Tuesday 7 June 1994

Children at risk

Sparrow Lake Alliance; Coalition for Children, Families and Communities

Dr Paul Steinhauer, chair, SLA steering committee and chair, CCFC

Ministry of Community and Social Services

Lucille Roch, assistant deputy minister, children, family and community services

Nicole Lafrenière-Davis, director, children's services

Ontario Association of Children's Mental Health Centres; C.M. Hincks Treatment Centre

Dr Freda Martin, association representative and executive director, treatment centre


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

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

*Carter, Jenny (Peterborough ND)

*Cunningham, Dianne (London North/-Nord PC)

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

*Martin, Tony (Sault Ste Marie ND)

McGuinty, Dalton (Ottawa South/-Sud L)

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

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

*Owens, Stephen (Scarborough Centre ND)

Rizzo, Tony (Oakwood ND)

Wilson, Jim (Simcoe West/-Ouest PC)

*In attendance / présents

Substitutions present / Membres remplaçants présents:

MacKinnon, Ellen (Lambton ND) for Mr O'Connor

Clerk / Greffier: Arnott, Doug

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

The committee met at 1547 in room 151.


Consideration of a matter designated pursuant to standing order 125 relating to children "at risk."

The Chair (Mr Charles Beer): Good afternoon, ladies and gentlemen. Our first witness today is Dr Paul Steinhauer, who is chief of psychiatry at the Hospital for Sick Children in Toronto.

I just note for the committee members that you have received the second summary of the testimony that we've received on children at risk. Bob, is there anything you wanted to comment on?

Mr Bob Gardner: The second summary does have something a little different for members. We picked up at the last meeting, from Mrs O'Neill, to bold the recommendations that the particular witnesses have made to the committee. We thought it would be easier for you to collate and organize them. Mrs O'Neill said she was doing that on her own time, so that's a great idea. We've done that in the summary.

We'll also have some draft, at the Chair's direction, of the material that was discussed in the subcommittee the other day and, with a little luck, the evidence from today for members on Thursday before they leave.


The Chair: I note, Dr Steinhauer, that you wear a number of hats, and the other one that you're wearing today is as chair of the steering committee for the Sparrow Lake Alliance. While some know of that, I suspect you're going to tell us more about it in the course of your presentation.

Dr Paul Steinhauer: Thank you, Mr Beer. I should also point out that while I am a child psychiatrist and while I am at Sick Children's, I'm not the chief of child psychiatry at Sick Kids. You did hear from my chief, Susan Bradley, I believe last week.

The Chair: That's right. Sorry. We have so many chiefs around.

Dr Steinhauer: I'm here today representing two groups: the Sparrow Lake Alliance and the Coalition for Children, Families and Communities. I've prepared a handout for you and I'd like to just briefly take you through it.

In the front inside cover there is a one-page report card on how we're doing with our children and youth in this generation, and the references to that are to be found at the end of this in the paper Youth in the 80s and 90s.

Following the table of contents there is a description of the Sparrow Lake Alliance. This was published in 1992. It talks about the 11 professions that are involved from the seven service sectors and the government ministries with whom we have worked. It doesn't mention that today there are 320 members of the alliance and it now has good representation from teenagers and from parents as well as from its professional members.

Following that, there is a one-page letterhead from the Coalition for Children, Families and Communities. This is a group that was set up by 17 organizations, purely for public education, to make people aware of the needs of children in the community and to try to enlist them on the side of bringing about the kinds of changes that are needed to support families in the 1990s.

That is followed by two tables, a blue one and a pink one, which I'm going to refer to in the course of my talk.

I've ended up with a paper, Youth in the 80s and 90s, which I'm going to talk about a little bit later as well.

That is the background material that you can have after I'm finished. But what I would like to do is mention to you that I've been a child psychiatrist for 32 years now, and for 27 of those years I was feeling like the boy with his hand in the dike and I was seeing patients in an office and very much sticking to that.

In 1989, however, along came the Ontario Child Health Study, which, as you know, confirmed what a lot of people had been thinking for a long time. It found on an empirical basis that 18.6% of the kids in Ontario met the criteria for one psychiatric disorder; that of those that had one disorder, two thirds had two or more disorders; and that only one in six of those with a disorder was receiving any treatment.

