CHILDREN'S MENTAL HEALTH SERVICES
MINISTRY OF COMMUNITY AND SOCIAL SERVICES
ADVISORY COMMITTEE ON CHILDREN'S SERVICES, CATHOLIC CHILDREN'S AID SOCIETY OF METROPOLITAN TORONTO
ONTARIO ASSOCIATION OF CHILDREN'S MENTAL HEALTH CENTRES
LAMBTON COUNTY ROMAN
CATHOLIC SEPARATE SCHOOL BOARD
LAMBTON COUNTY BOARD OF EDUCATION
KINARK CHILD AND FAMILY SERVICES
CONTENTS
Monday 14 January 1991
Children's Mental Health Services
Ministry of Community and Social Services
Advisory Committee on Children's Services, Catholic Children's Aid Society of Metropolitan Toronto
Ontario Association of Children's Mental Health Centres S-10
Beechgrove Children's Centre
Lambton County Roman Catholic Separate School Board; Lambton County Board of Education S-19
Kinark Child and Family Services
Adjournment
STANDING COMMITTEE ON SOCIAL DEVELOPMENT
Chair: Caplan, Elinor (Oriole L)
Vice-Chair: Cordiano, Joseph (Lawrence L)
Beer, Charles (York North L)
Haeck, Christel (St. Catharines-Brock NDP)
Hope, Randy R. (Chatham-Kent NDP)
Malkowski, Gary (York East NDP)
Martin, Tony (Sault Ste Marie NDP)
McLeod, Lyn (Fort William L)
Owens, Stephen (Scarborough Centre NDP)
Silipo, Tony (Dovercourt NDP)
Wilson, Jim (Simcoe West PC)
Witmer, Elizabeth (Waterloo North PC)
Substitutions:
Jackson, Cameron (Burlington South PC) for Mrs Caplan
Miclash, Frank (Kenora L) for Mr J. Wilson
White, Drummond (Durham Centre NDP) for Mr Silipo
Clerk: Mellor, Lynn
Staff: Drummond, Alison, Research Officer, Legislative Research Service
The committee met at 1334 in committee room 2.
CHILDREN'S MENTAL HEALTH SERVICES
The Vice-Chair: I call the committee to order. I have two brief announcements to make before we head into our presentations. They are both dealing with the schedule. The first one deals with consideration of two groups that want to appear before the committee. As members are aware, the subcommittee determined which groups would be allowed to make presentations. That was done prior to our meetings here and each caucus submitted lists.
One of the two groups is the Earlscourt Child and Family Centre. The clerk and members of the committee were contacted by Ken Goldberg of Earlscourt requesting that its committee be allowed to make a presentation to our committee. The other one is the Ontario Public School Boards' Association and the same request has been made. I would recommend that if the committee agrees, we schedule these two groups on Tuesday, one at 4 o'clock and one at 4:30.
Mr Beer: Agreed.
The Vice-Chair: The other matter is with respect to the time that each presentation will take and the order of questioning. I just want to bring to everyone's attention that under standing order 123, we do have limited time -- 12 hours in total. That also has to include time for preparation of our report and time for questioning and presentations, so we must adhere to the strict rule of a half-hour for presentation time. I will try to be as fair as possible in allocating questioning. I will try to allow each party one question. I think that is the fairest way to proceed on each presentation.
There is also the matter of Donna Roundhead of Nodin Counselling. She was unable to attend and asked that Charles Morris of Tikinagan Child and Family Services be scheduled in her place. That is tomorrow. I bring that to the members' attention at this time.
If there are no other questions or discussion, I would ask that we turn our attention to our first presentation. Is there a question?
Mr Martin: I am sorry I am late. I flew in from the north and it is pretty stormy out there today. I have a couple of questions I would like to ask. They may already have been asked or addressed.
The Vice-Chair: Would you like to catch your breath first?
Mr Martin: Yes.
The Vice-Chair: We have not started the presentation.
Mr Martin: I know that this is a particularly serious undertaking. The topic of the day is one that concerns me and, I am sure, everybody who is here in a major way. I want to make sure personally that the crack we are getting at it now is a good one because I know from my own personal experience in the north that there are many children suffering for a million reasons, but a lot of it is because we have not been able to provide the services necessary to give them and the people who work with them the support they need.
I have a couple of concerns that I would like to raise.
The Vice-Chair: Excuse me for a moment. Is this dealing with the question of scheduling groups?
Mr Martin: Yes, it is.
I recognize, looking through the list, a lack of participation by a whole lot of folks in the north who should be here. Not only that, but I brought this up before when we talked about how this might be set up. You do not really get a picture or a sense of the true problem that exists in the north if you do not in fact go up there, have a look yourself and talk to some folks in some more informal settings where they actually operate and live, as to just what is going to be an answer to some of the problems these people are facing.
It concerns me deeply that, first of all, there are not more people from the north making presentations from a wider cross-section of communities and that we have not, in our corporate wisdom, decided somehow to go up there and have a look ourselves. I know that we are limited by some of the legislation around this regarding the 12 hours and all that kind of stuff, but I also know that as a committee, if all of us decide that we want to do something, there is nothing to stop us from doing that, from what I understand. If everybody decides to expand or go beyond the hours that are now available to us or the ways and means of hearing from folks who seem to be inherent in the package that is in front of us today, we should perhaps look at that and seriously consider some other things.
The Vice-Chair: Could I just interrupt? If the committee might look at those matters that you bring before us, we can do that at the end of the day because I do not want to hold up our committee hearings. Many of the people who are presenting today have come from far and wide and I would not want to delay their presentation time.
Mr Martin: I realize that, and I hope you also recognize that I have a real concern that from the very beginning this thing get off on the right foot. I want to make my concerns known.
The Vice-Chair: We have a subcommittee agreement from all three parties that we would proceed in this fashion. The scheduling was worked out by all three parties.
Mr Martin: I will not take too much more of your time, if you do not mind, to present one other point.
The Vice-Chair: Okay. I will allow you another moment just to make your last point.
Mr Martin: My last point is that I do not sense or see in the list of witnesses who have come to present today a very wide representation of those whom we might consider advocates and parents of children, and also some of the children themselves: perhaps not the ones who are in stress today, because they may not be in a position to come and present here and feel comfortable, but certainly there are those who have gone through the system whom we might have in to speak to us and share with us what the concern is in all of that.
The last point I would like to make is, I really appreciate the fact that the Progressive Conservatives brought this forward at this time because I think it is a good time and a good topic to begin our session as a committee.
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MINISTRY OF COMMUNITY AND SOCIAL SERVICES
The Vice-Chair: Without further ado, I would call upon our first presenter, the Honourable Zanana Akande, Minister of Community and Social Services, to make her presentation. Welcome to the committee.
Hon Mrs Akande: Thank you very much. I must apologize to all of you for reading my presentation. It was on the best advice that I was given, so you will forgive me if I stray from it. I am not accustomed to speaking from this kind of note.
Thank you for the opportunity to meet and talk with you about the challenges of children's mental health services in Ontario. It is a timely discussion and one which requires our attention and energy towards effecting a solution.
In my many roles, previous and current, as a parent, as a teacher, as a special education consultant, as a volunteer and a committee member to many committees on children's services, including the Advisory Committee on Children's Services of the Ministry of Community and Social Services, I have been involved extensively with children and their families. This involvement has allowed me some knowledge of the needs of children and the family. More important, this involvement has emphasized the importance of a continuum of service for children.
Our mission, our vision, is to develop a comprehensive approach to the children and families of Ontario. To meet that challenge, we have to confront the causative factors of disadvantage: poverty, unemployment and deprivation, and cultural difference. In addition, we must also have a system of services in place that responds quickly and appropriately to individual needs. Only by effecting fundamental changes can we achieve our vision of a child- and family-oriented human services system.
Many forums are now talking about issues that relate to our children, in international circles as well as within communities and neighbourhoods all across this province. Here is our opportunity to meet and talk together, freely presenting our concerns and seeking solutions in the frank and open spirit that characterizes our government.
Change is in the air, and change is happening very rapidly. The world is changing, countries are changing and local circumstances affecting children and families are changing. We need to be ready to respond appropriately and make sure that our service systems adapt to the realities of the present.
Recently, my ministry received the report of the Advisory Committee on Children's Services. It is called Children First, to underline its basic concept that children should have first call on society's concerns and capacities and that children should be able to depend on that commitment in bad times as well as good. The report states that without different kinds of supports for children and families to reflect the new realities, the gap between the supports that are needed and those that are provided will continue to widen, that this will occur in spite of the substantial investment Ontario has made in services for children.
The advisory committee concluded that what is required for substantive change is a comprehensive approach for helping children and families that takes into account the expertise and resources of all the systems involved with children. Additional resources may be needed, but this cannot be determined until current resources are more effectively deployed on behalf of children. The report reiterates my own conviction that we need to make fundamental changes in the way we plan and provide services to children.
The message is coming to us from many directions. A recent report from the Ontario Teachers' Federation points out that communities are expecting schools to meet the individual needs of students, something that cannot be done without a network of community resources: local government, health services, youth-serving organizations, private businesses and the philanthropic sector.
The Premier's Council on Health Strategy and the Premier's Council on Industrial Competitiveness have both identified the importance of investing wisely in social policy for children and for youth. Health and social services, income and material supports, education and training are recognized as being essential for the health of the child and also for the social and economic wellbeing of society. The council submits that children should be seen as able participants. They have certain fundamental entitlements in their own right, not merely as extensions of their parents.
The Sparrow Lake Alliance on Children's Mental Health, which included professionals, ministry representatives from Health, Education and Social Services and community representatives, recommended better integration of services for children at all levels.
The message comes through loudly and clearly. We have to look at the whole picture. We have to talk and listen to each other and work together. We have to make changes and they must be comprehensive changes. Our response to children who are hurting must be enacted across ministries and across service sectors. As the advisory committee report put it: "There is no real system for children. We must create a children's system that has a shared vision of children's entitlements. We must establish mechanisms to put the vision into practice and to make the system workable.
I agree. If we are to be effective and make a difference in the lives of children and families, we need to create a system that is truly flexible, co-ordinated and integrated, a system that will ensure that each child and each family receives appropriate service when they need it. I see four basic principles for that system: empowerment, consultation, co-operation, accountability.
By "empowerment," I mean the need to give individuals more choice and more say in the services they require and how they should be accessed, to allow them to move away from the paternalistic control of the professionals and determine for themselves what is best for them.
"Consultation" means to me listening to and heeding what we are already hearing from committees and forums and it means talking to a lot more people. I want to hear from people who have not spoken up or whose voices have not been heard before. I want us to pay attention to and learn from our past undertakings and build on our successes. For example, there is the Better Beginnings, Better Futures initiative, which is testing the value of primary prevention for children at risk, and the interministerial committee on services for children and youth, which is working to develop co-ordinated and integrated services for children. Both these initiatives embody my third principle, that of co-operation, and reflect the importance of cross-jurisdiction and cross-ministry collaboration.
Lastly, we have to be ever mindful of our accountability. Let's try out new ideas, yes, but let's evaluate them as we go and make sure our programs are providing the service they are meant to provide. We cannot afford, in any sense of the word, to misuse our resources.
I said earlier that we must build on our past successes. We must also learn from our problems and this is where today's committee has much to contribute. The range of expertise and the witnesses who are appearing will serve to broaden our understanding of the issues and, I hope, offer suggestions on ways to address them. I anticipate that the work of this committee will help to inform my ministry and the government as we seek new ways to alleviate the distress of people in need.
The vision we share for the children of Ontario is achievable. My personal commitment to realizing that vision is this: I will seek ways to link the various bodies who have expressed concerns and ideas about children and families so that they may work together to achieve consensus and find solutions. I pledge to you today my wholehearted leadership in this all-important undertaking.
The Vice-Chair: We have 15 minutes for questions.
Mrs McLeod: Madam Minister, I appreciate your opening comments. I think we are all excited about the vision that is set out in the Colin Maloney report and we will have a little time, at least, for the committee to spend some time with that report, I know. But I think it is essential that as we look towards a vision that we do in fact build on what currently exists and that we have a clear understanding of the current situation so that we know the kinds of problems that have to be addressed.
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I was very interested that Craig Shields was appointed by the ministry to examine the concerns of the Ontario Association of Children's Mental Health Centres related to the waiting lists and the way in which those waiting lists could be managed. We have not seen the findings of that report yet. I wonder whether or not it is complete and whether you have some sense of his findings and the recommendations it contains.
Hon Mrs Akande: We have been told that we could expect those recommendations would come to us by the end of January or the beginning of February, and we are looking forward to them with much impatience in order to address that.
Mrs McLeod: A supplementary question to that and then I will yield the floor: I am obviously interested, as all of us are, in the results of that particular study, but I have a little bit of a concern even before it is presented that we might tend to define the need and limit our understanding of the need in terms of the waiting lists. I am recalling an old study -- I do not have it in front of me -- that suggested that maybe 50% of children who in fact need mental health services are even being referred to existing centres. So even if we find that the waiting lists are long, that may only be the surface of the problem that needs to be addressed. I am wondering, given your background of experience in the school system, where you often see the children who perhaps need referral, whether you concur that waiting lists alone are not the indicator of need.
Hon Mrs Akande: I do agree that waiting lists alone are not the indicator of need. I also am concerned about the waiting lists and I am concerned with the basic definition. Let me explain what I mean by that. Certainly if one child is waiting, it is too many children who are waiting. Let us be clear about that. Our focus is to address the needs of children and the waiting lists are not the thing that propels us; it is the fact that we want to present a continuum of service to all children who need it.
My concern with definition is one that also comes out of my experience, because as we define children so shall we address their needs. If we define them as requiring treatment, so shall we treat them, and if we define them as having behaviour difficulties, then we address them differently. I think that is extremely important, because frequently children wait on a waiting list for some specific service or treatment and are found later not to require that intense, that extreme, that in-depth service.
I also think that sometimes we do not often address children's needs by using the multiplicity of people around them. By supporting parents in parenting and supporting teachers towards better procedures for handling children who are somewhat difficult, we may be preventing children from being identified as exceptional who in fact have less than that problem.
That is not to diminish the importance of the lists. It is rather to say: "Yes, there are many children who are not on lists who have needs. Also, there are many children who are on lists whose needs are ill defined."
Mrs McLeod: I think all we can do with our committee hearings is begin to open some of the questions. As a one-time practitioner in the field, I would love to have an opportunity to discuss it in more depth, but I will pass to another person.
Mrs Witmer: To the honourable minister, I am pleased that you have prepared this report for us. I know from your own background that this is an interest you have. I have a similar background to your own and that is certainly the reason I put this recommendation forward for the consideration of this committee.
I guess one of the things that concerns me the most as both a teacher and a former trustee is the fact that children were falling through the cracks. Although the Ministry of Community and Social Services has some responsibility, the Ministry of Education has some responsibility and the Ministry of Health has some responsibility, no one was willing to assume the responsibility for the co-ordination. Because of the individual mandates and because of the budget restrictions and because of territoriality, I feel this is one of the reasons we have a gap in the delivery of service to these children who are desperately in need, children with social, emotional and behavioral difficulties.
Minister, would you consider or have you considered the establishment of some sort of a co-ordinating body?
Hon Mrs Akande: Actually, I am happy that you have raised that question because it is one I addressed in a very surface way in this report when I talk of a continuum of service. We have already begun meetings at the minister level and also at the assistant deputy minister level to address this question of interministerial co-operation.
We really do feel that children and families should have a continuum of service. It should not be, as you describe it, lockstepped into Education and Health and Community and Social Services and Tourism and Recreation, because they do in fact fall through the cracks. You are quite right.
More than that, when those services are addressed from that kind of vantage point, they are artificial and they are unreal. Who is to say that a child's problem is addressed by a social worker in Education from 9 to 4 and at 5 o'clock it is somebody else's? It is certainly an artificial way to address the problem. So we have begun that.
We have also begun other committee opportunities to address this whole thing of the provision of revisions in the way children's services are provided so that they are not blocked into little segments.
Mrs Witmer: When you are looking at an advisory committee of some sort and you are looking at a central focus for the provision of services to children, have you considered using the schools?
Hon Mrs Akande: We looked at and we are still looking at using many services. I would not say that we have removed that from our consideration, but I would say that it is important for us to use community-based services that are not owned by any one institution that is currently there, but are rather owned by a community process which defines or allocates services according to need when need is there.
If you put the services in the schools -- we are just in the process of considering it -- having come out of schools, we know that when you put the services in the schools, they are therefore defined by the structure that is already in place, that some time is not the most progressive or creative.
Mrs Witmer: I was surprised and disappointed that you mentioned the need for maybe additional funds. I would suggest that at the present time children's mental health services are severely underfunded.
Mr Martin: I have been hearing for a bit now the discussion around the approach and you elaborated a little bit further here. Are there any other things that are happening there right now that you think we should perhaps know about as a committee and that we should consider as we put together some recommendations?
Hon Mrs Akande: One of the things we are doing as a preface for this or as part of it is trying to identify services that are required by children as a part of prevention, as well as those that are required for those who have already, to use your expression, fallen through the cracks. We cannot afford to continue to support a system that feeds children into the same process that they are in, because obviously that does not work. The other thing is that we are trying to identify where those supports might be put in the system now for those children who are already having difficulty.
