workforce.

There are different stakeholders at that transition: the parents, the students and the business community. I don't think there's any example in Ontario where the three of them have come together at a community level and said: "What are we going to do about this? How are we doing to help these young adults make the transition successfully between school and the workforce?"

The outcome for this transition? Well, you can see these could be easily measured -- not the only ones, but how many are graduating from high school and what happens to them in terms of employment and higher education.

Marilyn, we're going to move on to you here. We're almost finished.

Ms Knox: So what should be done? First of all, we're talking about adopting a goal of equitable outcomes for all kids. We're not saying we're trying to produce a master race here. What we are talking about is to have a suitable range of outcomes for similar groups. If you get kids in a lower socioeconomic level, they should have the same range of outcomes as other categories.

There are five key directions. First of all, we're talking about all kids. We're not talking about picking at-risk groups, and Dan already spoke to the rationale behind that. There's more we could talk to if that's an area of interest.

The second is we're talking about outcomes that you can measure. It's the big gift, I think, that this report gives. In addition to a very simple framework, the four transitions that people can understand, it also says there are certain outcomes we're going to look for that are measurable, that we can look at at both a provincial and a community level.

The third is that we see the parents as being the prime person or persons who have responsibility for their kids but that the parents can hold the community accountable for appropriate programming to support what they do. No parents can do it by themselves; no school can do it by itself. It's a partnership.

The fourth is we're talking about a focus on determinants, that is, really looking at the things that influence healthy child development.

Finally, we're talking about the fact that the province is an enabler. We really see that the communities are the locus where things will change but that the government can help, and in some ways the government can get out of the way to allow communities to do the things that need to be done.

Moving to action, the last and ninth recommendation -- and we thought we'd be bold enough to add one more, that is, the report card -- we've already spoken to the fact that the first Ontario report card we're recommending be actually done by the Premier's Council in order to show people what we're talking about.

It needs to look specifically at outcomes, it needs to be a help in measuring how kids are doing at the community level and it needs to look at key environmental indicators. It will help communities decide priorities. For example, in one community you may find that the indicators around children being born are really unacceptable, and that may be a place to start, or those indicators are fine, kids are doing well as they get into school, but something happens at the adolescent phase, so another community may choose to start at a very different point, which is fine. The report card can help set those priorities.

After that, it's something that we believe needs to be done at the community and provincial levels each year. Whose responsibility that is ultimately is yet to be decided, but we don't see government or a private sector group or anybody doing this by themselves; it's something that could be shared.

If we think about the next steps -- and this is the last slide -- first of all, we have done many community consultations. There are hundreds of people who have been involved in the development of this, two people in the room in addition to the ones behind us.

The youth report from the Coalition for Children and Youth was released at the end of March. We were amazed at the immediate media reaction on the spot, but then the huge coverage really that the report received. People are nervous when you start to say that things aren't fine for kids, and I think we can say things are not fine for all kids and it's not fine enough. That report was the first step in sort of sounding the alarm bell.

The second is today, the report that is out.

The next phase in our work is community mobilization. If I can be so bold, this is probably the very first step in community mobilization, talking with you. Next Monday we're doing a round table with a handpicked group of people to give us some advice on community mobilization.

I believe the Premier called for all the MPPs to think about taking the report back to their communities and having conversations. We will be planning a very targeted program for the next 18 months to get people talking about a reorientation in this Ontario society towards a higher priority for children and youth.

The final phase, of course, is the report card.

That's what we really wanted to say. Dan, do you want to wrap it up?

Dr Offord: I think that's great. Nope.

Ms Knox: Then we can turn it back over to you. We've already had some back and forth.

The Chair: Thank you. We can call back some slides if that seems useful as we go through the questions and answers. I'll just say to committee members we'll be fairly flexible because I know different people are going to have questions on different parts of it. Why don't we begin with Mr Hope.

Mr Randy R. Hope (Chatham-Kent): I thank you for the presentation. As I reflected on some of the things that you've been saying, a lot of initiatives we've already tried in our community, and you said for phase 2.

While the presentation was going on, I wrote Tom a note and said your first phase would be right in Kent county, and I've already written the list of people who would be involved in a conference dealing with our youth. We had a very unfortunate situation in our community and now it's time to tap that energy and to promote it in a positive way to work with substantial problems we have in our community and try to help people in our community. It was a very unfortunate situation.

One of the problems I've discovered -- we're doing one on the economic renewal in our community and we tried to blend the social justice issue along with economics and jobs. We're working on that. But one of the problems we discovered and you talk about -- and I notice you were very careful in the words "the province getting out of the way" -- is dealing with some of these models to deal with the communities, how funding is provided from government to these agencies in order to do these jobs.