When I heard that, it reminded me of the first professional meeting I ever went to as a resident, where the head of the organization compared a child psychiatrist to a man who's going to a mighty river where drowning bodies by the thousands are floating down and he has to decide, what is he going to do? Is he going to wade in and pick out a few and give them mouth-to-mouth resuscitation and leave the majority going by, or is he going to go back upstream and try to determine what the source is and stem this wastage at its source?

That metaphor left us really with two options: We could either get better at fishing bodies out more effectively and do better at reviving them -- and that is basically what the Sparrow Lake Alliance has been trying to do, and because that's well described in the handout I gave you, I'm not going to go on with that further -- or we could go back upstream and find out why so many kids are developmentally drowning these days, with psychiatric disorders, with illiteracy, premature dropouts, poorly controlled aggression, violence and delinquency, rising rates of teenage suicide and accidents and rising rates of alienation. Can we go back upstream in order to get them off to a different and a better start, which is more likely to turn them into competent and resilient children, teenagers and adults?

I would ask you, if you would, to turn to the blue table in this handout, and I'd like to take you through it.

The blue table suggests that if children get off to a poor start and if they have poor outcomes, they're going to be poor outcomes for society as a whole.

If, for example, those children are raised in families that don't meet their attachment needs so that they develop problems in trusting and in relationships, they will turn into adults with chronic relationship problems within their families, in their workplaces, within society and when they begin to parent their kids.

And if they have school problems that lead them to drop out or leave them functionally illiterate, they will be poor job prospects as adults, they're more likely to be chronically dependent on society, we're likely to have to pay higher welfare costs and they're going to be predisposed to adult anti-social behaviour.

If we have kids who are alienated and anti-social and who have chronic emotional disorders, we're likely to be faced as a society with increased rates of vandalism, violence, teenage pregnancy and a need for costly services.

And if we have kids who don't learn to be productive, we're likely to be faced with adults who are chronically unemployed, with businesses who can't find the skilled workforce they need, which in turn will undermine industries' and society's economic base and we'll be left with fewer resources to meet the increased cost of welfare and services.

You can look at this from top to bottom as well. The child who has attachment failure and who doesn't develop trusting relationships is more likely to have school problems, is more likely to develop in an anti-social trajectory and is less likely to be productive in adult life. So poor outcomes for children mean poor outcomes for society.

We know a lot about what it takes to raise competent and resilient kids. We're not operating in a vacuum.

If you take a look at the pink table, the pink table lists what children's basic needs are. It talks about the prerequisites for meeting those needs. Then in the final column, it talks about what will happen if those needs are met at each stage and if they are not met. This is not just the Sparrow Lake Alliance talking. Everything I'm saying here has been said by the Ontario Child Health Study, the Canadian Institute for Advanced Research, the Carnegie Foundation, both Premier's councils, the Laidlaw Foundation children at risk project and the Vanier Institute of the Family. There's a virtual consensus about everything that is on that pink chart.

In 1980 I wrote a paper called Youth in the 80s and 90s in which I predicted that because of changes in societal and familial structure, we were going to see more teenage violence, more teenage suicide and more teenage alienation. I updated that in 1993, in the paper that's at the back of your blue handout. I added a second section giving some statistics about what's happening with kids and families in 1993, and adding a third section which talks about what we as a society could do if we had the will to do something about it.

I think one of our big problems is that there are major changes in our family structure and in our societies which despite the best intentions of many parents are undermining the developmental prospects of far too many kids. As the Canadian Institute for Advanced Research and the Premier's Council have said, the problem today is that it isn't just high-risk kids who aren't making it; there are far too many kids who should be making it who are not making it.

The problem isn't beyond solution. We know a number of ways that we can effectively keep kids from drowning developmentally. Of course, the more we do so, the more we free resources for management of those whose disorders we can't prevent.

For example, France had a program where they wanted to cut down on the number of very-low-birthweight babies, and the way of doing that is ensuring the health of mothers throughout their pregnancies, ensuring their nutrition, ensuring they're off drugs and ensuring they get good medical care.

They paid every mother in France $36 in order to get them to have at least four visits with a doctor over the course of their pregnancy. It was a fairly minimal thing. In spite of the cost and in spite of the fact that they gave that money to every woman in the country -- they managed to enrol 99% of the mothers in France -- they saved enough money when you consider that the medical costs in the first month or so of life of a very-low-birthweight baby are upwards of $100,000, and there are continuing increased costs in education. These kids are much more likely to get into trouble with society, so they're less likely to become productive citizens and more likely to get into trouble with the law. They found that they saved money even on that broadly based a program.