I have a great deal of difficulty with maintaining a child supposedly on a waiting list without service while there are others who can provide service for that child with whom the child is readily in contact. I am not saying that any service from anybody is as good as what this child specifically needs, but I am saying that some of those children must be defined in terms of their needs so that we can meet them more appropriately.
There are plans towards greater definition, plans towards using the facilities that we have better, in a way that can meet more children's needs without just adding more services, but there are also plans to look for where that need might be necessary and to add that.
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Mr Martin: I have a supplementary on that -- I had another question and I will try to put them both together -- and on some of the logistics around that. You have got bureaucracies now out there in the communities that are very into their own territory and protective and that kind of thing. Having worked with social planning councils trying to help determine in communities if needs are being met, if not, how can we readjust mandates of groups, and how difficult all that is?
You also talked about reaching out to groups that have never been heard before, children, parents, in all of that. Have you any thoughts about how that might be done? I see it as a huge problem.
Hon Mrs Akande: Well, certainly it may be done through our area offices, plus I am, on my own particular campaign, travelling around this province trying to learn more about what is out there and what is not, rather than just what is reported to me on paper. I am planning to consult with and I have already begun to consult with various groups that are involved with children's mental health services. Certain groups have already been meeting with me the last week and previous to that, and I will be going out to meet with others: consumers, past users, children, parents, as well as professionals.
The Vice-Chair: I have Mr Jackson on the list, Ms Haeck and Mrs McLeod. We will proceed in that fashion. I am informed we have seven minutes left.
Mr Jackson: Minister, by week's end we will have met with several groups, and some of us are quite familiar with their presentations. The faces and incidents will change, but it is clear that we will be presented with a picture in this province that is not very positive about the demand for services. We also know that the economy is in a degree of difficulty and that people, especially children, are trapped, whether it is in an abusive situation or whatever, and that their mobility to flee from some of these situations is limited as well.
My question has to do with the top of page 4. You make what I think is the most unusual statement in your address. "Additional resources may be needed, but this cannot be determined until current resources are more effectively deployed on behalf of children." Then the report reiterates your "own conviction that we need to make changes in the way we plan and provide services to children." I read that several ways, but the frightening way to read it, of course, is that you currently are not pitching the Treasurer with respect to additional funds.
Prior to the last election it was very clearly your party's position, and our party's position, before the government of the day that there should be a large injection of moneys to deal with the backlog in tandem with these kinds of improvements and changes which -- some are complex and some are simple, but we would not want to read into this that we are basically going to be studying this during the course of a year or two. Nobody talks time lines, nobody talks dollars, but clearly the situation is worsening, not getting better, while we study it.
I know by the end of this session, meaning this committee inquiry, that we are going to be left with a compelling sense that this is an issue that simply must not just be studied at this time but also that we must be reacting. That will perhaps surface in our report.
I am looking to you, Minister, for this incredible statement that "additional resources may be needed" when in fact it is abundantly clear to everybody that additional resources are required immediately.
Hon Mrs Akande: You have assumed, Mr Jackson, that I have not begun to knock at the Treasurer's door and I would at least say that this is an assumption that probably only you share. I will say --
Mr Jackson: You did say you were asked to read your report and I see that this was prepared for you, but I know that perhaps there may be --
Hon Mrs Akande: Prepared for me by my input, but I do appreciate your description. Thank you.
Mr Jackson: Thank you.
Hon Mrs Akande: One of the things that we have done, and why I put that statement there, is that I do recognize the great importance of defining the use of services. May I give you, by way of an example, some of the horror stories that exist within our own service education. May I explain to you that very often if children's services are misapplied, it uses services wrongly, so I am not suggesting that we have the problem solved. I am suggesting that there are two things we must do. We must define how children's services are applied so that children are getting the correct thing they need. For example, many of the culturally different children are seen as behaviour problems in some of our schools in situations and that is unacceptable.
Mr Jackson: I am sorry to interrupt, Minister. I am aware of that. I simply asked you about dollars and cents.
The Vice-Chair: I am going to have to interrupt. I would allow one question on your behalf --
Mr Jackson: I have heard this answer before. That is why I interrupted. I apologize for the interruption. I asked a dollars and cents question approaching the Treasurer. That was all I asked the minister for, the sense of urgency she was applying to look for additional resources. That was my question. I am aware of her response on several occasions with respect to how complex the issue is, and I thank you.
The Vice-Chair: I just want to remind members there is a time constraint.
Mr Jackson: That is why I interrupted.
The Vice-Chair: I have two more questioners, so I think we will move on to the last two questioners because we only have four minutes left. I see we are going to have to have a little more patience and perhaps I will intervene when I think it is appropriate, but I will allow the minister -- I apologize -- to respond and finish her response. Then I will move on to the other two questioners.
Hon Mrs Akande: As I said before, Mr Jackson has really assumed that I have not approached the Treasurer. I have actually looked in many ways and in many different places for additional funds in order to meet this need. I am also involved in making sure where the need exists so that it be more appropriately and effectively met.
The Vice-Chair: One short question if you would indulge the committee and then I will move on to Mrs McLeod.
Ms Haeck: There has been, I believe by the previous questioner, an allusion to the fact that possibly more study is required. From your presentation and other things I have read on the topic, I see there is really quite a wide array of studies available. How is your ministry responding to this plethora of information?
Hon Mrs Akande: Actually, when we talk about study we are not studying to see whether in fact there are children who require services. We are looking at ways in which those services may be applied more effectively. We are looking at how those services are being applied in certain instances that create such a great waiting list. We are looking at where those services are needed. There are uneven facilities in Ontario, so there are areas where there is a greater need than others. We are looking at the distribution of those services in such a way as to meet those needs, but we are also looking at the need, and where that need may exist, for more services.
Mrs McLeod: I want to ask you about the process for review and responding to the Maloney report, although I must preface that by saying I was somewhat concerned by your earlier response to Mrs Witmer's question. I trust that your response, seeming to suggest a real hesitation about services being located in the schools, based on a traditional understanding of what takes place in the schools and how that can be limited by the traditional structure, does not close the door to looking at the Maloney report recommendations which would see the school as the hub for some very non-traditional services. I see you shaking your head and I trust that the door is in fact open. May I ask you, then, what is the process by which you will be reviewing and responding to those recommendations?
Hon Mrs Akande: We have been studying those recommendations and we are putting out a synopsis of the paper plus the paper itself, and asking people to respond to that as a form of consultation. We are also making presentations within communities, at schools, at children's centres, at community centres, to child care centres and parents, to make as wide a presentation as possible in order to get as many responses to that as possible. Yes, you are right; I have not closed the door on schools. I am just concerned that we not consider only schools as a place where these services may take place.
The Vice-Chair: That concludes the end of our first presentation. I wish there was more time because members are obviously very interested and were sparked by your remarks. It will carry us forward into the next two or three days. Thank you, Minister. You are welcome to stay if you would like.
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ADVISORY COMMITTEE ON CHILDREN'S SERVICES, CATHOLIC CHILDREN'S AID SOCIETY OF METROPOLITAN TORONTO
The Vice-Chair: Our next presenter is the Advisory Committee on Children's Services, Catholic Children's Aid Society of Metropolitan Toronto, Dr Colin Maloney, who is the chair.
Welcome to the committee, Dr Maloney. Please speak into the microphone directly in front of you and introduce yourself. I would also take this occasion to remind you of our strict adherence to a half-hour for your presentation, as we are constrained by our time limits on this committee.
Dr Maloney: I should thank the committee for the opportunity to come here. As you know, the committee has just presented its report. Each of you received this report, of course, and I am sure over the holidays had time to read it. I would like to speak from the basis of that report to the issue in terms of the needs of children and I would like just to make actually three main points.
The first question is, are there greater needs today than before? By "before" I mean within the last 10 years. It is a very difficult question to answer. Many will affirm very clearly that the needs overwhelm our present resources.
Quickly look at the world of children. Whether you look at the factors in the report, whether you look at the factors of what is happening to the world of children, many more of them, in one sense, live in poverty, live in a family that struggles. Many more of them live in a single-mother situation and have to struggle much more than those that have double incomes coming into the family. We look at the divorce rate that now nearly reaches 50%; we look at the issues of family violence, of abuse. You know all these.
Does that world cause more pressure? Does the fact that most mothers who have children have to or want to work put more pressure, would you say, on those families? That is a very hard thing to prove. I think most people feel that there is more pressure and that the children of today face things like drugs. We look at our schools and we ask for AIDS education, drug education, sexual abuse education. When you and I were children, we did not have those.
Let's be clear. My first hypothesis in the report is that it is much more difficult. I do not want to exclude the fact that -- whatever it is, 75% -- a large number of our kids do very well. But is it acceptable to the Legislature of this province that we have a significant percentage now -- 20%, 25%, whatever it may be -- who do not make it well? Whether it is from an educational point of view or from a psychological point of view, we have a large number who do not make it.
I think you will be very convinced by the presentation that we do not have the resources to respond adequately to that growing need. That is my hypothesis that we start with. If you do not believe that, I will ask the people who speak after me to convince you of it.
This committee brought forward and said that to expand those resources is going to be very difficult financially. As you kept asking the minister, where were the moneys? What was going to be the solution the committee proposed was that obviously it was clearly a direction we would like to strongly put forward to this committee, that we are much better at growing children than fixing them and that to grow children well is what this committee should be all about.
I took the example that very many of you have struggled with in terms of the health of this province. Very clearly you would say, do we need good hospitals? We do need them. Everybody wants them when they are sick, but no one I know of recommends that the solution to our health issue is to have better and more hospitals. There has to be something different. We said we have to have a healthier Ontario, we have to have health promotion.
In this report I wish you would really pick as a strategic direction, can we have a healthier world for children? Can we have a promotional strategy that supports parents both in the workplace and in the pre-natal time, in that time that is so crucial to children in terms of parental leave? Can we have a support structure for parents so that there is a partnership for children, so that we will have many less children who need to be fixed because the home they have had could not take the pressure?
It depends on this government to see that there is the support, that there is a clearly promotional agenda for children. Otherwise, you face an economy that will not have enough children to work when they become adults. You face an economy that needs people who need more and more resources you do not have. Otherwise, you face a 20% dropout and failure rate that no business can tolerate, let alone a government and a society.
So we ask that our first strategy be a promotional support that enters into partnership both with business, the private world, and the social service world, to much better support those first five years of children's growth.
Second, we have asked that the fragmentation of service, which is notorious -- who looks after children from a holistic point of view? Who plans, who sets priorities, who determines what is the best use of these moneys that we as a province spend? Nobody. If we ran, to achieve something, a business that was so fragmented and expected to be successful, we would consider ourselves foolish. Yet in terms of children, we feel it quite all right to have thousands of agencies without any co-ordination on an overall basis either from the government or in the field.
I would like not to take much more time, but to leave some time for your own questioning. I do not think anyone in this province will argue with any government that spends money on children. What they will argue with is that you do not waste it.
My sense is that you say the second major strategy that the committee looked at is that children are too precious a resource for us to allow fragmented and disorganized services. The tool on which we base our planning for the cost-effective use of our response to children is no longer acceptable when we have the means and ability to co-ordinate it and to set priorities in a way that truly would be in the best interests of children.
Those are the two major directions I thought I should bring forward to the committee. I would like to quite willingly receive any questions on the report that you may have or on the specific directions we gave on how that co-ordination should be done.
Mrs McLeod: I regret that we only have half an hour with you, Dr Maloney. We could spend the entire afternoon.
Just by way of a very brief preface, I want to tell you that as I read your report it was like the experience I had reading the Hall-Dennis report some 20 years ago. I am one of the people in Ontario who says that as a compliment in terms of the vision it represents about children and about a holistic approach to children. The recommendations go in the direction of my bias, which made me very comfortable with the report. But I will pose two very specific questions about implementation because I am concerned that its fate might be similar to the other report that I mentioned as we get into the difficulty of implementation.
I will leave you with the two questions. I know they are not fully answerable today. One is that, as I read the report, my belief is that your recommendations would necessitate a very large-scale decentralization of existing services in order to be able to build around the school as a hub. I would like you to give some comment as to whether I have understood that correctly.
Second, I did have a little bit of a concern as you spoke about resources. When I was reading the report there seemed to be that sense that, if we could remove the duplication of service and ensure it was co-ordinated and effective service we are delivering, perhaps we would not need significant new resources. Yet in my understanding of the overcapacity, the demands on existing services, I really question, even if we have the ultimate co-ordination, whether we are not still going to need significant inputs of new resources.
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Dr Maloney: You had two questions. In regard to the first one in terms of decentralization and centralization, which has always been a major issue, clearly a new strategy has to be evolved. I think the best way to look at it, for myself personally, has been in the business world. The business world and the large corporations have a new sense of what is to be centralized. We need it much better centralized than we have ever had. There has to be the co-ordination, the direction, the sort of consistency that will achieve the equity that we need. It needs to be decentralized in a way that is quite different than just sort of sending it outside and having it as we do now. It has to be truly something that is allowed to be locally controlled in a way, so it is nearly a paradox.
But in terms of our new systems of information, the ability in a sense to overcome time and space through the technology that we have, a new tension between decentralized and centralized is possible. So that question is really a new question, and I think it has to be looked at, because there is a sense that we get fragmentation if we decentralize.
Yet when you look at the major international companies that I think would have at least as large an issue as we have in terms of this, they have achieved something that is radically new, something that gives direction, vision, gives a training ability, gives the responsibility from a centralized viewpoint, but allows a far more decentralized approach that allows the locality really to own what it is doing. That is the first question. I think it is a new strategy and I think we cannot go back to the questions of before.
In your second question about the money, you have touched obviously the crucial issue. From a political point of view, which you would understand, we thought it was not the most political to start off with the issue of money. I think we needed a vision first to say, "What should we do?" We had the belief that the people of Ontario will not question whether there is more money or less money if it is well spent.
We were not saying it would not cost more money. I have known of nothing in this world that does not cost more money, or very seldom. How much more? I think that would be a legitimate question to say more money, if we can demonstrate what we are doing now is well done and done cost-effectively. I think it will end up costing more money, but I do not think that is the issue.
Mrs Witmer: I appreciate all the work that you have done in this regard. I wonder if you could expand for us at this time and share with us how you see the school as the focus.
Dr Maloney: We have in one sense made a distinction between the resources and the building that would be a focus and, as the minister has spoken, in a sense we would not, without consultation, say this could be always and everywhere the focus. What led our report was in a sense that it was to be promotional.
Our strategy in the first place was to strengthen the healthy child, and not in a way that would pick out and say, "You are sick and you need help." We are saying all children need to be supported. We look to the universal system, which is the child care system to some extent, which is still already in the school system and gave us the first indication of where to go.
Where are our children to a great extent? They are in the schools. At the same time, we are very much aware that if you ask the teachers to do one more thing, you deserve to have a revolt on your hands, because they handle our problems of child abuse, AIDS, violence and what else. They are not there to solve all the problems. We wanted a solution that would help educators to do what they want to do best, which was to educate.
Our proposal asked that the school system be asked to go in partnership so that they would be allowed to do better what they do best and not to add something more to them. Nothing would make teachers happier than when they do not have the violence, the school kids who are hungry, the kids who, when they go home, they know there is no help for them. I thought we were looking for a partnership with the school in the sense, "Where can we best grow our children?" Obviously, the school was the answer.
But we also had a very key player that should be highlighted here, the recreation system, which I know is much more a municipality system in some ways, but key. If we are to have two working parents, as the economy of Ontario demands -- this province, at the present moment in our global competition, would stop if women who have children stopped working -- if we are to say, "You are to work," we have to support that in a way that we do not. We know the whole issue of child care has to be raised and it has not been raised. It will need to be raised by this government, by all of you.
It is a horrible, difficult problem, but we cannot, on one hand, ask parents to be our major partners in an economic way and not support them in a family way. We cannot say we will have a school that goes two or three months and then not have school and say, "You look after them," when many of them cannot. Recreation has to play a key part in that. That is why, when we saw that in many places they have that partnership with recreation, we thought that could be expanded and built upon and be far more promotional than we have presently.
I hope that got at your question. I know it is very general and vague, but that is why we went to the school system, leaving it up to the school system to say how that can be actually worked out.
Mrs Witmer: That is right, and I appreciate your comments, Dr Maloney. For years I resisted adding something else to the school system, but in the past few years I have come to recognize that that does seem to be the logical source to co-ordinate the action.
Dr Maloney: If it is just an addition, it will not work. It has to be a complementarity, a partnership that is of benefit to both sides.
Mr Martin: I am also a big fan of the Hall-Dennis report. I thought it was great.
Mrs McLeod: I did not know there were two of us.
Mr Martin: A vote from the north, eh? I thought it threw some creative, courageous challenges to us and I suggest to you that one of the reasons that it did not go forth is the resistance by the professionals in the field who either would not be or were not properly trained to participate in that. I guess, being from the north where resources are not always so readily available, I sense there is a bit of tension in some of the activity I have been involved in in terms of the very volunteer support group, the laywork of folks who support families and children in difficulty, and the professionals.