I just wonder about some of the recommendations. I mean, we've got turf protection out there too. We have a number of children's services councils, youth services, out in our communities. How do we get down those walls and how do we tell the province to get out? I have my own ideas, but I would like to hear maybe some of the ideas that have been brought forward.

Ms Knox: When we first presented the report at the end of February to the Premier's Council itself, we had intense discussion about this and concern about turf. You just have to look at what's happening strictly on the health care side, let alone involving all the other sectors that we're talking about, to realize it's difficult.

We also have been working closely with the Royal Commission on Learning, because what they're about to recommend at the end of the year is inextricably linked with some of the things that we're talking about. So we're hoping that a momentum starts, to begin with.

When we presented the work to the Premier's Council, there was some idea that maybe we should be getting a couple of communities that are particularly ready for action and try and uncouple some of the binding legislation that stops people from being able to try innovative things at the local level; unleash them to have envelopes of money so that they can actually move the barriers around. That was one of the ideas that came up.

Mr Hope: I looked at the children's services council, I looked at schools, I looked at day care, a number of groups. You talk about youth and interest groups. I have a group called HOBY, a leadership group, which is very active young people in our high schools, a very energetic public health unit.

You've got some who receive 100% funding, some who receive 80% funding, some who don't receive funding. You talk about communities being ready. I think communities are ready and I think some of the mechanisms of funding have to be lifted in order for the communities to be flexible.

Ms Knox: You bet. Yes.

Dr Offord: I would just add to that. I think your point's a very good one. I think there are a couple of issues. One is, as you know, there are two major groups of services for kids. There's specialized mental health social services, CAS; they're specialized and targeted. There's a whole group of resources which go into what we call mainline services: schools, recreation, public health. I think we have to have models where these two groups of services are brought together, because they act as if they're in separate worlds.

The second point is that within the specialized mental health social services, as you know, you've got children's aid and you've got specialized mental health services and special classes. Now, where a kid gets into this system is really due to luck and where he or she lives. They take the same kinds of kids, by and large. One can think of ways in which that sector could be improved by having a common intake system and common evaluation and stuff like that. There's a lot of work to be done. I think what we need are models of different ways in which that could be done.


I think also it'll be important to keep score. Nobody likes to keep score in the adjustment of kids and the life quality of kids. If you keep score, I think it allows for feedback. Let me give you one example. If you kept score on recreation, you'd say, yes, recreation's great in this community. It serves kids who have everything going for them. That's what it does. It doesn't serve kids who are at risk at all.

Now, my guess is that's the way it is in most communities in Ontario. We have good data in some communities. If that's true, then that's the challenge to recreation. It's not enough any more to say, "We're going to be satisfied by the kids who come out." You say, "No, no, your duty is to serve a population of kids." So it alters the whole thing around. I can't, from my own point of view, emphasize enough the importance of keeping score and finding out how we're doing.

Ms Knox: I think there's some will around making that happen. If you talk to the commissioners of parks and recreation, for example, there is an interest in supplying services to all kinds of kids. I spoke with the commissioner for North York, who's new there, and said, "What are you doing to involve kids in planning the programs?" It's one of the recommendations the Ontario Coalition for Children and Youth gave us: "If you're planning programs for us, involve us in it."

It may well be, with program planning on the recreation side, that if we involve youth more in thinking through what we do -- the timing, the requirements, the particular activities that are being made available, the money, all of those things -- truly we may find that it's money better spent and we may be able to set up programming that is appealing to a broader range of kids than we are at the moment. We're spending a lot of money on recreation programs already, so are we getting the best bang for the buck?

Mrs Yvonne O'Neill (Ottawa-Rideau): There's quite a bit here that I would like to ask about. I think one of your concluding remarks twigged a nerve with me. You said that people become very nervous when they think that things are not as perfect as they felt they might be in children's services. I meet with quite a few people in that condition. Do you feel that this condition is growing? Do you feel that there is a feeling that children's services don't have the profile they did?

We certainly have seen cutbacks in these areas, and some of them are pretty obvious. I guess what I'm asking is, do you think the situation is changing or do you think it's just because people are more aware? What would be your answer to helping me understand more what you were saying? That's my first question.

Ms Knox: Maybe I'll start. Part of it is we don't know well enough what the answer to that question is, but we do know there's more children living in poverty. We know that the suicide rate has tripled in the last 30 years. We know that violence is on the upswing in some areas. We know that dropout rates from high school are not acceptable. We know that functional illiteracy rates are, by some thinking, up to 20%. Some of it says we're probably going downhill and some of it says, regardless of if we're going downhill or not, it's not acceptable.

Dr Offord: We don't know. I think the anecdotal answer is that the people on the front lines feel overwhelmed. Children's services are just worn out. For myself, I could see kids seven days a week, 24 hours a day. The fact is, there are more and more and more.