Secondly, there's a home visiting program in Hawaii, in all of the outlying islands and in part of the main island, where they target every mother who has just had a child. They have a lay visitor who has some supervision go and give a questionnaire on the basis of which they separate these mothers into high risk for abusing their children and low risk for abusing their children. The ones who are considered high risk are intervened with and are referred to a number of appropriate services. They managed in this way to cut the risk of child abuse by 50%. If you cut the rate of child abuse by 50%, you also cut the rate of the school problems and the aggressive and violent problems that come from children who are abused by 50%.


A third example: The Perry preschool project, which is an enriched preschool intervention, part of the Head Start program in the United States. I'm talking about this one because it's been meticulously followed up, and when they followed those kids up at age 19 -- and this was a program that stopped when these children were six -- the kids who were in the program had only 40% the number of arrests and convictions of the children who had been in the control group. They had only 42% the number of teenage pregnancies. Some 33% more of them had graduated and either had jobs or were getting further training. When they followed those through at age 27, they found that the arrests had been reduced by 50% and that those people who had been in this intervention had a significantly increased rate of earning and were significantly more connected to their families. So that's an intervention just at the preschool period.

What difference does it make how kids are performing at that very early level if development isn't like an escalator where, when you get on at one point, you always go in the same direction? S. Kellam of the National Institute of Mental Health pointed out that we know the characteristics of those kinds of kids who are able to succeed, academically and socially, despite growing up in conditions of extreme disadvantage.

First of all, they are kids who are social participators. They're not too shy on the one hand; they're not too aggressive on the other.

Secondly, these are kids who are able to contain their aggression and accept authority. If they can't get their aggression under control, they're going to be in trouble once they hit school.

Third, they are kids who have the ability to concentrate and pay attention and work independently. Recent work coming out of the Carnegie Foundation is suggesting that children who are very poorly parented in the first year or two of life are in a state of constant stress, as a result of which they have constantly high levels of cortisone in their bodies and that the cortisone interferes with the linking up of their neurological system, so that what you end up with are children who, as a result of continuing stress, end up with a defective nervous system that interferes with their cognitive development, their emotional development and their social development -- irreversible change if children aren't well parented in the first two years.

Finally, these were kids who had identifiable areas of achievement.

Now, that doesn't mean that all children can or should necessarily be parented just by their biological parents. We know, for example, that 75-plus per cent of families require two incomes if they're going to stay above the poverty line. So when I'm talking about high-quality care giving, I'm talking about high-quality care giving either in or outside of their families, and I want to take a look at the effects of high-quality child care on children who are growing up in a disadvantaged situation.

High-quality child care increases their social competence; it increases their language and play development; it helps them get better impulse control so that they can self-regulate themselves better; they are more compliant with adult requests; they have fewer behaviour problems in grade 1, as rated by their teachers, and it helps compensate for the cognitive, emotional and social deficits that kids from disadvantage usually bring to grade 1.

On the other hand, if you take a child who is marginally or poorly parented and put him in poor child care, he will be more negative in his social interactions, both with his peers and with his teachers, he will have more language delays and he will have poorer academic performance.

You might say: "What does it matter how kids function at the grade 1 level? Development isn't fixed for all time." Kids can make up, it's quite true; kids do have some innate resilience, some more so than others, and kids can often make up for a poor start. But as John Bowlby has said, the kid who has been off to a poor start, often as a result of that is more likely to have increasing difficulties later on, and as Dan Offord has pointed out, once a kid is in a trajectory that is heading towards school failure or delinquency, turning him around may be like trying to take an 18-wheel tractor-trailer going at 100 kilometres an hour and expecting it to do a fast U-turn.

If you look at one example of this, the precursors of substance abuse in adolescents at the grade 1 level, 5% of withdrawn kids become substance abusers, 40% of aggressive kids become substance abusers, 60% of kids who are both withdrawn and aggressive -- that is, the angry loners -- become substance abusers. So the pattern that a kid is showing by grade 1 can have major implications, and that all presses in the direction of trying to get kids off to a good start.

Let's talk about schools for a minute. We know about the kinds of schools that can salvage and turn around some kids who are already on a path towards delinquency or illiteracy or dropping out, and I would suggest here the work of Charles Comer in New Haven and some of the work that Michael Rutter has done in England.