Do you have any thoughts about how we might meld that in terms of a movement forward that could be courageous and creative and yet not cost the kind of money that perhaps we may get into here if in fact we get into sending up to the north more professionals, which may not be what we need?
Dr Maloney: The issue obviously of turf, of the historical divisions that we have, the willingness to co-operate -- perhaps I could take time to relate one small incident that really amazed us. It was called a consultation and it was with a cross-section of directors of schools from all over the province, and from the north also. We presented a sort of draft of directions we were hoping to go in, and basically they said, "What we have heard so far would be considered a wimpish report." That left us a bit stunned, because we were going very gingerly with the schools in a sense, knowing how much they had been imposed upon. We did not want to be seen to be demanding more than we should.
That whole section of people I think were representative at least of those who were the best in the system in some ways, and we were very clear that the direction they pushed us in was the final direction we went into. I am not sure we would have gone so bravely -- not being seen as sort of, "Would you ever get this type of co-operation from the mainstream system?" became clear from that consultation. They not only expected it but said we would be failing the education system if we did not demand it.
One of the reactions I have had to the report from all systems is to the sense, "Well, in a general sense it does not get down to nitty-gritty and does not step on anybody's toes, so it is easy to be in agreement with it." But I would say there is the goodwill for that type of co-operation much more than 10 years ago or 20 years ago, in an extraordinary way. That is why we hesitated and said it was not just -- the north was one example. Not everywhere in the north would the school be the ideal situation.
I think one of the reasons we left that as sort of some options -- and the minister was trying to say that -- is that the north made it very clear to us that that was not always the best centre of the community, and we said a local community would decide that in the sense of that struggle with the north in terms of professional and the lack of it. The report really did not address that in a good sense. I think that is the one that has to be struggled with much more. Some of the initiatives they are doing now in terms of recruitment, doing it co-operatively, giving a better scientific base to things, have been somewhat successful, but I think that remains with us as an issue.
Mr Jackson: Very briefly, Colin, I have had an opportunity to read your report. It is a very good one. When you talk about vision, were you able to find any jurisdictions in North America which, in your opinion, are moving in the direction that you are calling for, that you saw some models of? Canadian models preferably since they have two school systems, which is a practical consideration when dealing with delivery arms. You talk about fragmentation, but we do have a dual system and there is some talk of a tripartite system, and certainly by language you get into four systems in this province. Can you bring to this committee's attention any jurisdictions where you saw some progress in this direction?
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Dr Maloney: We did not see this as a model which we took from any jurisdiction. It does not exist, as far as I know, in the sense we proposed. That is why it really falls into the category of vision. Whether vision becomes a nightmare in reality is always an open question, but what pushed us that way is where we put the child care. The second issue was what has happened over the years with the mentally handicapped. There is a variety in the spectrum of how that has been successful, but when it is supported, when it is resourced appropriately, it is very successful.
There are other initiatives in the United States; in Missouri, for instance, the school as a base for new mothers and their grouping together in relation to public health that is in the report. It was all those sort of streaming, the experience we have in Ontario; many cities have a contract with Recreation, and the school board and Recreation provide it. All those different elements forced us to this vision in a sense, sort of pulled it together. I think it was very much reinforced by many programs like that, to say, "Well, let's make a system that way."
Ms Haeck: I have had, as a result of my new role as an MPP, a chance to meet with a number of community groups, and most recently the local family and children's services. Our discussions and obviously some other things I have read have made me aware that there really is a fair bit of competition between a number of the centres out there, the family and children's services and the other mental health providers. How are you addressing that particular situation?
Dr Maloney: Nothing like money brings out where the goodwill is, when you put it on the table. You touched a key point, the sense that there has to be a strong centralization of direction, priorities and bases on which things are decided. It has to be there. When it is on the table now it is a sense of who gets what. It is not seen that way; it is history or whatever it may be. You ask, "Why is this agency funded that way or why that?" It is very difficult to get a basis that goes beyond history.
So in one sense there has to be a sense of priority-setting, a sense of rationale, why things are done the way they are, which you do not have now. We come back to the very first question: There is a key role for the central administration in those areas, which does not exist now. When you run into the problem of turf, who gets what and how they get it, it becomes a political issue rather than a service issue, which is unfortunate.
Mr Beer: I do not know what status a former minister has, but I would like to publicly thank you for all your advice and the work of the committee over the time I was there. Certainly, in reading the report, if you did nothing else you held forth a vision and a sense of integration of the services we must develop to support children, which are terribly important to have out there. I would hope this committee and the work we do can build and take forward what you have started.
It seems to me that there is a question around how you are suggesting we might organize this new vision. I appreciate that the committee may have looked at some very specific models and then backed off a bit to allow discussion to focus on how we can better integrate the services, both centrally and then at the local level. I think your response to the earlier question around new ways of centralizing and decentralizing is very interesting.
Specifically, provincially, is it your own view that we will have to set up a unit -- whatever we call it, ministry, secretariat -- with real power that will in effect take programs, authorities and money currently being disbursed by Community and Social Services, Health, Education and Recreation; and that in a similar way at the local level we really do need to be thinking about some other kind of body? It seems to me that this is one of the elements of your report, that we may have to rethink the role of school boards to the point where in effect you would almost have a kind of children's services board or council that would be carrying out the functions of school boards as well as the functions, perhaps, of children's aid societies or of a whole series of other agencies locally.
My question then is: Do we have to have something that is very clear-cut with real power at both those levels with authority to spend dollars, or can we do this in I suppose the traditional approach, trying to have more and better co-operation, stick in a few carrots but not really change the system?
Dr Maloney: That is a very key question. I think if the committee had been practical and more political, it would have gone the second way. We had the freedom, as a committee does, really to let that be your problem, to just look at it from the children's point of view, not look at the practical sense or the horrendous problems this would raise or the people who would be out of joint because you try to change their territory.
If you start with the system, you have to end up with a sense of, "Let's move it here or there; let's do what's practical." We did not look at that. We said if you look at the planning for children, should you not look at children from a healthy point of view, and where there would be special needs, look at it from planning, co-ordinated, the best setting of priorities both in a centralized and local way. That is where we came from, that principle.
I think it is very easy to agree with that in principle, that planning should be done in a co-ordinated, holistic way. Is that possible, given what our history is? That is the challenge. I think it makes it very difficult, because the report is idealistic, it is a vision. Can you change so much? So much is involved there. At least it should be open for dialogue to see how far we can go. In the committee, obviously, that principle is easy to defend. Is it realizable politically? Can you move so many things?
I think that would depend on whether you really feel that reorganization would be helpful to education: Will it be actually to the aid of education to do that? Then it makes it possible. If it is to disturb education and otherwise make it more upsetting than it is, it would be political and I think impractical. But if it is seen as enhancing the very question of our 30%, our literacy, our lack of being able to meet the standards of our economy in terms of our technical approach, if it means it allows something to happen on that, I think it may even be practical politically.
Mrs McLeod: I will again be very brief. I know Mr Martin, at the beginning of our committee's session, expressed concern that we would not be able in these few hours of hearings to address some of the very particular problems of northern Ontario. I totally agree with him. I was very pleased to see that your committee made a special effort to look at the problems of northern Ontario. Just so it is recorded from your report and into our record, you note that northern Ontario "consistently exceeds by factors of two to four times the province's suicide rate, infant mortality rate, illiteracy rate and rate of children taken into care."
My question is not answerable in the moment left, but did your committee have some sense of the way in which the particular needs of the north could be responded to and, if so, can we invite you to come back at some time to tell us what those responses should be?
Dr Maloney: You can invite me to come back for the responses. Obviously, this was a very, very complex issue and very difficult. There was no simple answer to it. We dealt in the report in generalities. You are basically dealing with an issue in terms of resources, poverty, distance and all those things, but to a great extent poverty. To say that there is one simple strategy to approach that made it impossible to deal with in our report, I would be glad to talk on that any time you want, because it deserves much more attention than that.
The Vice-Chair: We have run out of time. We would like to thank you for making this presentation. We hope to hear from you in the future as well.
Dr Maloney: My pleasure. Thank you very much.
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ONTARIO ASSOCIATION OF CHILDREN'S MENTAL HEALTH CENTRES
The Vice-Chair: Our next presentation is from the Ontario Association of Children's Mental Health Centres, Alex Thomson and others, I believe. Sheila Weinstock is also with you.
Mr Thomson: Sheila is the executive director of the provincial association which we represent. I would like to thank the committee as well for this undertaking. I would like to thank Mrs Witmer for bringing it to your attention. It is most helpful in terms of our ability to express our concerns to the government of Ontario and the public generally about the issues which are facing our association in our attempts to provide quality mental health services to the children and families in this province.
You have received by this time, I think, a copy of our brief. My intention is not to spend time walking you through that brief but highlighting some of the critical components from our perception. Then, Sheila and I are more than prepared to dialogue with you around some thoughts and questions you may have.
I will take about 10 minutes to highlight some of the concerns and issues we have raised for the better part of the last year. We are 85 children's mental health centres across this province, funded for the most part by the Ministry of Community and Social Services; in some situations, some dual responsibility with the Ministry of Health as well.
Our provision of care to children and family falls in generally three areas. We provide it on an outpatient basis; in day treatment processes and programs, which is essentially, in some respects, alternative to school programs with a psychosocial component to them; and 10% of our services are provided in residential services. So you can see the vast majority of our programs are provided in the least intrusive programs possible.
In 1989 we served 50,000 children across this province in those 85 centres at a cost of approximately $166 million; it averaged out to about $3,400 per child.
In 1989, we undertook a major effort to try and understand globally the pressures that were coming to bear on the 85 centres across the province. We understood at that time that we had approximately 10,000 children waiting for services in our particular centres. Some of these children, on average, are waiting six months to two years for that service. In some of those situations, it is a tremendously long time for those children to wait. The practical fallout of that is that the children who have to wait up to two years for service may only need the least intrusive service at the beginning of their wait, but by the time they get to the door they may need the most intrusive service. That is what brought us to the point of raising this with the government in a public forum. It has been a major concern to us throughout this last year and a half.
There are basically three points I would like to raise with you, and we also have some suggested solutions. The first and foremost point is the issue of access. We work from the principle, under the Mental Health Act, that children and families in this province should have a reasonable access to service, particularly mental health service. The difficulty with access, as I described to you, is the number of children waiting for service. It is exacerbated by the fact that those approximately 10,000 children, in many cases, we are unable to truly diagnose or assess because they are literally waiting for even that component of our service. There might be a single page of information, which really does not help us truly understand the needs of that particular child.
In keeping with the Maloney report, last year we requested the government to undertake a broad global review of the issue of children's mental health beyond the confines of the Ministry of Community and Social Services, on the basis that we too believe that the Ministry of Education, the Ministry of Health, Comsoc, Corrections, Recreation -- I think Mr Maloney and his committee have broadened the stroke somewhat. We are not in disagreement in principle with those issues, but what is brought to light is that here is another committee that recognizes that there is a broader context than just children's mental health centres providing this service. We advocate for that, we advocate for a better co-ordination and identification of the true responsibilities of all those actors in the progress we need to make with our children and families in this province.
We also have some difficulty with legislation. We believe there is not effective legislation to address the true needs of children who are afflicted with mental health problems and their families. The legislation is narrow. It does not allow for truly co-operative ventures between the Ministry of Health, the Ministry of Education and the Ministry of Community and Social Services, and there may be other actors as well. We requested then and we request now that there really does need to be an absolute review of the existing legislation, a broadening of its ability to practically deliver the services necessary.
Probably the most delicate issue that will be undertaken or reviewed throughout your two days, and hopefully the government's review of this in a much broader context, is the whole issue of resources. Mr Maloney before us indicated that the report is not a panacea. The report in principle has some very solid foundations, there might be many ways of its practical delivery, but do not go into it thinking that the problems will go away as a result of just basing it with a school-based program as its focus. There still will be a need for professionally trained individuals to assist those children who will continue to fall through the gap. There is no question that Mr Maloney's committee's report begs the province once again to truly look at preventive situations and preventive processes, and there is no disagreement with that. The more children we can provide a solid foundation for, the better off in the long run we are going to be, but there will continue to be children who will require assistance that is above and beyond what is normally required and provided for children.
This brings us to our particular issue in terms of resources, and that is the issue of human resources. We are a sector that employs 5,000 professional people whose mandate is to try and assist children who are beyond the normal ability to repair themselves or work through less intrusive programs. We are a system that has been under the gun in terms of staff turnover, in terms of our inability to attract and retain qualified staff to our sector. These figures are not new: In the central Toronto area alone, when we compare our non-profit organization's ability to pay professional staff compared to ministry-run operations, we are 40% behind in salaries. It does not make us very competitive. It makes our job a whole bunch harder. Across the different sectors, we are looking at a 28% differential with the ability of boards of education to employ social workers, psychometrists and psychologists. With the Ministry of Health we are a little closer, but we are still 15% behind in salaries.
What happens practically for us is that we begin to become the training ground for professionals who work in those systems. If you follow the logic of the Maloney report -- I am not lambasting it; I have read the report as well, and we will respond to it; I think there are a lot of good principles in it; I do not agree totally with some of the practicalities of the delivery of that. But if you follow that line and you put specialized services hooked into boards of education, you are going to have face that music somewhere. You cannot employ specialized services, social workers who might be employed at children's mental health centres but linked to a board of education, and have social workers within the board of education who are paid 28 per cent higher. It will not fly.
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That is again a critical issue for you as members of the government and the Legislature generally to struggle with. That problem is not going to go away, unfortunately. It does mean that we are concerned about the quality of service that we are mandated. Our share of the workload in this province is to deal with some of the very difficult children who fall out of boards of education, who fall out of other systems, and we are in a situation where we are employing a lot of young, inexperienced, although paper-qualified people. We are training them only to lose them in a few years to Education, Health and other job and career opportunities. You cannot say anything against these people because it makes sense, if you are in those positions, that you can earn more than in others to do the same job and hopefully, in effect, achieve the same goal of helping and assisting troubled children and families, and more power to them. That issue is a critical issue, no matter what path this government takes.
What we suggest as a resolution is that we would like to see the government now take and develop what we would call, at this point, an action-oriented implementation task force whose membership would be made up of Ministry of Community and Social Services, representation from Health, Education, Correctional Services and possibly even Recreation, the Sparrow Lake group, the various provincial associations that would have interest in these services, including ourselves and the Ontario Association of Children's Aid Societies, Ontchild, which is a very similar organization to ours, and consumer representation. The task and role of that task force would be essentially to take the responsibility for investigating and developing some long-term and medium-term solutions to real interministerial co-ordination.
We have been in a process for a year and a half with the past government. We have been involved and worked co-operatively with the governments of the past in their interministerial committees to no avail. We have not seen any real work come out of that. We are asking you to take a look at putting together a team that would be responsible to the public, the actors who are responsible for the provision of service and your membership -- members of the government, members of the opposition parties -- who would be able to act in a concerted effort to really look at possible solutions to how we can better communicate, how we can free up the different organizations to bring the resources that need to be brought to bear. Co-ordination of services at a local level is certainly in keeping with our own thinking.
I would like to respond to Mrs McLeod's question -- maybe it was Mr Beer's; sorry, I was sort of reviewing my notes over in the corner -- about whether or not a central authority at the local level is the answer and whether we should do it on the basis of a co-operative venture rather than power-based. I would go for the co-operative venture, and I would beg you to go to Hamilton and look at the Association of Agencies for Treatment and Development system, which has been around for 17 years. I made a presentation to this committee five years ago about that system. I talked to the former government about that system. It does require resources, but it is a co-operative venture that works, and all the actors whom Mr Maloney talks about are around the table and work on a community basis in the development of the provision of services. You might want to take that look-see in terms of that option.
An appropriate funding formula for locally based decisions so that each community has appropriate standardized services has been one of our issues, one of our concerns. The legislation does not guide and provide guidance for the standardized availability of services across the province. Much of that is dependent upon the local area office and some very local bureaucratic decisions that can guide whether or not you have children's mental health services or whether you have more CAS services here or whether you have something else. There has to be some review of that so that there can be some standardized ability for the government and local communities to provide minimally standard care in a spectrum of services in each local community or region, however you define that.
We also think that this committee should look at some of the legislative issues in terms of some of the real changes and not restrict it to the Child and Family Services Act. There are issues that go beyond the CFSA. It has implications in terms of the Education Act; it has implications in terms of the Mental Health Act as well.
Our last suggested responsibility of this committee might be, in keeping with Mr Maloney's report, to look at that whole issue of children's authority and local planning. We are firm believers in that. I do not know at this point whether that is the true answer, but that is an opportunity to begin working towards that immediately.
With regard to the tougher questions from our perspective and tougher questions from your perspective, we have some very immediate needs. We do have the same approximate number of children on waiting lists. We have not completed our second round of reviewing that list, but the numbers that are in are telling us that has not changed. We have a serious number of children, a large number of children who are waiting for service. We need some immediate assistance in this budget year to begin, as I said earlier, to even look at those kids and try to find out which of those kids are the most urgent kids and we can then begin to try to address those issues. As it stands now, the children wait, without our even understanding what they are waiting for or how severely disturbed and difficult they are. That is a major problem, not only for us but for this province. Those are the kids who are going to end up in adult institutions eventually unless we begin to address those issues. That problem has not gone away.