I think the difficulty is that the pressure is on what I would call these treatment resources to solve the problem, and that won't work. It will not work. Whether you have more money or not, it won't work, because the problem's too big. I think one has to back up and say: "Okay, we're going to need good treatment services, but it's going to have to be for a smaller group of kids. The group we have now is just too big." What we need now are programs at different levels. I think one of the strengths of this report is it backs up a bit and says, "What could we do for all kids?" These are some of the recommendations.

Now, that won't do everything for every kid, but our hope is, and there's some beginning evidence to suggest, that if these recommendations were in place, it would help a lot of kids. Then, I would think, there will still be some kids who will need specialized services, but it will be a much more manageable number. So children's aid case loads would be down, children's mental health centres' case loads would be more manageable, then it becomes more doable.

The way it is now, with no overriding push on programs for populations of kids, the treatment sector is trying to pick up the slack, and I think it is overwhelming.

Mrs O'Neill: I'm very pleased you've brought parents in an awful lot, even your first recommendation. Maybe you've met parents. Are they expressing needs to you themselves? The youth, I know -- I've had the same kind of meetings -- are suggesting that parenting skills need to be improved. What about the parents? Will they come on board, do you feel, with this?

Dr Offord: A lot of parents clearly want and are willing to accept other support, whether it be parent training or community support. Trying to raise a kid, particularly if you're a single parent, rich or poor, if you're isolated with no social supports, becomes a very, very tough job, so there have to be ways at a community level to provide these parents with social supports.

Having said all that, there's a challenge. For instance, parent training programs work, if the parents will come. They don't do everything for parents, they're not cure-alls, but it helps parents manage their kids. It doesn't help parents with wounds from their own childhood, it doesn't help parents with lots of stress, but it does some things. The challenge will be to see how we can get high-risk parents out to these courses. The parents you want most to come out to these courses are the hardest to bring out. There's a lot of work to be done as to how to involve parents, particularly those who need these outside supports the most.

Ms Knox: It perhaps is an opportunity for a workplace to get involved. If employers understood how important it was for their employees who have families to function well, what it does is allow them to manage their work and family lives better. If you think about what it would take, maybe over lunch hours or before or after work, for it to be one of the places you could deliver such a program, it's a very simple idea. It isn't a very expensive idea, and in the long run it may be more supportive than other ideas that come into play. It's a small one, but it may be one that makes quite a difference.

Mrs O'Neill: I think it's very important, and I'm very pleased you said it. I have some very small experience that the business community is very interested in this issue.

You mentioned something, Dr Offord -- or maybe you didn't mention it; it was more implied -- that I had some difficulty with. I have been meeting with children's aid societies quite often lately because they feel so threatened; I think that's one of the reasons they're coming. You kind of -- what should I say? -- lump them in with children's mental health services. They have a lot of difficulty with that. You likely know that. They see themselves much more in a protection role, and they feel that somehow or other there are several people trying to mould them into another function that isn't really mandated to them. I wondered if you could comment on that.

Dr Offord: Well, you're going to get more than one view on this. This is a controversial view. There is one community in Ontario where children's aid and children's mental health are coming together as one organization.

Here are the facts from our own work. What distinguishes the kids who come to children's aid over kids who come to children's mental health services is the fact that they are poor. Children's aid services in Ontario service poor kids, primarily. These kids have a lot of problems. And what service you go depends on where you live. When I last looked at the data -- they're old -- in Kenora 14% of the kids in Kenora go to children's aid society. Why? Because there wasn't anything else up there at that time; that was the only place to go. In Peel county, which was, relatively speaking, highly serviced, less than 1% went.

My own feeling would be that it can't be done overnight and all that sort of stuff, but as a first thing, children's aid and children's mental health should get together and have common intake procedures so we know what kids are going to what. My own feeling would be that it would be the same kinds of kids who are going to both services; it just depends on where you live. They do have different mandates to some extent, and that would have to be taken into consideration, but I think it's by luck and where you live that determines where you get into the system. If you're very poor in Hamilton, you go to children's aid; if you've got more money, you go to children's mental health. It's the same group of kids.

The Chair: Can you identify the community that is trying to come together?

Dr Offord: This is by word of mouth, so I hope this is correct. I'm sure it's Leeds-Grenville, that group up around Kingston. There are six counties there. They have come together, and as I understand it, they are working on or are going to have one joint children's aid and children's mental health.


Mrs O'Neill: I've had the opportunity this year, just in the last few months, to have more contact with the north and what they're doing, particularly in children's mental health. They really do believe things can be predicted very early. I guess it's because people who live in the north tend to stay, and some of them have worked with and seen children actually from prenatal and now they see them in the courtroom as young offenders; they're often called throughout that time. They can actually name names of families and children they could have foreseen. Do you get that same feeling, that we can learn something from the north in that respect?