What Comer did was he took the worst schools in the city of New Haven, which is a large inner city with Yale University like a jewel in the middle of it, and he moved mental health teams into the schools. They did not treat the kids directly; their main job was to work with the teachers to help them understand the kids, to help them understand the community, to build bridges between the school and the community and to get the parents comfortable with coming into the school and having them welcomed within the schools.

What he found was that, within three years, his demonstration schools were third and fifth in the city academically, well above the controls, they had had no serious behaviour problems and they kept that for 15 years. The staff morale and their energies and their expectations of the children were the major changes. They found it wasn't that they had any spiffy techniques to offer; it was the fact that they helped these teachers see that these kids could learn and could be expected to learn, and that the teachers felt empowered to help them learn and the teachers and parents became allies in the education of the kids.

I'm not suggesting for a moment that our school system is entirely responsible for how kids are doing in school, because there are good empirical studies to show that how children do in school is more a function of what's going on in their family than of what's going on in their school, and I'm thinking here of how well did the family prepare the child for school -- cognitively, socially, emotionally -- how well are they continuing to motivate the child, and how are they supporting the child and supervising his homework. As a result, it's no wonder that empirical studies show that at age 14 the family has more influence on children's school performance, especially in English and history, than does the school.

One other very important finding in terms of one of the problems in our society where we often have children spending long periods of time either alone or after school when both parents are working: Time alone and unsupervised at noon and after school at the junior high level is significantly correlated with increased drug intake in adolescence and with decreased academic performance. Kids who have fathers who are involved with them emotionally and are strict but fair are twice as likely to do well and only half as likely to do poorly.

There's no doubt about it: If we have outstanding services like the four models that I've talked with you about, these will help, but we need more than just exemplary mainstream, let alone specialized, services if we're going to do a better job at raising the next generation of children. We need parents who recognize that parenting needs to be an active and not a passive process. We've got to get beyond the fact that you can get by with a few minutes of quality time each week. Quality time doesn't happen when you plan it; quality time is something that happens when a parent and child are together and suddenly, at a particular point, the defences are down on both and they just connect with each other. I think we have to get parents to recognize that one of the things that is crucially important is that they have the time and the energy left to devote to their kids.


I recently was talking in Windsor and I ran into an old camp friend, and he was bemoaning the fact that on a recent visit to Toronto he'd spent some time with his daughter and her husband and their kids. One of the kids was seven and was already in serious problems in school as well as a behaviour problem of his own, and then the younger kid was also becoming a behaviour problem in her own right. His comment was that time with father in that family meant being allowed in the room when father was watching a sports event on television. This just isn't good enough. Kids need more active parenting than that.

However, we also need people who can support parents, and I'm talking here about the kinds of networks and communities that people used to have in their extended families but to a large extent have been lost. When women went to work, their community became the people they worked with rather than the people in the neighbourhood whom they used to spend the day with.

As a result, what we need is to rebuild, somehow, communities, whether they be based on neighbourhood, whether they be based on people who work together, whether they be based on religious communities, whether they be based on communality of interest or whether they be based on common problems.

June Callwood once talked about growing up in Belle River and talked about how any adult in that community took on responsibility for any child's behaviour in that adult's point of view. I remember when I was a kid here in Toronto we would have been mortified going out on Hallowe'en if one of our parents had ever come with us when they were "shelling out." But what parent these days would ever dare to send their kids out on Hallowe'en without an adult in attendance to make sure that things were safe?

I think what happens, as Garbarino has pointed out, is if communities break down, it means that kids are raised in an isolated manner and parents are liberated from the bonds and constraints of community standards.

If parents are going to have more time, we need workplaces that are going to be less undermining of family life, workplaces that are going to allow no-hassle relief time, workplaces that are going to allow time for family crises, either with children or with aging parents, workplaces that will allow flexible work hours, that may allow work in the home, at a computer station in the home or that sort of thing, that may give advice to parents who are having problems with their children or their aging parents.

A lot of American companies and Bell Canada have found that when you have family-sensitive workplaces, they actually pay off for the company in terms of the increased morale and in terms of the company's ability to retain its workforce and not have to be retraining people all the time. Then we're going to have to come to grips with the global economy. We're going to have to come to grips with the fact that most people aren't going to have a lifelong job any more; that there are going to have to be changes to our educational system because people are going to have to be learning throughout their lifetime and retraining as the needs of the job market change; we're going to have to change so that our self-concept isn't based as exclusively on work, as it is, since more people are going to be out of work for longer periods of time; and we're going to have to do more with apprenticeships. We're also going to have to have changes at the government level because, as long as I can remember, our provincial government ministries and our various levels of government have never had a single, unified focus on the needs of children.