The other immediate request we have for the government and this committee to review is some assistance in terms of the wage issue. The previous government had taken some steps to look at some compensation adjustments for direct child care workers. That is most appreciated. We are in the throes of undergoing that. We are not sure how far that is going to go, but we do have further needs beyond direct child care workers. We have to look in a broader context.
We all are faced with practical issues of pay equity. Right or wrong, many of our non-profit organizations have been in the same fix that other organizations have been, where we do have situations where we do need to make pay equity adjustments. That money has to come from somewhere. Otherwise, as non-profit organizations, we are faced with making tough decisions like cutting service so that we can make pay equity adjustments and having only 30 people employed rather than 40 and serving only 300 kids rather than 400 kids. Those are real situations for us and we need some assistance with that part.
That is my presentation. Sheila and I would be glad to address some of your questions.
The Vice-Chair: Thank you. I will start with Mr White.
Mr White: I have a couple of points. First off, I would certainly agree with you about the money issue, having worked in children's mental health centres in the past myself. I am better off in even my present job. I know in our area we have just started a children's service council, I think effective tomorrow. The impetus behind that came primarily from the local children's mental health centres, of which there are some six or seven, and probably the complaints from consumers about co-ordination of those efforts. I am impressed with that. You mention that as an issue here. But I am also impressed with the list here of how difficult it may be to co-ordinate services when I look at this list, of I do not know how many pages, in your submission of basically issues that revolved around some issues of pathology.
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They seem to be identified primarily from a medical or psychological perspective. There is very little reference here to some of the psychosocial phenomena that I have experienced as a social worker in children's mental health centres. I do not recall ever having worked with a child in a residential setting who was from an intact family, and of course most of the children I worked with were poor and often from slum areas. None of that seems to be mentioned here at all. It seems like because of the parameters of funding, the medical history, there seems to be somewhat of a limitation. I am wondering if that is something which you would be aware of or could share with us.
Ms Weinstock: Perhaps I could respond. The list that you have is a very succinct, brief description of some of the case histories, a list that was developed in the Windsor area. These certainly are not intended to be the only factors, but they do give a flavour of the complexity of the problems. I think the issues that you have raised exist and they only serve to further make each of these cases complex. That is why children's mental health centres require a kind of multidisciplinary approach, so that we can have the perspectives of the psychologists, psychiatrists, social workers and, where necessary, speech pathologists and others, who can look at the various factors and identify which is the most important in any one specific case and what is the best way to proceed.
Mr White: As a supplementary to that, certainly the research which we have -- what Dr Maloney spoke of a few moments ago, Dr Offord -- speaks to psychosocial issues as being predominant in terms of the genesis of children's mental disturbances or emotional disturbances. Yet we have a profound difficulty, because if the orientation is primarily medical, as seems to be reflected here, it is going to be difficult to deal with issues of children who have been witness to violent events, as Mrs Witmer has reflected in the Legislature; children who come from broken homes, where that has been the issue that has caused them the most disturbance. It does not seem to be reflected in your list of symptomatology.
Mr Thomson: I think you should accept the list exactly as you described, just symptomatology. It is not a reflection of the narrow focus of our ability to provide service, by any means. We are much broader in terms of the skills. One of the mandates of the membership of the association is that it is a multidisciplinary approach, including teachers.
Mrs Witmer: I would like to express my appreciation to you for the information that you have provided for us today and also during the election. I appreciate the lobbying that you have been doing on behalf of children in this province who are so neglected and who are falling between the cracks.
You have recommended here the creation of an independent task force. Do you see that task force working co-operatively in planning for and implementing changes and new directions for children's mental health services? Once that is done, do you then support the development of a local children's services planning advisory authority in order that, as Mr Martin has indicated, there is a need to address the local needs in a community? I think, as well, Dr Maloney talked about the need for centralization, but also decentralization, because there are unique needs in each part of the province.
Mr Thomson: Personally?
Mrs Witmer: Yes.
Mr Thomson: I come from a very unique community that has had local co-ordination for 17 years. I have been a participant, and a successful participant. There are very few changes that happen in my organization without some vetting at the community level. "What would you guys think if we did this?" The power rests with the individual organization, but you basically go to the table knowing that you have a responsibility to all the other actors, as they do to you. That has been built up over time.
That formula may not work in all communities. In terms of a co-operative local venture, yes. Whether it is as Dr Maloney has suggested, I cannot answer that. We have only received the report as well, and I cannot speak for the association by any means. In terms of co-ordination of services at the local level, yes. Beyond that, though, there has to be some standard ability to provide certain levels of care in each and every community. That is the responsibility of the government and the province of Ontario. So if that answers your question -- there are two tiers to it, as far as I am concerned.
Mrs Witmer: Just as a supplementary, I sense that perhaps you had some hesitation about the schools becoming the central focus, and I guess I would like to ask what your reservations would be. I think it is important that we know that.
Mr Thomson: This is my personal opinion. The association has not taken a position on this. It is based on my experience in Hamilton that whenever authority comes into play between organizations, then politics gets played and power plays get played. We work co-operatively with the local ministry's office. which is a participant in that process. It seems to work. That is all I can say.
That is my hesitancy. I would not want to see a superboard set up to control and have authority in all those cases. I think it is too broad a mandate in that respect. I think you have to have some specialization even at the local level, and boards of education know what they do best. But when they fail with a child through even their own special education systems, they also know it is best to rattle that child out to a children's mental health centre which has some specialized ability to assist that child. That mix still has to be there.
Mrs Witmer: I would agree with you, by the way.
Mrs McLeod: Two questions. First of all, very briefly on that, you mentioned the waiting list and your sense that those waiting lists continue to be about the length that you felt they were when the original review was undertaken. May I ask whether or not you have a sense whether the rate of referral is less because the referring agencies or individuals are aware of the waiting list and the referrals somehow, therefore, become less relevant because the treatment or the intervention is not going to be available when the problem is most acute?
Ms Weinstock: I can certainly respond to that in that this year we have received a number of responses to our survey saying that some centres have stopped collecting waiting lists and that people in the community are aware that they are not going to be able to be seen and therefore they are not referring. So there is some of that.
Mrs McLeod: I continue to believe that something we have to look at along with the waiting list, which is obviously a concern, is the referring source and how well the service is addressing the needs of children at the referring source, which brings me to the second question, which is essentially a follow-up of the one that Mrs Witmer just asked.
I am going to take 30 seconds just to tell you my bias. I had an opportunity to work in a somewhat aberrant situation with a children's mental health unit in a hospital setting, where I was not restricted by the clear delineation of what was the role of the school practitioner and what was the role of the mental health practitioner. My concern became one that the referring source had to be able to diagnose the problem before it knew where it should be dealt with. If it was a mild behaviour problem it could be dealt with by the school; if it was more moderate or severe it had to be referred to the children's mental health centre.
My perspective may be biased by coming from a northern community where the resources are limited and where we do not see duplication, we see almost a fragmenting of the child. It is difficult to frame the question briefly and ask for a fairly brief response. Do you have a sense that there is in fact duplication, or do you sense that the co-ordination of what existing agencies are doing is necessary so that we can bring all those resources to bear on the child without that separation of the types of intervention that are needed?
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Mr Thomson: I think there is bound to be some duplication in any system along the way. I do not think that what you will see in real terms is absolute duplication, where someone would put a child on the waiting list and continue to provide service. Children who get referred to children's mental health centres tend to have used up all the usefulness of other, more normative services, so they are coming to us with real problems that cannot be dealt with in the system, whether it is education or the children's aid society or wherever. I do not think there is a tremendous amount of duplication in that sense. Does that answer your question?
Mrs McLeod: It does in part. Let me try to be a tiny bit more specific. Do you find that children s mental health centres in the province are able to do any learning disabilities diagnosis, for example, where there is a sense that perhaps that is an underlying problem? I do not want in any way to negate Mr White's comments about the further underlying problems.
Mr Thomson: If they happen to have a working psychometrist in their system, then they may be readily able to and they may have to wait even for that service. I know for a fact that in Hamilton we do employ a psychologist on a consulting basis at my centre. We pay him on a fee-for-service to do those.
When we go to the school board, when we are working with a child, for instance, who is in school, and at Lynwood in residence, by example, and we say we need some psycho services to this child, we will wait six months for that in the board of education, so we will go out and purchase that service. That may be duplication in that respect, but they are not a priority of the board of education at the moment because they are not really there yet.
Ms Weinstock: If I could just respond briefly, as well, Mrs McLeod, there are some bureaucratic difficulties to children's mental health centres being able to respond, for example, to children with learning disabilities. The issues you have raised really are the reasons we are so clear that this needs a multiministry response. There are programs coming out of hospitals, even though the Ministry of Health says it has no responsibility for children's mental health. There obviously are programs for troubled children in the schools, but because we are pretending it is only in one place, it seems very fragmented. We really need a multiministry approach to bring all those resources together and create a coherent plan.
The Vice-Chair: I hate to interrupt, but we have one minute left. Mr Owens would like to ask a very brief question, and then we have to proceed.
Mr Owens: Where is your pay equity process at this point and approximately what kind of dollars are we talking about and extra resources being required to fund that process?
Mr Thomson: I am sorry. I cannot report to you about the whole association and in what position each organization is in terms of pay equity. Some have completed it, others are in the midst of it and some are just beginning to tackle it, I suppose. It depends on the organization.
What I can tell you in the broadest context is that if we took some very exacting information that we have received from 33 centres of our association that operate in the Metropolitan Toronto area, these figures are not related directly to pay equity, but they relate to their equivalency in comparison to direct-operated entities like Thistletown. We are looking at approximately $9 million in that area alone for 33 centres to make the adjustment and make the jump to equity and comparable salaries between non-profit organizations that are run by voluntary boards and the ministry-operated system. What you might find there, Mr Owens, is that there is probably a fairly direct link between pay equity adjustments and equity adjustments in that many of our organizations are under the gun to be designated as having the ministry as the employer, because we do not have true comparatives in some situations in our organizations.
The Vice-Chair: I would like to thank you for your presentation, which was very succinct and interesting. I am sure it will further our debate.
I hate to rush like this, but we do have a very strict time line and we will proceed to our next set of presenters now. Those members I did not get on in the previous sequence I will try to bump to the next sequence in terms of order of presentation. Please bear with me. I have to follow this procedure. Mr Martin will be next in terms of priority on the list for questions.
BEECHGROVE CHILDREN'S CENTRE
The Vice-Chair: I call on the Beechgrove Children's Centre from Kingston; Phil Ogden is the director. Thank you for joining us. You may proceed. I remind you that we have half an hour for your presentation. If you would like to allow time for questions, you can split that up any way you like. Usually it would be 15 minutes and 15 minutes, or however you would like to proceed.
Mr Ogden: Thank you for the opportunity to present some of my own personal views. My background -- just a little so you know how I arrived at some of these opinions -- is that I have been in the administration and planning of children's mental health in Ontario for the past 18 years at various levels. I have also been a Ministry of Community and Social Services planner in a regional office. I have worked for four different agencies. I worked for one of the ill-started local children's services committees back 10 years ago. For the past eight years I have been executive director of one of the largest centres in Ontario, the Beechgrove Children's Centre. So that is how I come to some of these observations.
In spite of substantial increases in the global funding of children's mental health in Ontario over the past decade, waiting lists, as you have heard, continue to grow. The mental health of this child population appears to be deteriorating and those children with psychosocial problems seemingly are more disturbed and disturbing. This is not only noted by children's mental health centres, but I am sure that if you have educators appearing before you or people from the child welfare system, they will all tell you exactly the same thing.
Just let me say that you are going to hear some comments from me that probably will parrot some of the others. I did not get together with them. I did this independently.
I think it is time to closely examine how our society is contributing to or creating these problems, to re-evaluate whose responsibility it is to intervene with these problems and to re-examine strategies for both the promotion of positive mental health in our children and families and the provision of treatment and rehabilitation services.
With the substantially broadened public definition of children's mental health -- here I want to digress a little bit. I heard a question previously from one of the members of the committee about how narrow is mental health. Well, let me tell you, for most of our centres I do not know where the boundaries are any more. What is not mental health?
Let me tell you that we have problems with behaviours in home, school and community. We have conflict in families. We have inadequate parenting, delinquency, drug abuse, family violence, physical and sexual abuse, learning disabilities, hyperactivity, truancy, school and parent conflict and non-compliance, as well as the medical conditions that were specified in the document.
So we get the full range, and I think that is true of every centre, and it is hard to tell any more what is not mental health as far as the public demand or the professional demand is concerned.
With a substantially broadened public definition of children's mental health and with the increasing stresses on children and family life, children's mental health becomes too important and demanding a topic to be left dangling visionless between two ministries. It is far too large a problem to be left to the 85 children's mental health centres funded by the Ministry of Community and Social Services, plus the 20 or so clinics funded by the Ministry of Health.
No legislation exists in Ontario -- you have heard this before -- that entitles children with even the most severe mental health problems to services. There is no guaranteed access, even no directive access. There is no entitlement for even the most severe problems. For life-threatening emotional problems, few communities have any designated centre or protocols for responding to children under 16 years of age.
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Just one quick example: This is unique only to the extent that it happened very recently in our centre, but this could be played out many times a year across the province because of the split in jurisdiction between the two ministries.
We see about 1,500 children a year, about 110 of those in residential treatment, the rest on an outpatient basis at our centre. We rarely need and require medical assistance. We do not cry wolf. We handle extremely difficult suicidal cases every day of the week, every day of the year and so we very seldom insist on medical backup.
We had a girl who had a lifelong history of abuse, a very disturbed, very disturbing girl, a very acting-out girl who once in a while would lose it and have a psychotic break. She was in our residence and this happened. We held her, held on to her, used manpower, used all our skills for about six hours before we called for help.
Meanwhile, she assaulted and quite seriously injured a couple of our staff. So we went through our list of possible psychiatrists in the community so we could sedate the girl. We made seven phone calls over a couple of hours. Nobody responded. Nobody could free themselves up. It was not their problem; it was our problem.
We finally, with police help, took her down to the emergency ward at one of the hospitals, which is actually quite close to our centre, and there was all kinds of political bureaucracy and reasons why they could not see the girl or should not see the girl, and was it not our problem?
It was not until the doctor said, "Police, accompany the girl into the room," and we said, "We don't think that's such a wise idea: we'd better stay with it," and he said, "No, I can handle it," and the girl proceeded to break free from the police and bang her head on the floor until she was all bloodied that they finally came around that they had to do something about sedating this girl.
That is just one example. It was an extreme example, granted, but those kinds of things happen every day somewhere in the province of Ontario because of the split jurisdiction between the two ministries.
As I was saying, hospitals and children's mental health centres in many communities are able to evade responsibility for these children by laying blame on the opposite system. I have just done that myself, because we have been trying to get a full-time psychiatrist for about a year and a half, and we cannot recruit one because they do not want to work in our system.
Government policy does nothing to clarify these situations. In fact the lack of co-ordination between the two ministries sets the tone for this evasion of responsibility.
No standards exist within the ministry exclusively for children's mental health centres. There are some general standards in the Child and Family Services Act applying to all programs funded by the ministry, but again, there are no standards explicitly for children's mental health centres. I would say there are some differences between children's mental health centres and other sectors funded by the Ministry of Community and Social Services.
I am personally unaware of any individual in either ministry who has both extensive experience in and substantial responsibility for children's mental health issues. Currently within the Ministry of Community and Social Services there is a push for amalgamation of children's aid societies with children's mental health centres, without any discussion of the implication for clients of obscuring the line between mandatory and voluntary services. It seems to this observer that such blurring of mandates will lead to even further loss of power by disadvantaged families or those experiencing severe psychosocial problems.
We find in our centre when there is a lot of pressure on the family or on the child to engage in treatment, either from the education system, from the family doctor or from the children's aid society, that it is almost the kiss of death for therapy. It is very difficult to do that. Granted, children's mental health centres have to become much more innovative in how we hook or bond with resistive families, but you cannot force them into treatment.
Mental health workers are demoralized by the perception that their efforts are not valued by the ministry, indeed the perception that many within the ministry have a welfare perspective which is anti-mental health. I say that is a perception but perceptions become reality.
It appears to many of us that the ministry, in its genuine attempts to hold down costs and make services more accessible for the disadvantaged, may be attempting to reduce quality to the point that effective intervention with difficult clients will become impossible. However, I would like to commend the Ministry of Community and Social Services for its recent funding and innovation in Better Beginnings, which looks at a long-term perspective for community prevention projects in mental health. I think they are to be commended for putting that in the funding mechanism and making that available to various communities.
Children's mental health agencies -- we are not without problems either in spite of substantial changes over the past decade -- also continue to lack the data, the consensus and the vision demanded by Ontario children's increasing psychosocial problems. We often are too parochial in our age or problem criteria for services. Many of our agencies are too small to cope with the myriad administrative community and clinical problems in any cost-effective way.
I think there has been some reference made to the thousands of agencies that Comsoc funds. Just let me insert here that in one of the communities that we serve, and we serve a six-county area, you can go up the main street of town and you can find -- now, there are not children's mental health centres, but there are various programs funded by the Ministry of Community and Social Services. It is something like 16 different offices on one street. I think that is crazy, and all these are agencies of 6, 8, 10, 12 people. It is not cost-effective.