Dr Offord: I think you can, but I'm putting in a word of caution about prediction. We're not that good at it. That's the overall answer. People can give individual cases: "I knew that kid when he was four. I knew he'd be in difficulty, and here he is." But there are other sides to that. A lot of kids like him at four are not in difficulty at 15, and a lot of kids in difficulty at 15 weren't in difficulty at four. When kids are in difficulty at four, we should intervene because some of them are going to grow up to be that way, but we're not going to be that accurate at predicting in the long haul. That's why I think there should be interventions at different points.

Mrs O'Neill: You still talk about early intervention, though?

Dr Offord: Absolutely, but not the only thing one would do.

The Chair: We're going to move on. Everyone wants to ask some questions, and we'll make sure everyone has time.

This is an excellent opportunity to look specifically at this report. We have talked with representatives, who are sitting in the room, from the Coalition for Children and Youth, and I just want to say to members of the committee that we are in the process of working out a specific time for them during our children at risk, just so we can effectively complete this part. While this is done under a different legislative section, it really all fits as part of the whole. As we move on, we will have an opportunity to speak directly with the youth who prepared that specific report.

Mr Tony Martin (Sault Ste Marie): Thank you for coming today. I came to this meeting from chairing a minister's working group on violence in schools, which is a big issue. One of the things you've mentioned here in a couple of places is the issue of kids feeling safe. I've got a couple of questions out of that work, because we've done an awful pile of it over the last number of months, trying to get a handle on this thing and put some things in place that will be effective and helpful.

You put here the "perception" of increased violence. Is it really simply a perception or is there increased violence out there?

Dr Offord: I don't think we know for sure. To know whether there is increased violence, you'd have to have good measures, of whatever it is you want to measure, at three points in time to know how things are going. The feeling of people is that there is increased violence, if you talk to child care workers and teachers etc. One would have to take a firm look at the same kind of data collected at three points in time to make sure those anecdotal, clinical observations are indeed real. You'd find out about youth arrests and stuff. I'll give you one example in the States.

In the United States, kids in 1993 report the same amount of anti-social behaviour as they did 10 years ago -- they themselves. What's clear in the United States is that official statistics for youth crime show a tremendous rise in violence. Youth are reporting the same amount of stuff they've always reported, but it appears to be much more serious now.

To say that youth violence is getting worse -- I don't know the answer to that. Maybe it is known by data in Ontario.

Mr Jackson: How is it in your own practice, for example? How long have you been in practice?

Dr Offord: A long time, 30-some years.

Mr Jackson: Have you seen an increase in violent or anti-social behaviour in your cases? I thought that was the case.

Dr Offord: I think it is, you see, but what I say I don't think is a good example of what the deal is. It's not just who comes to me. The issue is on a broader scale. One of the things that should be looked at, and perhaps the data are available, is to say whether indeed violence is rising. Maybe it is rising, and if it is, then you could say, "Look, we collected data in 1980, 1987 and 1994, and by gosh," in whatever it is, youth expulsions from schools or youth violence, "things are getting worse." Just make sure that those data are available and firm before one makes the statement that it's getting worse by a certain amount. I'm just being cautious.

Mr Martin: Certainly we're trying to put in place some mechanism of reporting so that we can get some numbers and have some hard data on that.

Dr Offord: Our report card will be very valuable in that respect.

Mr Martin: When I look at this, it certainly looks good and I want to go out and do some of this and make it happen, but it's not as simple as that. It's actually quite complicated.

Another discussion we had today at the table that I chaired was the question of defining what parenting skills really are. Today, with the family being constituted differently in various circumstances and the different cultural groups we have in Ontario and all of that, how do we get a handle on all that? Did you do any looking into the impact of that on some of this information and how that interfaces, that kind of thing?

Dr Offord: I'll just say, and maybe Marilyn has something to add, that we're not very good at it. Our group runs parenting courses. These parenting courses probably do better with white, middle-class people. In some of those schools we did research in, there are 63 languages spoken. This is a whole new Canada and Ontario, compared to when I grew up in Ottawa. The parents have different ideas about parenting than I'm used to, and what is needed to help them with parenting is probably going to be very different from the kinds of things that would help people I grew up with.

One of the strengths of Ontario is our cultural diversity. One of the challenges is to think of ways of making these recommendations applicable to the wide diversity that's present in Ontario, not just the native community, which is a huge challenge, but other cultural groups. I would think we just don't know much about that yet.

Mr Martin: I'm not sure how I'm going to put this, but it's the issue of seeing more kids coming out of poorer situations who find themselves in difficulty. I did a bit of work with young people before I got here, and that wasn't necessarily the case. I dealt with kids from all levels. How does that really shake out? Why would that be the case for me, given that you've said very clearly here that one of the determinants of health is prosperity?