Instead, you've got separate ministries -- Health, Community and Social Services, Education, Tourism and Recreation, the Attorney General -- each of which is marching to its own drum, which is duplicating, which is competing with, which is guarding its turf, which is ignoring, which is reinventing the wheel and which is offloading responsibilities on to other ministries and on to other levels of government as it comes under financial constraints. Especially when times are bad and money is short, this tendency of the various ministries to bunker in and not cooperate for the sake of -- you know, we used to have a secretariat that was going to try to keep people thinking together in planning services for children, and as you know it was disbanded. We now have a Premier's Council which has come out with an excellent report which I'm sure you're all familiar with, but the unfortunate word that we're getting from junior people in a number of the ministries is that the word from the top is, "The Premier's Council is looking after that integration stuff, which means we really don't have to worry about that too much."

Government will continue to be more a part of the problem than a part of the solution until such time as we have a solid commitment to a unified focus on children. No wonder Marion Boyd, when she was Minister of Community and Social Services, told us that despite all their talk about the importance of integration, ministries will do more to fragment than to coordinate services for children until that kind of single focus is established.

Finally, I think we have to get across a recognition of the importance of all of us, as individuals, as leaders within particular groups within the community and as members of organizations, becoming involved in doing something about the problems of families and the problems of children. We just can't sit this one out. We're either part of the problem or we're part of the solution.

This has led to the foundation -- it was originally set up by the Sparrow Lake Alliance, but the alliance is now just one of 17 partners -- of the Coalition for Children, Families and Communities. This coalition has taken on the job of trying to make the community aware of the needs of children. It has done it by forging ongoing links with journalists such as Michael Valpy in the Globe and Mail and Leslie Scrivener and Nancy White in the Star. You may have seen the series in the Sunday Star for the last three Sundays. We've got two copies of the Scrivener series and copies of the series by Michael Valpy. We are hoping over a period of time to develop an awareness in the community, and we trust that if the community understands the issues, the community will join us in feeling that something has to be done about them.

One of the other things we have to do is help the community see some issues more clearly. For example, with the recent changes in the Young Offenders Act, one of the things we have heard has been screams from people who are saying that more and tougher sentencing is really all that's needed, with a complete negation of the importance of prevention. But empirical studies have shown again and again that if you punish kids and don't have a relationship with the kid you're punishing, the net result, if that punishment comes from a judicial system, is that the offender becomes more aggressive, more anti-social, more rebellious, he is more likely to reoffend, and you have the increased cost of keeping him in jail.

On the other hand, we've got to help people see that there are known antecedents of anti-social behaviour in children and youth, and we know what they are. They are poverty, they are failed attachments, they're father abandonment and they're anti-social behaviour of the parents, and these are some things that we can do something about.

So these are some of the issues that we think are really important, and I am speaking to you here really not as a psychiatrist, not as a representative of the Hospital for Sick Children, but as a representative of these two larger groups that have reached a consensus on the sorts of things that I'm talking about and that have reached a consensus with our colleagues in the Premier's Council, the Laidlaw children at risk group and the Canadian Institute for Advanced Research, which Fraser Mustard is representing.

The Chair: Thank you very much, Dr Steinhauer. I suspect that we could spend profitably a number of hours following up on the points you've made, but in the time we have available we'll try to explore at least some of them. We'll begin the questioning with Mrs O'Neill.


Mrs Yvonne O'Neill (Ottawa-Rideau): Dr Steinhauer, I had an opportunity in the House today to talk about people with experience and I said that I felt they had certain qualities that maybe some of us don't have. I'm going to repeat that because I think you have them: wisdom, perseverance, patience, mixed up with empathy. I hope you will accept that as a compliment.

I really feel that what you are saying is very practical; it's very clear. I'm very pleased that you brought forward the role of fathers. I think that's very important. I'm very pleased that you are somehow influencing the media, and I've noticed that. The importance of neighbourhoods also: I feel you highlighted that.

I have three or four quite brief questions.

You didn't really say Ministry of the Child. Are you talking that?