Few of us have the time or the incentives to closely co-ordinate our services with those of other children's mental health agencies. I am glad that Alex gave you one glaring exception to that. It is terrific what has been accomplished in Hamilton, but many of us are not doing that.
Never mind co-ordinating with those of other children's service sectors. Some of us continue to provide expensive long-term residential treatment without the data to support clinical effectiveness, many times because no programs options for these children exist. Again, few incentives exist to encourage children's mental health centres and children's aid societies to work together to create less expensive alternatives.
There is a lot of turf war between the two sectors. It remains easier to lay blame on the opposite sector for failure to provide or fund these options than it is to do something about it. Many of our mental health professionals continue to engage in expensive long-term relationship-based therapies instead on focusing on shorter term, goal-directed interventions and skill development and arranging volunteers or paraprofessionals to build supportive relationships with needy families or children.
When the demands of clients, waiting lists and organizations monopolize our attention, many clinicians do not take, unfortunately, the time to keep abreast of research literature that can improve service delivery effectiveness.
Well, what can be done? I would like to table my own observations. I did not know that Dr Maloney was going to appear just before I did, or two before I did, but I would like to bring to your attention several highlights of that paper that I agree should be studied closely.
I think we have to establish entitlement to children's mental health services if even for only the most severe problems, establish a single entry point in each general community for families and children experiencing a whole range of problems or a variety of problems -- one point of entry -- and increase the capability of schools, public health nurses and family doctors to serve more effectively in prevention areas, early identification and as entry points for more specialized services.
Public health nurses are already doing some mental health prevention with families. I think if we increased their training and the mandate, they could even do a more effective job. Schools with positive mental health environments can act as powerful prevention programs. There is evidence that a school with a positive mental health environment can inoculate, if you will, some children otherwise at risk of psychosocial problems. Conversely, schools with negative mental health environments can exacerbate problems of at-risk children and even put some otherwise stable children at risk for psychosocial problems. Schools can make or break a lot of children and their problems.
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Schools should become long-hour -- by that I mean 7 am to 10 pm -- year-round community centres, housing integrated recreation programs and, in many cases, day care and health and social services. Schools should become visible alternatives to hockey arenas or hanging out in shopping malls. Schools must become places that parents and families consider their own. I think most schools are not at this stage.
Establish one provincial authority for children which has broad policymaking authority. Delegate to community bodies full authority and latitude to implement an integrated service system for children and families under these provincial policies.
The last one I would like to emphasize from the Colin Maloney report, Children First, is establish a unified family court with jurisdiction for all issues where the welfare of children is at stake. That would include custody protection, child support, all those things.
Some other recommendations you probably heard and will hear again, but these are my own:
Mandate the establishment of an outreach crisis service for children and families in every community of at least 20,000 population. These will deal with severe family conflict, threats of self-or-other harm by young people and severe emotional crisis, which could release stress on some of the children's aid societies and schools.
Have an objective body review the wisdom of blending, be that co-locating or integrating, mandatory services such as child protection or young offenders with voluntary services such as family support, children's mental health, day care development services, etc. My own observation is that this review needs to be done external to the ministry; it needs to participate, but it needs to be external to it.
Give someone the clear mandate to provide mental health and support services to 16- to 18-year-olds. A particularly pressing need is supervised independent living for those unable to live at home because of abuse or chronic and severe family conflict.
Implement at least one of the recommendations of the Provincial-Municipal Social Services Review Committee, that of the province assuming full funding responsibility for children's aid societies. Child protection, in my opinion, is and should remain a provincial funding responsibility entirely. I think it is too important a matter to be influenced by the resistance of a municipality to increase in its yearly budget, and that sometimes happens. Talk to any CAS director and he will tell you that sometimes enters into the decision of whether to place a child or not.
Research literature shows principals to be a key factor in the positive mental health of a school and its children. Have the Ministry of Education establish criteria which would include such a criterion in the selection of principals. It is time that any educational personnel who are into power and control and who do not like children be weeded out. There are some; they should not be promoted.
Work towards establishment of a continuum of mental health services in each general community. A continuum would ideally include prevention, early identification and intervention, outpatient treatment, intensive crisis counselling, day treatment, therapeutic foster homes, therapeutic group homes, residential treatment, and inpatient hospitalization for those in imminent medical plus emotional danger only in the latter case.
Establish incentives for pilot integrated programs between service sectors; eg, children's mental health and boards of education. Honey always gets you more than vinegar. Try some incentives. I see very few incentive programs around the province today.
Low-cost accessible recreation programs, and here I am parodying what Dr Maloney has said, are also vital in the prevention of mental health problems and delinquency, particularly for disadvantaged children. Many smaller communities lack these, and frequently welfare children are left out of increasingly expensive rec programs. Community development efforts in recreation should be funded by both local and provincial government. These would attempt to develop inclusive, low-cost, adaptable rec programs at the grass-roots level.
An observation is that many of our municipalities fund hockey arenas. Most children do not play hockey. It is really only a small number of children who can play competitive hockey. The vast majority of children are left totally out of recreation programs in municipalities.
Focus public attention on what is known about media violence and its increasing effects on children and families. Much work, and I would point you to Goldstein in New York, is now showing strong linkages between prolonged exposure to media violence and an increasing propensity of some of our children to use violence as a way to resolve problems. There is a lot of information on that and I would encourage you to focus some attention on that.
Thank you for the opportunity to present to this committee some of my own views. They are not the views of anybody but myself, and I would try to respond to any questions you may have.
The Vice-Chair: Thank you for your presentation. We will turn our attention to questions. I have several people on my list. Would you like to proceed, Mr Martin?
Mr Martin: Let somebody else.
The Vice-Chair: I have Mr Malkowski, then Mr Beer and Mr Hope.
Mr Malkowski: Thank you for a very impressive presentation. I appreciate getting more and more background information to help me better understand the problems. You were saying there is no standardization for children who require services from mental health centres. What do you feel should be considered in terms of standardization? What would be a priority? That family support services be provided? Do you feel that mental health workers need further skills? What would you like us to consider in terms of what kind of standardization would be required?
Mr Ogden: I think that almost all the studies in Ontario. community studies by district health councils, children's services committees, planning groups, have identified crisis as the single biggest gap in most of our communities. That is where I would start, a crisis service that has an outreach capacity into the community, into schools, into homes, coffee shops, wherever. That is the place I would start. Then I would try to build an integrated system, a continuum of services much as is in my documentation here. Certainly there is a need for more outpatient counselling, there is a need for more integration, but crisis is at the top of my list, and I think you would find that in most communities.
The Vice-Chair: We have less than 10 minutes, so one question from each party and then we will have to proceed from there.
Mr Beer: Thank you for your paper. I think it is all the more valuable for being personal and also reflecting the broad experience you have had in the field. One of the things I was interested in was that I do not suppose anybody could serve as Minister of Community and Social Services without recognizing very quickly that he or she never had enough money to do all the things he wanted to do. It seems almost in every way that you are drawn back to: Can we organize the system better to at least make the dollars go farther? You raised some areas where you wondered whether we could have this better co-ordinated.
In the late 1970's, George Thomson and his group -- Keith Norton. I guess, was the minister then -- came in with the major changes at that time to the whole children's services system; very good changes they were, too. One of the things that a number of people have since wondered about is the fact that the children's services councils were not mandated; they were left as optional. You noted that you had worked with one that moved on from being optional to disposable. When you look at co-ordinating at the local level, we heard from Alex about the one that functions in the Hamilton area. My brief experience was looking at a number of different co-ordinating groups, some of which worked better than others. Is it your sense that what we are going to have to do here is not to tell the local area, however defined, precisely what it has to do but that we are going to have to mandate some body with the responsibility, if you like, to bring everyone together? Because it seems to me if there is not something like that, then what happens?
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You mentioned the proposal that children's aid societies and children's mental health societies become one and the same. How do we go about getting the kind of co-operation and co-ordination at the local level if we are really going to make that work, and use the resources, limited as they always will be, to the best extent? What is your advice after a number of years in this area?
Mr Ogden: I have wrestled with that one a long time myself, but I am not perfectly comfortable that I have concluded for myself the best direction. However, on balance, I do believe you have to have a clear vision provincially with general policy emanating centrally. Then I think you have to turn it over to the local community to figure out how to implement that. While it worked very well at Hamilton and in a few communities it worked very well, as far as I know that took about 10 years to build. That may be the best way to do it, but I do not think we have 10 years. I think we will have horrendous problems if we wait 10 years, and there is a lot of communities that have not even started. I would personally give a mandate for that kind of authority to a local body.
The Vice-Chair: We have to go on. The next question is from Mrs Witmer and then, if we have time, Mr Hope.
Mrs Witmer: We have heard today from the minister and from Dr Maloney that some of the causes are poverty, single-family homes, divorce and unemployment. You mention here that we should be taking a look as well at media violence. Have you personally seen this having an impact on children in the community you serve?
Mr Ogden: It is impressionistic and not scientific from my perspective, but we run into that all the time: In my opinion, sometimes it is enough to push over the kids who are unable to separate reality from fiction and kids who are borderline anyway or who have a lot of stress. Even more insidious, I think, is the solution of violence even for normal kids. They see it over and over. I really would encourage this committee some time in the future to have Dr Goldstein up to talk about his research and findings. Even though it is from the United States, there is a lot of food for thought. It is frightening, the kinds of stuff that he is finding about media violence and how it has affected kids.
Mrs Witmer: What type of action do you see children taking as a result of what they see on TV or read about?
Mr Ogden: At the most innocuous level, they try things they see: kickboxing, jujitsu, things they see on World Wrestling Federation. They try that on each other in a playful way and sometimes that can be destructive, but in a less functional, more dysfunctional way you see kids resorting to violence very quickly. They have not seen role modelling of other kinds of ways of solving their problems, but they have seen many instances on TV and sometimes in their own families of the way to resolve any kind of conflict, any kind of disagreement. It is to resort to violence, so we see kids very quick on the draw to resort to violent actions.
Mr Hope: To be very quick, without a long speech, most of your reference in here deals with welfare. As a person who has represented working people for the last 13 years, we have those who are called the working poor, with both parents out working; the child is now the victim of the so-called social depression that has now set in on an individual. Maybe I am not clear on where your terminology of "welfare" comes from. Does it mean just the status of the income coming into the home, or the status we all are faced with now, called welfare as general assistance?
Mr Ogden: My response is that by "a welfare mentality," it is doing things to people. That is the concept I do not want to have us perpetuate. I want us to do things with people, together. I do not want to control people. Unfortunately, much of our legislation is into control rather than understanding the problems and coming to grips with them. I do not want children's mental health centres to get into that mode of agents of social control. I think we are supportive agents and that is where we should stay.
Mr Hope: You see the parents fearing to come forward with a mental health problem, "not my child," because of the lifestyle they may have come from? Is that still part of what happens?
Mr Ogden: Children's mental health is still stigmatized. Mental health is still stigmatized. By the growing definition, I think more people are willing to use it, particularly for parental conflict, than used to be the case and I think that is healthy. But it is probably mostly professional-driven, by educators, doctors and nurses, rather than the public at large. I think we still have some substantial education of the public at large. We are really afraid to do that, because the waiting list is already so horrendous we could not accommodate them if we went out and told them there were more services available, anyway. So sometimes we do not tell.
The Vice-Chair: Thank you very much for your presentation.
LAMBTON COUNTY ROMAN CATHOLIC SEPARATE SCHOOL
BOARD
LAMBTON COUNTY BOARD OF EDUCATION
The Vice-Chair: We move on now to our next set of presenters. I want to make note of the fact that the Lambton County Roman Catholic Separate School Board, represented by Bert VandenHeuvel, and the Lambton County Board of Education, represented by Peter Cassel, are going to make a joint presentation. It is interesting to see that there is a degree of co-operation among the boards. You will be making your presentation for the combined period of one hour. Whatever way you would like to split that up in terms of your presentation and then questions, I leave entirely up to you. Thank you for joining us and the floor is open to you.
Mr VandenHeuvel: I will ask Peter Cassel to start the presentation, I will kick in when it is my turn and then we will go back to him.
Mr Cassel: If the committee members have in front of them this non-partisan yellow document, this is what we will be using as our reference point. We will be going through it, not reading it word for word; I plan in my part of the presentation to paraphrase some of the sections in it to supplement and add to. Committee members may want to make note of that as we go through for questions later on.
It is indeed a pleasure and an honour to be here today to make this presentation to the standing committee on social development. As we sat in the audience listening to the previous three speakers, we could not help but be impressed. Odd, their perception of school boards. We hope to balance that perception for you today and to share with you perhaps a different point of view, a different orientation, and I think in total provide for your committee a rather balanced view as to what the needs of these children might be.
We are unique in that we are here today showing co-operation between two school boards in a community, Lambton county, including the city of Sarnia. Not only are we here as two officials from those boards, we are here representing 21 boards of education across the region of southwestern Ontario. Those who know the region will know the city of London, the city of Windsor, boards like Oxford, Kent, Middlesex, Huron and Perth, a variety of boards making up a variety of different structures administratively. We are here as representatives of those 21 boards, working on a county of Ontario that could be considered representative of a rural-urban area, so I want to stress we are somewhat typical.
The proposal we share with this committee calls for improved co-ordination in the delivery of health services to children and perhaps offers a new means for parents to better access the services -- and we stress this -- that already appear to exist in this province. Before the specific details of the proposal are presented, it is important that the committee appreciates a brief history of the circumstances that have precipitated the current dilemma facing boards of education in dealing with children who require mental health services.
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What I would like to do is just go back over a brief history, a brief chronology, for committee members in particular to see what the orientation is of boards, why we have reached this decision to present today.
I was part of the structure that on 12 December 1980 helped behind the scenes to introduce a bill known as Bill 82. Bill 82 is now law. The government of the day proclaimed the bill as a significant step forward and no one, I think, would dispute that.
During a speech to directors of education from across Ontario shortly after the bill was passed, 30 January 1981, the then Minister of Education, the Honourable Bette Stephenson, declared that "the bill ensures that every child of school age must be enrolled in school upon presentation by the parent or guardian."
I was part of the Ministry of Education task force working behind the scenes at the time. It was my job, on loan from the Lambton board, to assist boards in southwestern Ontario with the implementation of that bill. It was an awesome piece of work. In order to prepare the bill, boards of education had until 1 September 1985 to plan and phase in special education programs and services that were required to implement that legislation.
This is a key point, and I want to stress this point, that the Ministry of Education in turn expected to have in place "mechanisms for closer collaboration with other ministries" to provide the additional support services some school-aged children would require. Dr Stephenson, when she spoke to those directors of education, made several points that evening, including that mechanisms for closer co-operation would follow.
In an attempt to gain this closer co-operation, this interministerial agreement, which became known in our circles as memo 81, was issued on 19 July 1984. The agreement was signed by the three ministries, Education, Health, Community and Social Services, and was at that time the Ontario government's commitment to see that all pupils with special needs received support services they required to benefit from, I stress, an educational program -- not a mental health program; an educational program.
When it appeared, the agreement centred on health support services in school settings and failed to mention the provision of services for children who may require services to deal with social, behavioral, emotional or psychiatric problems.
Prior to and since 1984 in particular, the ministry with the lead responsibility, and you heard it in the three presentations today, is definitely that Ministry of Community and Social Services whose collaborative role with the other two ministries, Health and Education, continues not to be defined by agreement or by law. And for that, ladies and gentlemen, that is an issue for us today.
If I could digress just for a moment on the home care aspect, and this is the Ministry of Health, for an administrator like myself or Bert to be able to get on a telephone and call our counterpart in home care and say, "We have a child who requires physiotherapy in our schools. Could you deliver the service?" and not to get a beat-around-the-bush or some kind of vague answer but a direct statement that they can and will provide is indeed a simple and co-operative working relationship. It can happen, and it can happen with a simple change of policy in this province, that we can in fact have a better, easier working relationship if the political and collective will is there. It has worked since 1985 with the Ministry of Health and the Ministry of Education, ie, boards of education.
Since 1 September 1985 boards have assumed that the responsibility for programming for all behaviourally disordered children, regardless of the degree of severity, is entirely their own. If a pupil is admitted to one of the 85 mental health treatment centres in this province to receive assistance, it is more often due to good fortune rather than collaboration on the part of the board of education. The linkages between mental health services and education are left to chance in most communities.
Under the Education Act and regulations, boards of education may purchase services from other boards. In other words, the Lambton public board can purchase services from the Lambton separate board and vice versa, but under current legislation we may not purchase services from mental health centres. That is a key point. Therefore, many pupils who require treatment services are denied access by boards of education who do not see such services as their mandate and from treatment centres that operate according to independent admission criteria which may or may not define the need for treatment from a school perspective. I stress that to you too. We do not always see the world the same as mental health treatment centres, and that possibly comes as no surprise.