Another question: We're seeing a phenomenon out there today of young people going to welfare, and there's the penchant to say that the great majority of them really shouldn't be there. There's a huge backlash and there's a huge effort now to try to catch the ones who are in fact abusing the system. Do you have any thoughts on that, given that we're looking for resources to put into the kind of thing that you're suggesting here?

Dr Offord: You're raising large questions. The first one is an important question. Poor kids are at increased risk for everything I don't want my kid to have, and I'm sure you don't want your kids to have, by two or three times. But at a population level, most of the kids who have these things are not poor, because the poor are such a small segment overall. If you could eliminate all the serious anti-social behaviour emanating from kids among the poor, you'd make a reduction in the overall problem. I don't know what the exact figure would be; my guess is that it would be no more than 20%.

Most of the problems that afflict kids in Ontario occur in other than the poor, because there are a lot more kids. The poor have more of them. You've got to think of solutions and not say, "If we could only get it straightened out with the poor, we'd be in great shape." The fact is that we will not. It will not attack the major numbers of kids who have problems. That's number one.

The second thing is that we've finished a piece of work that we're going to have out shortly. If you look at unemployed 20- to 24-year-olds in this province, you find that by and large they're a healthy group of young adults. The difficulty appears to be that there are not jobs for them. They're not a disadvantaged group overall; there are some within them who are disadvantaged. If you contrast that with school dropouts, however, kids who drop out of high school before graduating, you find that these kids are a very disadvantaged group, and it's not just educationally. They have a lot of difficulties before they ever drop out. They have much higher rates of psychiatric impairment.

The implication of that latter finding is that if you want to do something for dropouts, it's not just an educational problem. We're going to have to find ways of delivering a wide range of services for these kids and deliver them in such a way that these services are acceptable to these kids. In our work we found a big difference between high school dropouts, the disadvantaged group and all sorts of sectors, versus the unemployed young adult, who generally tends to be rather healthy compared to his peers.


The Chair: Mr Jackson, I understand that we may have a bit of a time problem, because you have to go and do some interviews on the report. So if you would go ahead, I will do my utmost to get those who are remaining on as well, just so members are aware.

Mr Jackson: I would like to thank the co-chairs for being available today and for being so concise in your responses. It's appreciated. I don't always agree, in particular with Dan. We've been before each other three or four times in various committees around social policy and children.

Let me say at the outset that I had hoped the report would have focused in on the tripartite nature of how this province deals with children. I facetiously felt that the title Yours, Mine and Ours was the Ministry of Health, the Ministry of Comsoc and the Ministry of Education and that "Yours" was generally the plight in Health, "Mine" was generally always the claim in Community and Social Services and "Ours" was this sort of split personality between our public and separate boards over each child in this province.

Underlying that subtle humour is a very serious concern. I can think of no other fine-point example than how we're handling preschool speech-language pathology in this province at the moment, which in my view is tragic. We've got millions for third-language instruction, but we can't teach a child to communicate in the first working basic language of the school yard. I don't indict the report; I just had more hope placed in it that it would have zeroed in on that. You may want to respond to that. That's my own personal view and I think that's really the tough nut for us to get at, just as we've had to deal with that at the other end of life's schematic, with long-term care, for example. We really must deal with this issue.

The second thing I wanted to raise for your consideration is that the transition to school is a critical issue. People have said that we have a fine educational system, and we do. We have one of the most expensive educational systems in the world and therefore we should be able to get better results, in human terms, out of our educational system than we're getting.

I guess my fear is that your recommendations -- there are only two of them. One of them -- forgive me for saying this -- smacks of basically a labour agenda, that somehow, if you read it very carefully, we're talking about parenting and children and then we're talking about workplace policies, friendly policies in the workplace, flexible hours, flex-time options, sick leave to care for sick children, extended parental leave, top-up leave provisions, options for part-time work, work at home. These are all labour issues; I'm sorry, but they are.

I've never quite seen a report flag that in such clear and concise terms. If we look at the 1.3 million on social assistance in this province and the million-plus who are unemployed, if we really want to get at the nub of a large, disproportionate percentage of children at risk, their challenge isn't who makes the box lunch and gets Johnny out to the bus to get to school while mommy and daddy go off to work. This is not the atypical at-risk situation in this province. We're looking at probably -- the numbers in March came out -- a quarter of a million children from single-parent families who are under the age of 10. Then also we have 375,000 children of single parents on social assistance. These are the largest cohort we've seen in our province's history and almost disproportionate with provinces like Newfoundland and others where chronic unemployment and serious problems have become more accepted than we should be allowing them to be in our province.

Again, you may want to comment on that, but when we were looking at a priority for social service reforms to ensure that a child has a guaranteed access to an economic envelope of opportunity, recently we've had some policy announcements that this just is not doable.