Dr Steinhauer: I don't know how practical it is to have a Ministry of the Child. But what I do know is that, for example, I'm spending Wednesday of next week, all day, at the Ministry of Health, which is developing a health promotion policy. This is after the Premier's Council report Yours, Mine and Ours has come out. Rather than trying to fall in line with that and see what the Ministry of Health can do to go along with it, they are taking 20 people for a whole day in order to reinvent the wheel -- this kind of thinking.

In the past year, we've had policy reviews by the Ministry of Community and Social Services, the Ministry of Education and the Ministry of Health. They have all acted as if they were the only ministry involved with children, and that just isn't good enough. With the exception of two major programs that've been in place for years -- and I'm talking about Helping Children Adjust and Better Beginnings, both of them excellent programs -- those are the only real, effective interministerial collaborations. There is far too much of ministries going it on their own, sloughing responsibilities to other ministries developing comparable programs.

I don't know whether a Ministry of the Child in a province of this size is feasible, but certainly something has got to be done to get people to get serious about planning together. Maybe the answer is having communities decide how they are going to allot the funding to the various sorts of services. The danger in that, however, is that communities that are not affluent and articulate might lose out to other communities that are better able to fight for what they want.

Mrs O'Neill: The northern communities are aware of that. If you do make a decision on that, let us know.

My other questions are much more, I guess, practical. You didn't say much about the faculties of education or professional development of teachers in the school boards. I do know the social contract has had some effect on professional development days. Do you feel there is enough being done there in either of those two centres regarding teachers as significant partners?

Dr Steinhauer: I think teachers can have an extremely important role. I think teachers have to have a double role, because they are not going to be able to educate successfully those 20% or 30% of kids who come to school either with psychiatric problems and/or hungry and/or with emotional problems as the result of an abusive or conflicted family situation. So they're going to have to deal with psychosocial needs of those children before they're going to be able to educate them.

I don't think personally, and I know the alliance and the Coalition for Children, Families and Communities don't think, that teacher education adequately prepares teachers for that, and I think in-service education probably isn't paying as much attention to the psychosocial aspects of teaching as it should.

Mrs O'Neill: Have either of those coalitions or committees you've been part of had faculties of education representation?

Dr Steinhauer: We have been in contact with faculties of education; we have not had members of faculties on the alliance. There is an education task force of the Sparrow Lake Alliance which has been talking about involving several of the staff of two faculties of education on a project looking at teacher training.

Mrs O'Neill: My last question is even more practical. You talked about lunchtime and after school being pretty significant in the child's day, and that if they spend that alone there are difficulties. Both as a student and then as a teacher the lunch-hours and after school were more structured than I think they are now. Do you feel it's worth pursuing those two times in the school day?

Dr Steinhauer: I think a sort of latchkey care centred around the school, possibly by other staff, by recreational staff, possibly by teachers -- but I think the quality of supervision of those times is important. It's kids who are completely unsupervised and left on their own who are more likely to get into trouble.

I think one of the problems we get into is that at times these days you may have a day care centre, you may have a recreational program, you may have academic staff working with children of the same families out of the same school and they don't communicate with each other because there are status issues involved from the various ministries that are sponsoring them.

Mrs O'Neill: Have your groups, either of them, done an evaluation yet of Better Beginnings, Better Futures or the adjustment program?

Dr Steinhauer: Some of the people in our group are very much involved in the Better Beginnings program. As far as the Helping Children Adjust program, that was conceived actually at the founding meeting of Sparrow Lake and that story is told in that first handout that we've given you.

Mrs O'Neill: We had a very powerful representation here from the Better Beginnings, Better Futures program, which has gotten -- what should I say -- spinoffs that none of us could have imagined, and when you said that getting self-concept from work, people who are on social assistance, but who are making significant contributions to their communities, came forward very proudly and told us just how they've turned things around.

Dr Steinhauer: I think that can be wonderful for people like that. When I made that comment about work, what I meant is, I'm a number of things: I'm a psychiatrist, but I'm also a father; I'm also a husband; I'm also a member of a number of groups, and I think that my being a father and my being a husband are just as important a part of my worth as my professional status.

I think our society gives all its perks for how much you earn and the status of the job that you have, and I'm saying that if the economists are right in saying that more people are going to be unemployed for more of the time, we can't have their entire self-esteem based on the job they're doing and the money they're bringing in. We've got to start thinking of that or we're going to have a lot of systemic depression.