During November 1989, the Ontario Association of Children's Mental Health Centres -- and you have heard a bit of this this afternoon -- began an active campaign to increase public awareness concerning what it claimed was the rapidly deteriorating quality of treatment services to children. The association claimed that at the time there were an estimated 10,000 children on waiting lists for treatment. Their message called for what they called "universal access," a concept that, if translated into law, would see mental health services equated to physical health care services.
By 20 March, the issue of the waiting list for treatment services was being raised in this House and, on 12 April 1990, Andy Brandt moved the following resolution:
"...recognizing the increased incidence of behavioral problems and violence in schools, and recognizing that children in Ontario currently do not have a right to mental health treatment, and recognizing that there are 10,000 children presently waiting for treatment in children's mental health centres, and recognizing that there is a lack of legislation in Ontario which specifically governs mental health services for children, the present government should make the provision of children's mental health services a government priority and take immediate action to ensure that all children in Ontario are provided the mental health services which they require and deserve."
Perhaps, Mr Chairman, that is why you are meeting today.
The resolution passed the House on vote of 46 to 5 and reflected the concern of legislators from all three political parties.
Bert and I belong to a group called the Western Ontario Regional Special Education Council which unanimously passed a similar resolution on 11 May 1990:
"Whereas there is an increased number of behavioral problems in schools, whereas the Ministry of Community and Social Services does not have a treatment role that supports such pupils in schools" -- and I would underline "in schools" -- "(similar to the health support services of the Ministry of Health), and whereas the Western Ontario Regional Special Education Council supports a treatment role for the Ministry of Community and Social Services in schools, be it resolved that: The council requests that the Ministry of Education explore with the Ministry of Community and Social Services the implementation of treatment services in schools by I September 1991."
I stress that this resolution had the support of 21 boards of education, that is, the administrators of those 21 boards who deal with special education problems and concerns every day.
As mentioned in our opening remarks, the council serves as a forum for school board administrators with supervisory responsibility for special education to meet with officers from the Ministry of Education at least three times a year. We met in London in May 1990 and the officials from the 21 boards supported the resolution and requested a meeting with senior Ministry of Education staff to seek their reaction. We call this in the vernacular "taking it up the pipe." In other words, we wanted to see if our view of 21 boards in Ontario would be supported here in Toronto and would find support across this province.
On 21 November 1990, the council had the opportunity to meet not only with senior staff from the Ministry of Education, but a senior staff person from the Ministry of Community and Social Services was able to join this meeting. School board administrators were surprised to hear the level of support expressed for the resolution by senior staff from both ministries -- I would stress "both ministries" -- and were impressed with the level of activity and projects that were taking place in other regions across Ontario. It was acknowledged at that time that only one out of six pupils who require services is actually receiving some form of treatment.
Issues and problems related to human resources, and you have heard many of those here this afternoon already, time and fiances were reviewed for the benefit of the council. It should be stressed, however, that a great deal of provincial support and enthusiasm was expressed for the resolution, realizing that there are many real obstacles to successful implementation. You have heard many of those obstacles again repeated for you.
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One of the key goals the Minister of Education discussed at the 21 November meeting was a desire to move towards an integration of services -- now this is a buzz term; you are going to hear this quite often in presentations, "integration of services" -- in an attempt to meet the needs of these pupils. Increasingly, the school is seen as a focal point in the life of a child and the logical place where resources should be located. It makes sense. Health services, health clinics and psychiatric services would be available at the school the pupil attends if the vision of integrated services was to become a reality.
A major benefit of the integrated model, in which teachers work more closely with other professionals, would be that both parties would profit through the professional development. Another benefit, and perhaps the greatest benefit, would be the ability of parents to better access the services in a collaborative mode with the school, thereby keeping their children in their natural homes, their natural schools and their natural communities.
In a news release dated 18 December 1990, the Ministry of Community and Social Services announced the publication of a report entitled Children First. The report was produced by the Advisory Committee on Children's Services and made a total of 63 recommendations. These recommendations are designed to ensure the entitlement of children to be "raised in conditions that contribute to healthy growth and development."
Again, this report calls for the integrated framework that ensures that the entitlements of children are met through a holistic system of "supports and services." The authors are realistic when they recognize that voluntary collaborative measures among different agencies, including perhaps boards of education, will fail because of "protected turfs, conflicting values and confused accountability."
In order to bring about the sweeping changes the committee feels are necessary. Children First calls for a reorganization of the provincial government to integrate all children's services under a single authority. While this recommendation may be extreme and far-reaching, the intent is clear. The present system is not working well and that fact is clearly recognized by individuals within the Ministry of Community and Social Services.
If I as an individual may just digress for a moment, this bringing together -- and I heard it in the three presentations previously -- of some sort of single authority, single children's services, I would view as perhaps a long-term goal, not a realistic immediate possibility. There is just frankly too much turf on the road. What we will present here this afternoon may be an intermediate step along a lot of steps to get to perhaps an end goal.
For a variety of reasons, I am going to pass the next part of the presentation to Bert.
Mr VandenHeuvel: Recognizing that there are some people who have had familiarity with school boards, this may be second nature to you. For others this may be somewhat revealing, if not astonishing.
In any case, what I want to address very briefly is what we in school boards try to do in terms of philosophy when we have to deal with children who need some kind of intervention. Our target is to give the most enabling intervention that we can possibly do. Also, one of our other philosophies is to keep the children in the regular classroom as much as possible.
I will just take a very brief moment to go through what you see on page 7, the diagram which is called the cascade model of delivering special education. What it essentially describes is that what we want to do is keep the children as close to the classroom as possible, and wherever there is intervention, to go to the most appropriate level that is required to help that child.
Now, if you will notice, the first two levels are mostly in the classroom. Then the third and fourth levels are taking the child away from the classroom but still within the school setting, with a regular classroom, with part-time special education in level III, and moving up the ladder, special education where the removal is more than 50% of the time from the regular classroom and will be in a special education classroom. If you noticed, when you move up to level VI, we are basically saying the level of treatment this child needs is beyond what we can do in a school setting and the child should receive treatment prior to getting education. That should take place in a residential school treatment facility or a special provincial school.
The intent is to keep as close to the classroom as possible but to provide the level of service that the child needs and make the intervention as short-term as possible and return to the regular classroom as soon as possible.
What we are basically dealing with is, what can we do within a school setting? I will try to address that on page 8. If I am going too rapidly, I am sure that I will get some questions, but I recognize that our presentation time is limited so that you will have the questions. The model itself is not the thrust of this. I felt you needed the background information.
At school level, we do have the mandate and we are required to provide education to all children. That has already been mentioned and certainly it is nothing new to you. The difficulty is that not all school boards intervene with the same vigour and the same enthusiasm. That may be for a variety of reasons, whether from a philosophical basis or because of the financial restrictions that certain boards may encounter. That is not restricted to southern Ontario. I notice my colleague, a gentleman from northern Ontario, is not here, but the issues are provincially, not northern and southern Ontario, different. The problem is when you have lack of money, it is all over the place.
What I am trying to say here within this section is that there are problems with commitment on the part of school boards, and that is because we have some options. Currently, the school boards use a variety of interventions, and they can be looked at as a continuum. This could be directly in the classroom, where the teacher may be receiving a teacher assistant to work with a child, or a child care worker. There may be a social worker or someone who works with a classroom teacher, giving some ideas to the classroom. There may be a behavioral class which may remove the child from the actual classroom within his community. There may be linkages between outside agencies and the school board. In any case, the focus is still on the educational needs of the child when we are talking about the mild and moderate cases.
What is coming to our attention more and more, whether it is someone at the public board or, in our case, we are beginning to find that more and more children are coming to the attention because of the fact that they are not getting the appropriate intervention, and they are coming at a younger age. In my previous life, so to speak, I was a principal of a secondary school and we found that we could intervene with the students in grade 9. Now for the last five years I have been superintendent of special education and education, and we are beginning to find that the problems are occurring at a much younger age. In fact, we are now dealing with children as early as grade 1 and grade 2, and these are problems that are out of hand. I think those are the kinds of issues that we really have to be concerned with.
What I want to address in the next section is the severe cases, the ones that we really feel we need some support with, and those are the ones we probably try to address in terms of being at the upper level of that scale that I explained to you on page 7.
The severe cases show all or most of the following behaviours. They have very aggressive tendencies. They are violent in both the classroom and the playground. They injure themselves as well as others. They certainly lack co-operation. They do not adhere to any rules. They are very frequently involved in stealing, frequently involved in violent play, whether that is within a classroom or outside, as I mentioned in the playground. They will not accept any responsibility for what they have done. They just believe that it is not their problem, it is somebody else's.
Defiance -- they do not know how to resolve problems. The previous presenter mentioned that it is quite often the case that they do not know how to resolve problems, and obviously when they do not know how, then they use what they are seeing on television, which is often very ineffective. The list goes on, and I do not think I need to dwell on each of them, just to recognize that these are very severe when we are dealing with them in a school setting and also when the child is still at home in a family.
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The nature of the behaviour and emotional problem is so disruptive to the child's normal development that learning is negligible. They are currently in schools, but I assure you that they are not learning much. If they are learning, it is just by chance. In fact, the school board's primary responsibility related to assisting students with skill and knowledge acquisition, which is one of the main mandates of schools, is superseded by treatment of the child.
In other words, we cannot deliver education. What this child needs first and foremost is treatment and that is not the capacity of a school. We do not have the education, the training, and therefore we do not do a good job at it. Most school boards do not have access to funds to provide for that level of service.
Access to outside treatment agencies is often non-existent. Maybe those of the ones -- we have called it a crack, but I can assure you that it is more than a crack: It is a huge gap. The access is non-existent or often much delayed. School staffs and administrators can at best provide a caretaking approach. Essentially what is happening is that we are keeping a body in the school, keeping it warm, keeping it off the street, but we are not carrying out our mandate which is to provide education. The impact on the individual school is that we are just controlling it. On the child, it is even worse. It often adds to additional frustration for the child as lower self-esteem because of all the things that are going on in his or her life in the classroom and in the school yard, and essentially what happens is that he becomes isolated from his classmates.
You wonder, are we talking about huge numbers in every school? I can assure you that what we are talking about here -- we may be somewhat conservative because we are trying to focus on the primary and junior divisions of the schools -- when we are talking about the mild and moderate, I can assure you that there is probably one in every school. When we are talking about the very severe, the ones we are trying to deal with at this point, we are not so sure that we are talking about one in every school. In fact, we estimate that within our two school systems we approximate one for every four schools, so we are talking about roughly, in the system I function in of 20 schools, we probably have about five or six youngsters who really need the label of "severe" and need the treatment we are talking about.
Again, what we are mentioning here is that it is occurring at a much younger age and we feel that there are a couple of solutions to it that this committee should focus on: early intervention and appropriate treatment and prevention. Again, we believe that we have a task to do in education on both those issues.
Again, we do not want to claim that we have invented something new here. Children come as whole entities. They do not come neatly divided for Education, you know, where we deal with the intellectual, and in the Health ministry we only deal with the physical, and the social and emotional would be given to Community and Social Services and the cultural to the recreational. Kids do not come neatly packaged and say, "Well, you've got a problem here; go get a solution." They come as whole entities.
The problem then that we have to address is, how do we solve it when these children come to us with problems? This requires co-operation on the part of government ministries. We have to co-operate and collaborate and take responsibility for providing the services that are required. This co-operation then should be based on a partnership of equals, not where one ministry decides that it will not accept responsibility because of a lack of staff, a lack of funding or different priorities or an unclear mandate. I believe that this is where the current problem is, that we have these issues in existence and as a consequence we are not providing the services that are needed.
Peter mentioned a little bit earlier policy program memorandum 81 which outlines the responsibilities that should be assumed by the Ministry of Education, the Ministry of Health and the Ministry of Community and Social Services. It is our view that too much flexibility currently exists for the lead ministry, Community and Social Services, to delay or to deny services altogether. We do not have that privilege. When the children come to our door, no matter what their problems are, we have to deal with them. We cannot say, "Well, we'll make a waiting list and when we get to you we'll get to you."
We believe that is part of the problem. The impact on the decision-making ministry, Community and Social Services, is relatively minor when it says. "You're on a waiting list." Neither the child nor the parent has much political clout to get something changed as individuals, so there is not much of an impact on the ministry by the decision that creates havoc within the child, the family and the school.
To state the obvious, the child and the family cannot remove themselves from the problem. They live with it and all of the consequences. Even at the school level we can begin to distance ourselves to some extent. The principal may at some stage say, "You are suspended from school because of the consequences that you are delivering on other children." If it gets worse, then the board may say, "We are going to provide education within the home."
That still does not solve the problem for the child and that particular family, so we feel that part of the solution has to be to remove that optionality from the ministry that is charged with providing care and treatment, and again the emphasis has to be on treatment. As long as there is no treatment, we cannot do the job of educating.
We agree with the reports that have been brought to your attention this afternoon, and I want to focus just very briefly on what Peter mentioned just before he turned it over to me. Our concern is that before all these recommendations that you are going to come up with as a committee can be fully implemented, hundreds, if not thousands, will continue to fall in that crack and be denied access to essential treatment. We also concur with the report Children First that the school is the key to the solution. We already serve as a focal point for children's lives probably from age four and onward, in most situations, to the age of 20, so that whether we recognize it or not the school is a focal point.
Parents feel relatively comfortable -- I am not saying all parents and that they are always at ease, but relatively speaking when they come to a school they feel comfortable in dealing with the staff and the personnel who are there. There is no stigma attached and that is one of the concerns the previous presenter mentioned, that there is usually still the stigma when you seek mental health care. If that is provided and looked after at the school level, perhaps that would be eliminated or at least reduced.
In any case, what happens is that if there is treatment provided by another agency the school has to be part and partners with that treatment. It is only when that partnership takes place, when we take our share in assisting that child, that there will there be long-lasting effects on the child or the adolescent.
I also want to caution the committee members that school boards cannot assume this additional responsibility without some reallocation by the Treasury department. Now, earlier one of you asked the question of the minister, has she made some overtures to the Treasury department? We certainly encourage that if this is going to take place, that some additional responsibility be laid on the Ministry of Education, that through school boards some funding be provided so we can provide the personnel and the facilities and the administration that is required to do the job.
The last paragraph indicates it would be unfair for us not to offer at this time to the committee what is felt to be a means of dealing with the problem on a scale that addresses the issues of funding, availability, accessibility and collaboration in a manner that is responsible, and I believe that is the mandate of this committee. So Peter will now try to present you with one working model and there may be others.
Mr Cassel: When we began our investigation, it was again northern Ontario that seemed to be leading the way. In a particular board in northern Ontario, the Central Algoma Board of Education is part of a group known as the Integrated Services for Northern Ontario, lSNO.
The group was formed by the three ministries, Education, Health, and Community and Social Services, about nine years ago and during most of this time it has remained dormant. It has not been an active group. In reality, ISNO has only been in operation for approximately one year. It was built on good intent. However, the mental health centres throughout northern Ontario have received extra funding to provide extra staff to assist this particular program. Details of the amount of funding unfortunately are not available to us, but are said to be modest increases to existing program departments. I would stress that is what we are saying today. We do not think it is necessary to build an entire restructuring of the system. What we have discovered in northern Ontario in the model we are about to present is not a great incremental cost structure.
When a principal of a school within the jurisdiction of that board makes a request to the local centre for services, a protocol has been established that it clearly define what action may be expected at the school level to deal with the referral. In other words, they have agreed on a game plan well in advance. It is articulated, written down and the script is followed. The consent of the parent is sought before the referral to the centre has been made. Criteria have been established to determine whether or not the referral is urgent and thus a priority for the assignment of staff.
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If it is determined to be a priority. the services are provided in most cases -- here is the magic we are looking for -- in the school. The board of education, in this case the Central Algoma Board of Education, does not provide funding for any aspect of the services provided by the centres. The schools in turn have been very conservative, and I would stress that with a small c, in their referrals and have not done so unless there were what the director of education terms a real problem.
Most of my information on these pages, on pages 12 and 13, comes directly from Mel Baird who is the director of education. Some of the committee members may know him.
Their incident rate would be similar to what Bert mentioned earlier, about one of these children for every four or five schools. In the board I am responsible for, we have 18,000 pupils. At any given time, there are about six to 10 of these pupils in our system who are causing the system a lot of anxiety, about six to 10 out of a total population of 18,000.
The ISNO model is not perfect and both the educators and treatment personnel have gone through periods of stress and adjustment. This is a normal process and is to be expected when individuals with different mandates must work together to establish common goals. The same stresses were felt when board of education personnel began to see health care professionals in schools around mid-1985. The practice of medicine has been left to qualified personnel in the school!i and teachers have been left to do what they are trained to do: that is, educate. The pretence of providing treatment services to pupils by placing them in special education programs is a time bomb whose tick is becoming increasingly amplified.
Bert and I are here precisely for this reason. We are increasingly feeling more and more uncomfortable with boards of education providing services that are clearly treatment as opposed to education. It is almost unfair. Clear and decisive movement action is required to deliver on the commitment that Dr Stephenson made, at the first part of our paper.
In conclusion, boards of education, at least boards of education in southwestern Ontario, are seeking access to the range of psychiatric treatment professionals who are not currently available to schools. As you have heard, the proposal is rather conservative and attempts to focus on the truly severe cases, the cases in greatest need.