Yet your report mentions nothing of it. Again, that causes me some concern. There's some very good stuff in here, but if I were looking for the big issues to crack some of the toughest things out there, those two I was looking for, and I didn't see them. Perhaps you could tell me why.


Mr Jackson: I've been waiting for the parliamentary assistant to Comsoc to make some contribution to this.

Ms Knox: What we did was we looked at what the determinants of health would be for children entering school, and as we talked about what the determinants were that you could take action on, you could measure, you could do something about, that were amenable to policy change, high quality care and prevention of injury were the two that came to the top of the list. They're not the only two, but if you look at interventions on those two, high quality care and prevention of injury, these are the recommendations that fit up against those.

You may dispute the choice of those determinants, but if you're picking those determinants, those are the ones that make a difference, and if you look at entry into school, sort of prior to getting into school, there are issues around school that we need to deal with. I think if you look at the transition stage 3, it speaks to that more, some of the issues that you're raising.

We felt that at the local level was where there was the need to bring the pieces together, and it absolutely doesn't duck the need that Health, Community and Social Services and Education have to come together, and if we look at a community where we start to change things and we get the government to unbundle some of the funding and look at envelopes, the opportunity will be at the community level to do exactly what you're talking about.

Our thought was not to be so prescriptive as to say who has the lead and what each community must do, but to give them the framework and the measures so that they can figure out what to do.

Mr Jackson: Marilyn, you hardly even say that in the report. I wouldn't expect you to pick the lead ministry.

Ms Knox: We said all of those things in the report. Tell me why you don't think so. I'd be glad to hear it.

Mr Jackson: I suspect that the courage in any report is in its recommendations, and it was in that area that I was looking for something a little more substantive or some insights with respect to differentiated entry points.

It's very easy. We're talking to a child psychiatrist who's dealing with two- and three- and four-year-olds. In the educational sector we know that approximately 60% of the cognitive development of a child is occurring between the age of birth -- pre-birth, depending on the report -- to the age of six, and yet not to have had this whole area of entry into schools thought out in something a little more beyond, "If there's sensitivity by your employer, whomever you're employer might be, that we believe there is room for improved parenting" -- there are too many children in Ontario who don't have parenting, or that the social assistance and simple survival within it has created problems for children, and as the doctor has referred to, we've even got them ghettoized in terms of identification if we look at certain housing projects in Toronto.

That was my comment. I'll re-read the report, but like all persons in the interests of a brief presentation, I went immediately to your recommendations section --

Ms Knox: It doesn't live for you.

Mr Jackson: I could've written eight or 10, and I'm sure you would've liked to have written eight or 10, but for some reason the symmetry was to have just a couple in each of those levels. It's your report.

Finally, and I have to yield the time because the Chair is being most patient with me, perhaps, doctor, if you'd look at whether it's young offenders' statistics in this province or incidence reports by police, you will see just how serious our violence problem is and the nature of the violence, whether it's in our schools or just in the youth cohort, but I was concerned that you felt that it wasn't quantifiable enough to be able to make a statement that we are living in a more tolerant-of-violence society or we're in a more violent society than we were 10 -- or whatever other two points you wanted to examine.

Dr Offord: Maybe the data are available; I simply don't know, but I think it's important to find out. If the data are available, some conclusion could be said about that.


Mr Jackson: It didn't come up in your report that much, is what you're saying.

Dr Offord: I don't understand your point. Is your first point that we didn't talk about the lack of coordination among ministries? I just want to understand it. In just plain English, what's your first point?

Mr Jackson: My concern was that I was somehow hoping that you would, either in the recommendations section or in the report, identify in clearer language your concern for the various ministries that have almost competing interests.

Dr Offord: Got you.

Mr Jackson: Your response to Ms O'Neill's question about the role of children's aid societies might have caused me even more concern, because I see that as more the only legal protection a child has in society through that piece of legislation is our children's aid societies, and that frightens me even more.

Unless the Chair will allow us to get into a debate, I was quite concerned about those responses.

Dr Offord: Let me try and answer that question.

The Chair: If I could, it's just that I have a couple of others who want to ask questions. I appreciate you're getting close to a bit of a time problem. I wonder if you could just reply to that, and then I would like to try to at least get in one more questioner before we have to leave.

Dr Offord: I think we clearly understand that ministries have to work cooperatively together, if that's the issue. What we did in the report, I think, is a wise thing. This report is not directed only at government -- it is not -- and the wellbeing of kids in Ontario will not be solved by government alone, believe me. It will be solved by communities outside of government.

Now, our recommendation for the preschool I think should be in line with you. We feel that kids should have a stable and supportive relationship in the first five years of life if they're going to do well in grade 1. That is a recommendation. How that's to be brought about and bring the different sectors together to do that -- one can try and do it at a provincial level. We are going to try and see if there are models in communities, as Mr Hope mentioned earlier on, that can bring those services together.