Boards of education were promised collaborative services as part of their new mandate to educate all pupils, exceptionalities notwithstanding. The resolution that was adopted by the Western Ontario Regional Special Education Council in May 1990 was simply a restatement of the need for collaborative treatment services similar to those health services first identified by Dr Stephenson in 1981.
It is time that the commitment was honoured and boards of education and the parents they serve have a mechanism to access the range of school-based treatment services, including from time to time institutional settings if need be, that presently are under the authority of the Ministry of Community and Social Services.
This is quite a machine-gun approach this afternoon. I would welcome questions.
The Vice-Chair: You have given us a great deal to discuss.
Mr White: I want to express my appreciation for your report. It is very thorough.
The issues you deal with, in terms of the problems that some children may present within a school board, where the mandate, the direction and the emphasis of course is on education and not on treatment, has been a perennial problem I understand for many, many years.
On page 11 of the report, you mentioned the recommendations of a provincial children's authority. You seem to concur with it and yet you are saying there needs to be something done beforehand. Could you comment further on the idea of a provincial children's authority.
Mr Cassel: I would be pleased to. As an intermediate step, and perhaps this provincial children's authority could remain a goal for the province, I would welcome the opportunity to be able to pick up a telephone and call my counterpart at the Ministry of Community and Social Services office and say, "We have a need," and to know that Comsoc officer also has a similar responsibility. He or she would have a mandate to provide services.
That does not mean our judgement, our assessment, has to be taken at face value, but at least there is an opportunity to begin the dialogue right there at that point. This is the coming together of Education with Comsoc. We do not mean that it would come under. It does not mean that we are under. It means we are co-partners, that we are, as we said in the paper, equals. Both have a clear and distinct mandate. When they said that they envisioned a provincial children's authority, I would see at this point in time of the evolution of services in this province that it would be absolutely disastrous to move forward with this rapidly.
Mr White: As supplementary, what would you see as being an intermediary step?
Mr Cassel: An agreement or law which brings Comsoc into this fray clearly and decisively as a partner. Right now it has no legislated role, as we can perceive it.
Mrs McLeod: I also appreciated your report very much. My struggle with the issue is the distinct mandate, because as you have said the child is a holistic individual and it is hard to separate the child's needs so clearly between the mandates in the different ministries.
With that in mind, let me just press you a little bit more on the intermediate step model you have proposed, because it seems to deal more specifically with the more severe behavioral problems and the access to service for children who need that kind of service.
What about the child with a milder, moderate behavioral problem in this school? Is that not a frustration for school personnel to deal with, given the fact that your central mandate is to deal with the learning needs, the special education needs? Yet that child with the milder, moderate behaviour problem, if it is specifically related to the learning problem, in all likelihood needs some involvement and intervention with the family, and the school has difficulty doing that and lacks the trained personnel to do it.
Mr VandenHeuvel: I will take a stab at that and perhaps Peter can add to what I have to say. Yes, it does add to frustrations in the classroom. I can certainly vouch for the fact because we started a committee of five schools which really brought to our attention that they had difficulties with these. You hear the teachers speak and you hear the principals speak on these issues, and yet they feel that they can manage this with support, so we are not saying to the schools to sink or swim. They need support and we have to do some in-service training. Depending on what range they are at, if they are towards the upper end, with needs towards the severe of the moderate level, then we probably need social service work with direct intervention of a social service worker, which is a professional in a classroom with specific strategies.
On the other hand, if we are talking of the lower end of the scale, the mild -- someone earlier in the presentation intimated that possibly we could do a better job of doing some work on the prevention, that if we did it in the earlier stages in education and get some social skills programs, possibly we would even prevent the mild arriving at this particular level.
It is frustrating. They are asking for help. We feel we can do it at the school level with the current staff available, with some supports from outside. When we get to the severe, we cannot handle it because those children need treatment before we can educate them.
Peter, do you have anything to add to that?
Mr Cassel: No, that is fine.
Mrs McLeod: If I may, I think you are very brave. In long-time association with school boards, I was quite honestly impressed with the focus being so much on the needs of children that schools were willing to take on more and more responsibilities simply because the children were so needy. I know that the support was not always there and this is another step. I hear you saying you are concerned that although you think this is the way to go, will the support be adequate? But I have a sense that even with those mild and moderate cases, if we are talking about early intervention, some additional resources to deal with the family aspect of the intervention that is needed, the school needs that support.
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Mr VandenHeuvel: Some of it relies on the goodwill of teachers. I recognize that. I know that Peter had similar experience in some of his schools, that there are teachers who are there providing breakfast programs so that later on in the day the behaviour problems will not occur. A lot of it is because of the enthusiasm of teachers and the willingness to go the extra mile. I am sure if we said, "This is an expectation," there would be a whole different issue, but they do provide it and it is working so far. But we do need help for the ones who get towards moderate and towards severe.
Mr Beer: The figures that you used around the roughly one child in four schools who would, in your view, have a need for major intervention and help -- I wanted to be clear on that because I think sometimes you wrestle with, in terms of all the kids, when they have need of help, what are the relative degrees and where we should be really focusing. You mentioned that was from your own area, Lambton. Would you say that was reflective of the southwestern Ontario school boards that you are speaking for today as well, and do you know if that could be applied more broadly, or would you expect that perhaps Metropolitan Toronto or Hamilton or Ottawa, some of the larger urban areas, would have a greater need in terms of those most at risk?
Mr Cassel: I will try that one, Mr Chairman. I think what you can hypothesize, and I frankly have no evidence to support this today but I think it is good common sense, is that the larger, more densely populated urban areas are going to have a higher incidence of the type of children we are defining here. The smaller, more rural boards of education will have, just by the nature of those boards, far less incidence of the type of children we are describing as severe. My experience borne out visiting and working with boards of education across southwestern Ontario would reinforce that. It would be difficult for me to give you an incidence level in Toronto.
Mr Beer: But certainly your sense is that in London or Windsor, for example, it is likely that that could be one per school as opposed to one in four.
Mr Cassel: Possibly.
Mr Beer: May I just have a brief follow-up to that? The other question that emerges, I think, as we look at structures as to how to then really come to grips with this, and I would like your thoughts on this, is, should more funds and more personnel be allocated to the school board so that those people in effect are in your employ, the additional staff that you need to deal with many of these problems? Or is it more that you want to have the money and you would be purchasing that, be it from children's mental health centres, from a local hospital or wherever? It seems to me that becomes fairly important in terms of how we put together the son of children's authority, if you like, if we were to follow the Maloney model. I just wonder, where would you see that working out?
Mr Cassel: Perhaps neither option, with respect. There is a third alternative to consider. That is to perhaps better fund the mental health side of things so that those people, as we discovered in central Algoma, can in fact provide those services in co-operation with the board of education. We are determined -- I think Bert and I would say this and so would the other 21 boards -- to keep our identity rather clear.
We are a board of education, not a board of treatment, not a board of care, not a board of anything else but education. That is our primary mandate. As soon as you start clouding this by boards of education hiring psychiatrists, social workers, child care workers, and the list goes on, you begin to blur that distinction, you begin to blur the mandate. So I guess, in summary, what we are trying to stress here is, we want to be able to work with that sister ministry; not take from it, not take its staff or any programs, but I guess frankly to have it clearly as a partner in this treatment-education delivery.
I will give you an example that just crystallizes, perhaps, for committee members one of the reasons I am here today. I have a 13-year-old student within our system. That student right now has not one but two teacher assistants assigned to her every minute of every teaching day. She can become violent with no prior warning, aggressive to not only herself but any other children in close proximity, or adults or teachers or authority figures. We are left, frankly, as a board of education, taking the dollars-and-cents resources of those two teacher assistants and applying them to that individual child. Are we providing treatment or education? I would say on the scale of things, we sure are not providing much education day by day. It is containment, it is control, it is therapy of some sort. It is well outside our mandate. Ten, 15, 20 years from now the parent may come back to us and say: "My child worsened because of what you tried to provide. You caused a deterioration. You did not provide the treatment services my child required."
I paint that scenario briefly to illustrate to you we are providing special education programs and services, not treatment services. We do not advertise them as such. But increasingly our mandate is becoming more and more blurred as we get more and more children who have unique needs. Ten, 15 years ago that child would be in an institution; no doubt about it. That child now is back demanding education in a community school.
That is the balance. That is what we are trying to seek in this particular report, and I think one child is typical of the type of children we are discussing.
Mr Hope: I noticed your pyramid there and I started to wonder about the pyramid in itself. Are we not labelling more children? I guess my question would be, who would do the categorizing of that individual? What kind of level would that individual be at? I guess I question where that would be.
Is it not true that between the educator and the services provided in a lot of the communities -- and I am talking specifically in the Chatham-Kent area, where I come from. As we are trying to work more closely with the boards of education to try to get access to the services, the services are not there. We do not have in rural Ontario the special qualified individuals to do proper analysis, and they only come in once or twice every week, or something like that.
I guess where I am starting to be a little hesitant is about your labelling of children in the school system as to behavioral pattern, as I see the TV -- and my own son is one of the victims of World Wrestling Federation wrestling who likes to be a part of it. I guess I question the labelling of a child and the categorizing of that child. Does that not create more of a problem because the children the child may go to school with are now putting on more emotional pressures? I personally would like to see the parents more involved with the child, with the process of trying to correct it, because there is no sense in the educators fixing the problem and the social worker fixing the problem and then putting the child back into the home, and the problem is still there when he gets home.
I think there has to be a joint effort by the parent, the educator and everybody who plays in that field to be a part of it. As you say, we are trying to close the cracks up. We have got to close the cracks up right there. Everybody has got to work together.
Mr Cassel: May I just comment? I think it is fair to say boards of education can deal with the WWF. This is the child who does not fit this category, does not fit the definition we are presenting today of severe. This is the child whose behaviour is extreme. The behaviour is obvious to most people who deal with this child not only in school but in the community, anywhere the child interacts, that this is a child obviously in need of additional services, treatment services in this case.
I do not want to make light of the cascade and so on. It is simply a conceptual model that we deal with to discuss and kind of conceptualize children. Children do not appear in cascades or packages; they appear as entities.
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Mrs Witmer: First of all, I would like to congratulate you on what I feel is an excellent report. I think you have certainly presented the case of school boards across this province extremely well. You have allowed the committee the opportunity to see how they do function in relationship to the students with special needs. I also appreciate the fact that the two boards did collaborate.
You have mentioned the fact that you are now starting to provide treatment rather than education. Certainly, coming from a board of education myself in the last few years, this is something that I heard more and more frequently from teachers and administrators. They express to me their frustration that they were providing treatment, as opposed to education, and there was nowhere that they could access this treatment. Really, I know many educators in this province are at their wits' end. I know some boards have created behavioral classes to deal with these students, and as you have indicated, you provide treatment. How many behavioral classes have you created, or how are you coping with all of these students with severe emotional problems?
Mr VandenHeuvel: In our case currently we have one for the intermediate level. That would be grades 7 and 8, essentially. Because of the needs we have within our community, we are looking at whether we need something for the primary and junior division, because some of those youngsters who really ought to be receiving treatment are still within our schools. We cannot get them treatment, and when the treatment is there, it is often too short to make a major change, so they come back in our school systems. So we are looking at having one for the primary and junior division, which is grade 1 to roughly grade 5 or 6. We are looking at it very seriously now to see what we can do and we want to do a little bit more than holding them and, to do what Peter says, to more or less put them in a holding tank. We want to provide some kind of treatment, even though we are not really treatment personnel. But we want to do something. I guess we feel helpless just to let them sit in a regular classroom and veg out and where we have to have someone supervise them and control them on a one-to-one basis.
In our system we currently have one. We are looking at the possibility of doing another and then there is still the area of the secondary, which can also have youngsters. If we do not do something with this group, the secondary area will become even more severe. So there is some demand from the secondary personnel as well.
Mr Cassel: I would just offer this opposite point of view. We tried a behavioral class. It lasted for one year. It was just like taking six pieces of sandpaper and bringing them together. They just grate and spark off each other. It took us one year to realize that was not the right approach for our system. We tried also to have a co-operative venture with one of our mental health treatment services in our county. That went fairly well, where we had treatment and education going hand in hand. It was a section 27 class, of which some of the jargon here -- it is simply an access for our services. But that had to be discontinued because the Ministry of Community and Social Services folks were not receiving adequate funding and could no longer continue to provide that service.
Our approach is simply now to try to divide and conquer, to keep the children away from each other, possibly with teacher assistance or in smaller special education classrooms or whatever, but it is not to bring them together. So each board will have different approaches in trying to cope. The point is, cope alone.
Mr Martin: I would say first of all I am impressed with the two school boards coming together and presenting this. However, your presentation does create some real concern for me, I have to say. It has caused me some confusion in that, on one end, we hear that there are waiting lists of people in our communities who are in desperate need of service of a mental health nature, and yet I hear you saying -- tell me if I am wrong -- that there are not really that many, that there is one in every so many schools who would be considered severe. Maybe I am just not understanding the levels of severity, but I just need to be clarified on that. The problem, as far as you are concerned, is huge out there. There are all kinds of kids who need service and we need to develop a system that speaks to its working properly to the benefit of the children. I hear you presenting a very simple answer, which is to have Comsoc sign an agreement to carry its end of the Bill 82 agreement of something that was passed, and yet I do not know whether we would be here today if there was an answer that simple just readily available.
I guess I have to say that it creates a need to hear from some folks who are perhaps the parents of children so that they might tell us a story that they have lived through with their children. I know, having been a trustee with the school board and also working with social services and addiction research people, that school boards in my experience have denied very much the presence of drugs in their schools when confronted about it. That got in the way of any effective programming being put in place. Anyway, I just throw that out to you for some comments.
We know that it is there. I would focus on what we have tried to show the committee. It is the truly severe that we have tried to address in our statistics. Again, I also want to state, from my perspective, I was working at the truly severe in the primary and junior division. If we look at the entire school system, that probably would be two out of four instead of one out of four. Now, that would be for my school board.
The Vice-Chair: One final comment, very brief. We have just about run out of time.
Mr Cassel: What we envision, again, to repeat the concept, as clearly as we can: Mental health centres will have their own totem-pole, their own priority ranking. They can admit, they can be demit, they can do the treatment. But when we have a child of the type we have described here today identified in a community, service has to be provided, and that may cause disruption in the totem-pole. "Mild" may be bounced off, I am not sure how many, but that child we have described here today has got to be considered a priority.
The Vice-Chair: I would like to thank you for an interesting perspective that you have brought to our discussions and a very wholesome debate that took place. I am sure it adds a great deal to our bottom line which will be dealt with by our researcher and a lot to consider there in terms of the new model. So thank you very much.
Mr VandenHeuvel: Thank you for allowing us to make a joint presentation. Two heads are better than one.
KINARK CHILD AND FAMILY SERVICES
The Vice-Chair: Our next presentation is from the Kinark Child and Family Services. Jeanette Lewis is the executive director. Welcome to the committee. The floor is open to you; you have half an hour. I am just looking at the clock to note when we start our time here.
Ms Lewis: I would like to thank you for this opportunity to present to the standing committee on social development and I would bring special greetings to Mr Beer, who is the member for York North, where Kinark operates one of its programs. I understand also that Mrs McLeod was involved with our program in the Thunder Bay area when we were operating a program there.
Kinark is a not-for-profit children's mental health service with programs throughout the province. I have listed in my written presentation where we serve children. We have operations in Simcoe county in the city of Barrie and the city of Midland. In the regional municipality of Durham we run a program in the city of Oshawa. In Northumberland county we have programs in the city of Cobourg and the town of Campbellford. In Haliburton county we have a program in the town of Haliburton. In the regional municipality of York we have a program in Newmarket and in Georgina and in Peterborough county we have a program in Peterborough. As well, we operate in Haliburton county, near the town of Minden, a large outdoor site which provides therapeutic recreation programs for children with special needs from Kinark and also from some 28 other not-for-profit social and health care organizations.
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We are a transfer payment agency, in the nomenclature of the day, and we serve over 1,000 children annually. Our organization gets all of its money from the Ministry of Community and Social Services in this transfer payment mechanism.
I think it is fair, when we talk about children's mental health services in Ontario, to recognize that there is a vast array of services in our province and that our province has shown leadership in providing high-quality professional services. I think this is a credit both to the government and to the service providers, and many jurisdictions are envious of what we have accomplished. So we should not be too distraught with all of the criticisms we have heard today. However, it is a day to bring forward issues, and as we bring these issues forward I would hope that the committee is also mindful of the many successes we have in our province.
I think it is also worth while noting the kinds of children's problems which are served in children's mental health centres. Most of the children we treat at Kinark have very, very serious problems, things like suicide attempts, self-injurious behaviours, sexual and physical assault -- and in that category we have both the perpetrators of assaults and the victims -- fire setting behaviours, property damage and threatening behaviours towards authority figures.
I am astounded when I read the next statistic, which is that 95% of the children who are admitted to the residential treatment beds in our programs have suffered from some form of abuse, primarily sexual abuse.
To articulate the severity of the problems demonstrated by the children in our centre, I would like to describe 29 cases which were referred to us under the age of 10; these were recently surveyed by two research consultants from Kinark, Eugene Sunday and Ruth Parry. They looked at the problems these children demonstrated at referral -- and remember these are children under the age of 10. Over one third of these children were referred because of withdrawn, anxious and fearful behaviour, which often included a preoccupation with thoughts of death or threats of suicide. In all of these cases there had been a parental separation within several months prior to the referral.
Two other major groups were identified: One group was referred for highly impulsive, overactive, disruptive and aggressive behaviour, the aggression often including assaulting another child or adult with some form of weapon; those from the last group were referred because they were victims of intrafamilial sexual abuse. Of these children, the boys demonstrated physical aggression to other children, defiance and negative behaviour. The girls tended to be described as depressed and withdrawn.
I brought these data because I felt the committee would like to have some understanding of the kinds of problems that children's mental health centres deal with. We had some debate earlier today about whether this is psychosocial or medical or whether it is learning disabled or whatever. I think the truth is that we have a very severely disturbed group of children who are often put together under various labels, but none the less they come to the steps of our children's mental health centres.
I would like to refer next to the Ontario Child Health Study, and I know Dr Offord is going to be appearing tomorrow. In the study it was found that 18% of Ontario's children demonstrate some form of psychiatric disorder yet only a very few of these children can be treated. We have heard from the Ontario Association of Children's Mental Health Centres, of which Kinark is a member, that we have some 10,000 children waiting for treatment yet our system is primarily focused on a case-by-case method of service delivery.
I think we have to look at incentives to develop other methods of service delivery. We are just not going to be able to do it all on a one-by-one-by-one basis. We have to start looking at populations and more systemic kinds of interventions. We need some kind of incentives so we are able to develop these kinds of initiatives. Certainly the kinds of proposals which were submitted to the Better Beginnings, Better Futures project would be a good place to start in terms of creative responses.
We also articulate a position here that all communities in Ontario should have access to a full spectrum of children's mental health services, which would include primary prevention, co-ordinated treatment service delivery and advocacy to represent the best interests of the children and the families who are requiring service.
As we have heard today, children's mental health services in Ontario are primarily delivered through a voluntary system, and our centres are run by voluntary board members who give many hours to try to decide how our services should be organized. The most chronic issue faced by our boards is that of funding shortfalls, and an inordinate amount of time is spent on dollar kinds of issues.
In the last five years, base funding for Kinark has been increased in lesser amounts than the consumer price index. This is no news to anybody, but this is further compounded by wage settlements which we have had to make well beyond the CPI. These have not been unreasonable settlements; these have been settlements which were instituted to try to bring front-line workers in our industry to some reasonable rate of pay. Regardless of those settlements, we are still faced with a situation where front-line workers are paid fairly unattractive salaries. When I came to Kinark just a very short time ago, we were at that time paying our front-line child care workers just a little more than $22,000 a year.
What we have to do to even maintain this level of service is to continue to cut back on the kinds of services that Kinark was funded to provide. We have had over the last years a gradual erosion of services in our organization, and this was done purposefully by our board of directors because there was a commitment made that we were going to maintain quality even if it meant we had to reduce some of the quantity. The problem is that residential treatment beds get reduced and other kinds of critical services get reduced and then there is a ripple effect through the system.
We have just heard a good description from our colleagues in the board of education, and I am sure the children's aid societies, when they come to speak to you tomorrow, are going to talk about the kinds of difficulties they are having servicing this same population of children in foster homes and in group homes in Ontario. Those facilities are not funded or organized in a way to deal with the kinds of difficult children we are describing here. We really need to look at a response that is going to target all of our sectors.
The funding problem is particularly frustrating in children's mental health centres when there is a perception that direct-operated government facilities with similar mandates enjoy a higher level of funding support, and we have heard other speakers today refer to this. The level of funding is manifested in the most basic way in rates of pay for our front-line workers, and I would like to refer to a study that was done by the executive directors of the Metro centres during the summer of 1990. At that time, we surveyed the salaries of child and youth workers in our system and compared the results to a similar classification in the public service, which is, I believe, the child care worker 1 classification. The average rate was $24,222 per annum in a transfer payment agency, while a similar person was paid $35,111 per annum in a government direct-operated facility, so it is little wonder that somebody is going to make a career shift when offered an opportunity in a direct-operated facility. Needless to say, this has caused some fairly severe issues of recruitment and retention of qualified staff in our centres. Staff often come for basic training and then leave us to go to better-paid positions, and the net effect is that we have a very high turnover of staff.
I would also like to comment on the services approach to budgets which has been required in our system during the past years. This is actually a well-conceived plan, but in reality it operates very poorly. Annually, each organization prepares an elaborate service plan document which details what services will be performed by the organization and at what cost. In many organizations these documents are over an inch thick; any of you who have sat on boards of directors are well aware of how complex and how complicated they are. In reality, all of the players know that the real rules are to take the approved base budget, add the percentage increase in the transfer payment allocation and then dovetail the services to fit, so we go through a time-consuming and frustrating exercise which is perpetuated and which really does not change the essential context in which services are delivered.
We have also had, as transfer payment agencies, significant additional costs resulting from government-driven initiatives such as the employer health levy, pay equity, accelerated remittance schedules for source deductions -- this is primarily on the part of the federal government -- and now the GST. Although we support these government initiatives, we need to have the resources to pay the costs. For Kinark alone, the cost of pay equity will be $1 million. We began to pay that last year and now in 1991, but we have really had very little support in terms of how these high costs will be met other than the requirement that it be found in our overall base budget.
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In addition, our agency faced additional costs of $500,000 per annum when we adjusted the staffing pattern to allow two staff on night shifts after a staff member working alone was murdered. Because of this serious incident, we have implemented the standard of two staff working together during the night and have received no additional funding support to ensure the personal safety of staff in a high-risk industry. We recommend that all residential centres in the province receive adequate funding to ensure that staff do not work alone in a treatment house.
I would also like to comment on the annual planning time frame. We have a budget cycle that goes on an annual basis, so the planning time frame tends to be annualized as well. We would like to urge the committee to look at a longer planning time frame which would allow for some true planning and which would be based on services requirements such as child population and social indicators rather than the audit-driven time frame that we are now under. We are certainly not opposed to monitoring and audit requirements -- I think that is part of good accountability -- but the two must be separated.
The funding constraints have not allowed alternative forms of service delivery to develop during the last five to eight years. In fact, in the children's sector there is virtually no research and development component. I do not think you would find any industry able to operate without R and D. We are trying to respond to the needs of children in the 1990s using treatment and prevention models which were essentially developed in the 1960s and 1970s. Because of the extreme funding constraints, all of the dollars have gone into service and there has been very little money for any kind of research or program development which has offered new models to meet the kinds of changing needs. I rather facetiously ask how many of us would find a 20-year-old car acceptable today, but I will leave that for your reading.
We from Kinark Child and Family Services urge that there be incentives developed for linkages among ministries. We have seen at the interministerial level some significant developments, but we have not seen this played out in the local communities. I think what has happened is that we have seen occasionally what we have called investing-for-children dollars flowed to the local communities and local children's services committees then asked to recommend how these dollars should be divided. As one of our local area program directors said to me, "It's like a bunch of vultures swarming on a piece of prey," because nobody has seen new money for so long. So it really begs any kind of true community needs assessment and it basically becomes one of power and politics.
I have closed the paper with some recommendations, basically that we look at funding inequities among ministries and between direct-operated government facilities and transfer payment organizations, address them and rectify them.
We look at the budget cycle, and I would encourage you to look at a longer time frame to allow us to implement some significant changes to programs.
I think we have to look at economic incentives to encourage interagency and cross-sectoral programs to develop. I think I say in my paper that value statements and philosophies are fine, but sometimes you have to put your money where your mouth is. If that is truly what is believed, then we have to find some ways to help people to live the values.
We also recommend that all residential centres in the province must receive adequate funding to ensure that double staffing and other necessary safety measures are a minimum standard in all treatment facilities. I think it behooves us to make sure there is not another Krista Sepp disaster because of a funding shortfall.
Last, we recommend increased encouragement and support for prevention and promotion initiatives such as the Better Beginnings. Better Futures project, to begin a process of developing creative responses for the children in our province.
Thank you for allowing me to present today.
The Vice-Chair: I will just point out that we have approximately 15 minutes for questions. I have thus far Mr Jackson, Mr Owens and Mr Beer.
Mr Jackson: Thank you, Ms Lewis, for a very pragmatic report, well written and presented. It was very easy to follow and it will be helpful to the committee.
I am interested in the dollars, and you referenced those in a couple of areas. You do that with respect to the costs of pay equity. Not all your centres have implemented at this point in time?
Ms Lewis: Yes. Kinark has negotiated a pay equity plan with both of our unions -- we have two unions in our centres -- and also with our non-union staff. We paid our first stipend last year, which was at the minimum allowable rate, which is 1% of the amount of the annual payroll, I believe.
Mr Jackson: Yes. You indicated earlier in your presentation, prior to that point, that one of your creative responses to these situations was to reduce not the quality of service but the level, the degree of service, cutting beds, and so on. Do you have that in more specific information with respect to staff that have been let go -- or not replaced, I guess, is the more appropriate, non-offensive way of putting it -- and/or beds that are no longer filled?
Ms Lewis: All right. I have come to Kinark recently, so I cannot talk to you specifically about the number of staff.
Mr Jackson: Is there someone else in the room who might be invited to join you?
Ms Lewis: I would refer you to the number of beds, though, because I can speak to that. I believe that about eight years ago, Kinark was opening 198 beds throughout the province. We are currently operating 72 beds. Now some of those beds were divested as part of a planned divestiture for other services to take over the services. But our not-so-creative response in terms of the erosion of dollars has been to cut beds, because it has been felt strongly that we are not going to jeopardize the quality of what we offer to the children we serve.
Mr Jackson: But cutting beds means cutting staff, because you are on a bed-staff ratio.
Ms Lewis: Yes, although I think in some respects the standard of staffing at which Kinark is presently serving its children is somewhat more enhanced than it was eight years ago as well.
Mr Jackson: So your staffing ratios have grown?
Ms Lewis: Yes.
Mr Jackson: Very quickly, Mr Chairman, if I may with respect to the reference, I was under the impression that additional dollars did flow to agencies after Krista Sepp's murder, that in fact there was an announcement that additional funding was transferred, and I get a sense that you are not realizing it or that it was absorbed somewhere else. Could you clarify that a little better for me?
Ms Lewis: There were additional dollars announced. They were flowed to young offender facilities. Kinark is not one of those, so we did not get any of it.
Mr Jackson: That was the catch-22.
Ms Lewis: That is right.
Mr Jackson: So they were announcing based on an incident, but they were not the beneficiaries of the -- I remember now.
Ms Lewis: That is right. The organization in which the incident occurred got none of the money.
Mr Jackson: Yet you are faced with having to provide the adjustments in the best interests of your staff, and this is an agency cost of $500,000?
Ms Lewis: Yes it is, because, you see, we did not implement it only in the area where the incident occurred.
Mr Jackson: Yes. It is a legitimate concern in all facilities.
Mr Owens: Further to Mr Jackson's questions around staffing, with a 30% turnover rate in your centre, how are you able to provide the safe levels of qualified staffing during shift periods, or are you faced with having perhaps one qualified staff versus three unqualified -- or volunteers or bodies, for the lack of a better word?
Ms Lewis: One of the things that we are faced with doing is paying very high dollars for overtime costs and to provide relief shifts with qualified people. We try not to staff our centres with people who are not qualified. We have an extensive training program within Kinark which people undergo before they work shifts in the residence.
Mr Owens: Just further to the overtime statement, how do you deal with issues of a burnout?
Ms Lewis: I think the burnout issue is reflected in the turnover rate. That would be my uninformed guess. I think people deal with it by walking.
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Mr Owens: In other words, if it is not being dealt with, they go out the door. They vote with their feet.
Ms Lewis: Yes. Unfortunately what happens is that the quality of care suffers because once people feel like they are ready to really undertake their role with some sense of competence, perhaps they are offered a better job somewhere else for a much higher rate of pay. So we are continually faced with having to staff our programs with, let's say, less experienced people than we would wish.
I think this is not unique to Kinark. I think you would find this fairly common among the centres, particularly in areas where we are facing fairly high costs of living and people just cannot afford to continue to work in children's mental health for extended periods of time despite their best principles.
Mr Owens: Finally, if we get to the issue of continuity and quality, and it almost sounds like you wrote my script for me here today, if you could address that issue of continuity where, if you have a 30% staff -- to me, that is completely ridiculous; you cannot have any level of continuity with a turnover rate that high.
Ms Lewis: That is right, and it is a problem for the children who are in treatment. It is a problem of credibility for families because if you are the parent of a child, you continually have to tell your painful story over and over again and you feel like you are starting from point zero.
Mr Beer: Mrs McLeod had to leave but she said to express her regrets as a former Kinark employee and board member, so you are right; she was very involved with your organization.
Mr Jackson: She took a pay cut and went into politics,
Mr Beer: That is right.
I was interested in your comments about economic incentives in encouraging cross-sectoral programs, interagency work and so on. When you look at the players in the field at the local level, I think one of the things that has been addressed today -- I know you have studied and listened to a number of presentations -- is how we organize on a local community level, however we define it, whether it is a region or several counties.
What would you like to see at the local level? Would you want this to continue to be the Ministry of Community and Social Services that is making those financial decisions through its area or regional offices, or do you think there needs to be some kind of local children's authority, community services, council -- however you want to define it -- that would perhaps be allocated an amount of money and then you and those active in the field would determine, whether on a multi-year basis or a year-to-year basis, how those dollars should be expended? How do we approach that from the local level?
Ms Lewis: I think it is both/and, and I liked very much the response Dr Maloney gave around a centralized beginning with local authority. I think it might be well worth while for us to attempt to define what minimum services would be required in all communities -- this would include such things as child protection services, children's mental health services, education services, recreation services -- and then leave it to the local players as to what the variations and computations locally would be, so long as those minimum standards are met, that there is some level of mental health service funded, some level of child welfare funded, some level of education funded, and so on.
I think there are various creative ways that that could be played at the local community level, but there has to be some central control, otherwise it is going to get skewed. We have all heard some of the worst examples of local decision-making. There are also some very good ones.
There is one other thing around the earlier part of your question in terms of incentives. Maybe we could begin with some preference being given for any kind of new initiatives to proposals that are signed maybe by three agencies or three organizations or intersectoral kinds of proposals rather than only uni-agency kinds of proposals and funding increases. So if Kinark and the board of education, and perhaps the children's aid society in a local community, come conjointly and say, "Look, we've worked together and we think this is one way that we could respond in Durham, in York or wherever," that there be a higher priority given to those collaborative kinds of proposals than to singular proposals from organizations.
Mr Beer: I think just in closing, if one looked at the proposals made to the ministry under the Better Beginnings, Better Futures program, that indeed there were many that were from a variety of groups, and I think, if I recall the group that was looking at all the different proposals, that one recognized that there were far more that ought to be eligible and that one wanted to fund. There just were not the dollars in the first go-round, yet there were some really first-rate proposals that in a sense did a lot of the things that you talked about in your proposal.
Ms Lewis: Certainly they bear a second look, but at the same time we cannot jeopardize these services that now exist because we cannot see a further erosion.
The other creative response under the former government was some of the initiatives under the Premier's Council. There was a school mental health project funded that had many of the requirements that are being spoken to in the Children First document.
The Vice-Chair: There being no further questions, I would like to thank you for making your presentation today and wish you well,
Ms Lewis: I thank you for staying so late to hear us.
The Vice-Chair: It is all in a day's work.
Before everyone leaves, I have a couple of reminders.
Tomorrow's committee session will begin at 9 am sharp. As per our agreement, we will proceed even if we do not have all three parties appear. I hope that does not mean no one will show up at 9 o'clock sharp, leaving me to hold the bag. That is the first thing.
Second, as a result of the inclusion of two additional groups to our format here, we will be now going to have an hour and a half for our recommendations towards writing our report with our research officer, so that will take place on Wednesday between 2 o'clock and 3:30 pm. That is a revision. We had two hours scheduled previously. We are now going to have to cut that back to an hour and a half, which I am sure delights our researcher. That is life with respect to standing order 123.
The other thing is we would like the subcommittee to meet on the following Monday 21 January before we have the final drafting of the report presented to the full committee, which will take place at 2 o'clock or start at 1:30.
Clerk of the Committee: No, 2 instead of 1:30.
The Vice-Chair: Right. We will start at 2 then as opposed to 1:30 and the full committee on Monday 21 January. We will start at 2 as opposed to 1:30 because we only have a half-hour left to us to deal with recommendations for the full committee to hear the final draft of the report.
As a result of that, I think it is good for the subcommittee to meet that Monday, perhaps at lunchtime or in the morning to deal with crossing the t's and dotting the i's and making sure that the report is at least near ready for the full committee to then look at and approve final recommendations.
We simply do not have the time to deal with it in full committee.
Is that acceptable to all members?
Ms Haeck: So you were suggesting we start at 2 o'clock instead of 1:30?
The Vice-Chair: Right.
If it is not acceptable, we can scream at the House leaders and bring a motion forward and the full House can deal with standing order 123. That is the only alternative we have.
The committee adjourned at 1720.