Your second point about poverty I didn't understand: that the way to help poor kids is what, to give the parents employment? I wasn't quite clear what your point was.

Mr Jackson: Some of the social assistance reform that was targeted for children was recently shelved by the government. I just didn't want to get into a political statement, but obviously it wasn't discussed at your committee.

Dr Offord: But just let me tell you the point there. I think it's clear that there two ways to help poor kids. It's an open question. I'm all for ways that make things easier for the parents. Also, another way to help poor kids is to make sure that they have equal access and benefit equally from programs that are available for all kids. In both cases, I think we're deficient in the province.

Mr O'Connor: I appreciate your report and the thought put into it, and I appreciate your coming before this committee. At times we do get carrying on a wee bit, because we'd like to see more in here, you know, and we know that you've had to focus on just some.

Something that wasn't talked about, again, very much in this report, and I just wondered if you can explain perhaps why or how it could have fit in as part of the report card mechanism, is violence at home, violence that's in a community. We talk about community involvement and the transition to work and community and everything else, and I think we've got a problem there as well. We've got a lot of hidden problems, and you've mentioned in your opening that family violence is out and it's open now; it's not hidden any more. But I don't think we've dealt with it, and I don't think you have, but I wondered if maybe you can explain why and if there is room for that to fit into the report card.

Dr Offord: Clearly, there's room for it on the report card. The problem with it is that we're going to have to find a way of getting measurement of it that appears to be fairly reliable. I would agree that that's an important issue and some of the interventions that will happen in these communities -- if we knew what to do to prevent that and knew how to measure it, it would help us a lot. I agree with you. It's an important issue, and in the next stage we're going to have to figure how one might both deal with it and measure the outcome.

Mr O'Connor: I was in Guelph on Friday. The Ontario Farm Women's Network pulled together people from the rural communities to talk about this type of violence and what not, and it is something that's difficult to deal with.

One of the recommendations, your slide 30, talked about the mentoring in all secondary schools. Would you expand on that for me? My riding is rural, and I also have a native community within my riding, and I know that other parts of both Durham region and York region have a higher ethnic makeup and diversity. I wondered if you wanted to touch on that. Would it be targeted, or not targeted? How do you approach it?

Dr Offord: I want to get back to your first question and comment in a minute. My own feeling would be not to target it, not to say: "Listen, you don't need a mentor, but I want you to get a mentor." That probably does adolescents more harm than good, if you stigmatize or label them.

I think it would be open to all. The point you raise is that it would have to be done in a culturally sensitive way, that the mentor would have to be seen as suitable by the person to be mentored.

Also, the score would be kept at the population level -- very important. What will happen with any mentoring program is that the kids who need it the least will be the first ones to pick it up and the volunteers will be the first to pick them up. What needs to be done is to find a way to find out: "Who does not have mentors? And what particular things do we have to do to make sure that these kids who appear to be most in need of mentors are likely to get them?" That's the importance of keeping score at the population level.

You had one other point about reducing violence. One of the things we know works in preventing child abuse -- we don't know much about how to prevent things, but if you take young single moms and you provide them with a telephone and a trained home visitor on a regular basis -- it could be a public health nurse, it can be a trained home visitor -- there are data to indicate, of very strong scientific design, that these parents do better and their kids do better. Whether it does everything for these parents and how much better off the kids will be over the long haul, we don't know. But I think we have some leads one could put in place at the community level to try to cut down, at least to try to prevent, early severe child maltreatment.

The Chair: I think we've worked out an arrangement that will ensure that Ms Carter and Mr Rizzo get to ask their questions, but Marilyn Knox has to leave right now. I believe Dan Offord can stay for a few minutes. I thank you for coming to the committee today, and we'll complete the questioning to Dr Offord.

Ms Knox: Could I say one or two things before I go? First of all, this is the report available from the Premier's Council on Health, Wellbeing and Social Justice. What encourages us from the conversation we've had here today is that we were right to be bold enough in phase 1 to get the conversation going. We were also right not to think that we had it all figured out by the end of the first phase. It's important for the community mobilization to be a piece of what each and every one of us around this table does, and if you believe there's more to this than we've gotten to, then it's Yours, Mine and Ours.

It perhaps is something that needs to go beyond political agenda, although the politicians are absolutely fundamental to this. As Mr Hope pointed out and Mr Jackson pointed out, you all have very strong views and experience in your own areas and you know what's going to start to open things up. We don't know. It's why we didn't overprescribe in this.

We very much appreciate the interest and the very engaging conversation. What I can say is, every time we have this conversation, from the group of seven paediatricians I spoke with in great detail on Saturday morning, to this group, to the coalition's conversations and so on, every single time the conversation is most engaged, most concerned, sometimes at cross-purposes, but always in the long run trying to do something, that now is a time that we can't ignore this. We appreciate the interest and the fact that you put us on the agenda just like that.

The community mobilization has now begun. It's a good test for us to know that we need to go out and get more input. Perhaps there will even be another report that comes in at the end of that phase. Thank you very much.


The Chair: Thank you very much. We'll now complete the questioning. In the interests of time, Mr Rizzo and Ms Carter, perhaps you could encompass it in one question.

Mr Tony Rizzo (Oakwood): Just a couple of words. You are talking about families changing. I wonder if you considered the new family of the future. People are talking about the same-sex family and what the implications are going to be for the children in the future.

Dr Offord: I don't know. The only thing I can say is that the Ontario I grew up in wasn't like it is now, and it's changing in many ways. That's one way. Cultural diversity is another huge way. One is going to have to be open and not feel one knows too much. I don't know what will happen there. "Humble" is what I was trying to think of. I just don't know.

Ms Jenny Carter (Peterborough): This is such an enormous subject, it's hard to know which thing to raise, especially in limited time.

I think we're at a point now where changes that have been happening over a long period have come to a crisis, with more and more moms going out to work. In the old days, moms had to stay home because there was so much to do in a household, and now we've got all this automation and ready-made food and so on. It's evident that it's better for women that they can get out, but it's not so evident that it's good for children, so we have this problem.

Do you think the main emphasis should be on having universal day care so that women can just go out like that and forget about it, or should it be more the kind of thing I think they're doing in Scandinavia, where you give very long parental leaves and allow both parents to have quite a long time off with some kind of pay?

Dr Offord: Again I don't have all the answers. The one thing that's clear is that the mother has to feel comfortable with the arrangements. That appears to be a big predictor. Some mothers feel comfortable going right back to work; some mothers feel comfortable taking the six months off or whatever it is.

I don't think it's either/or universal daycare; there has to be a way in communities to make sure that whatever the working arrangements are of the parents, the kids have a stable and stimulating environment. That can be in day care, it can be in preschool resource centres or it can be in a variety of ways. But all of us have to understand that for the future of the country, we have to find ways of looking after these preschoolers in a consistent, stable and stimulating way.

Ms Carter: Absolutely, and I think you're right that the mother has to have that choice.

Another thing concerns me. When we look at aboriginal societies, we say a lot of the problems they're experiencing are because they almost lost their culture and they don't know where they are in the world and they have to get that back. Do you think a similar thing is happening with the rest of us, that kids are too liable to grow up without really being involved in any heritage, partly because we have so many different ones coming together that it's hard to maintain any given one and we're left with something that's kind of a mishmash and a bit thin?

Yesterday, I went to a Mother's Day concert at the art gallery. It was young musicians, who were superb. They all seemed to be children of immigrants, for some reason. I thought, "I'm sure none of these kids is going to get into crime or drugs or anything, because they're just too involved in something."

Dr Offord: I think you've hit on a very important point. Clearly, the cultural roots that people have and that kids have are important.

One of the findings from the youth report was the tremendous amount of racism these kids experience. This is a thing that's not going to be solved by government, for sure. How the heck are we going to raise a generation of kids who are going to be tolerant and respectful of a huge diversity of ethnic and cultural and racial backgrounds? When I was growing up in Ottawa, it was Anglo-Saxon and that was it, and a few other people we thought were odd. It's very different now, and we're going to have to think, all of us, of how we can help raise kids who are tolerant of these differences.

My own experience as a clinician coming in again: This is a huge problem, a huge problem in the schools, and how that's to be solved -- all I know is that that kind of stuff starts early on, and we're going to have interventions throughout the life cycle.

Ms Carter: I think it's important for kids to have their own culture, not just to be tolerant of other people's. Some of them just don't.

Dr Offord: I agree with you on that point.

The Chair: We could go on, but I know you have to head off. I want to thank you and thank Marilyn Knox again for coming before the committee.

There are a number of issues we haven't been able to get into, not the least of which is thinking through the community report card and how that will evolve. I understand from your remarks that that is something the council is going to turn to next. As a committee, we may at some appropriate time in the future want to sit down and have a look with you at what has evolved, because clearly that's going to become a very important element of the work you've described.

In closing, I would like to thank you all on behalf of the standing committee. This has been very helpful to us and also for those who have had, and will have, because of the way these things replay, the opportunity of watching the hearings on television.

Over the course of the next few weeks we are going to be looking at the question of children at risk and talking with some different provincial groups and others about that issue. Everything you have placed before us today fits in very well as a kind of an appetizer, in more ways than one, to what we are about to do.

The committee adjourned at 1717.