Mrs O'Neill: Thank you for your common sense.

Mr Stephen Owens (Scarborough Centre): Dr Steinhauer, I apologize for missing the first part of your presentation, but I want to tell you that in terms of your theories with respect to unemployment and how we should be looking at ways to support the family, I heartily endorse them.

In my experience, both as a trade union president and now on the other side as a manager administering a collective agreement, it's my view that workers need to have that kind of support with respect to their families so that the family unit is taken care of but there's also a high level of productivity because there isn't the stress that accompanies a less hospitable environment for that.

I also think you're quite correct in your assessment about the kind of fundamental restructuring that's going on and how we have to redefine our definition of "work" and what makes a person worthy in the eyes of his and her fellow members of society. As you say, the perks have always been accorded to the $100,000 and $200,000 earner, but now as more and more people are becoming unemployed because technology has changed -- there are also only so many refrigerators and so many VCRs and so many cars that people need -- we're probably getting pretty close to maxing out in terms of the demand.

I guess I would like you to, from your perspective and your experience, make some recommendations to the committee that I and my caucus colleagues can take back to our government, particularly the Ministry of Labour, Ministry of Economic Development and Trade, to start working on those systemic issues that you've identified.


Dr Steinhauer: I'm not sure to what extent government can persuade our major industries that it's in their best interests, as well as the province's best interests, for them to have more worker-friendly policies.

The vice-president in charge of industrial relations for Bell Canada, who sat on one of the committees of the Premier's Council with me, was saying he felt that if government tried to legislate this, it would be counterproductive. He felt that industry would do better if it got the message out to other people in industry that it can be better business to have worker-friendly workplaces.

The other thing you might think about is, are there ways where you can make it worth a company's while to have worker-friendly policies at a time when we've got good statistical evidence suggesting that half of the women who work and who still do the majority of the parenting are expressing significant stress as a result of that and a third of the men who have children are reporting that they have major stress because of it?

I'm not sure what government can do; I'm not sure what the unions can do; I'm not sure what the employers can do. I think one of the things we can do at first is make it an issue, that the result of this is that too many parents are coming home absolutely bushed at the end of the day and they don't have the time or the energy to do anything but shush their kids up.

It's a very solid theory of child development that if kids find that they're getting less of the nurturing and that the only time they hear from their parents are when they're being pushed to do this or told to go to bed or told to be quiet, they respond oppositionally rather than positively.

Mr Owens: In terms of the educational system, what kinds of checks and balances would you like to see inserted, whether programmatically or through policy? The children's aid societies presented last week and my question was with respect to accountability: How do we keep kids from getting lost in the school system?

I represent the riding of Scarborough Centre. I'm sure you're more than aware of the issue with respect to the expulsion policy that's in effect. It's my personal view that throwing a child out is just throwing the problem into society, with no program to deal with either the child or the family.

Dr Steinhauer: Mr Owens, you're raising a number of very important questions. At the risk of giving you something more to read, the Sparrow Lake Alliance developed a submission to the Royal Commission on Learning and I would gladly make a copy of that available to the clerk because I think that sums it up much more succinctly than I could.

Mr Owens: I would appreciate that.

The Chair: If you would, Dr Steinhauer, make a copy available to the clerk, then we can ensure that all members of the committee get one.

Dr Steinhauer: Fine. I will send it tomorrow.

The Chair: That's fine.

Mr Randy R. Hope (Chatham-Kent): A couple of the issues that I heard you talk about were ministries working closer together and there was the question asked about the Ministry of the Child which we heard. I'd prefer things to be done more at the local level.

Reading what you have presented in this document and reading the Premier's Council on 2002, its report on the health issues in our society, I am of the opinion that what we need to develop is a human services board and get rid of turf protection of agencies. You know, there are over 7,000 agencies just in the Ministry of Community and Social Services that provide support to communities, yet we're not dealing with the community as a whole.

What is your opinion then about envelope funding per ratio? You hear right now communities are comparing each other and saying, "You get x amount of dollars to service children and we only get x amount." What is your opinion about an envelope funding process and developing a human services board which deals with the global issue?

Dr Steinhauer: In contrast with having each ministry fund its own set of services, until we get envelope funding I think each ministry is going to continue to fund its own services. I think envelope funding is the key to communities getting down and taking responsibility for what goes on, particularly if they're combined with the use of the community report card that the Premier's Council is in the process of developing. I think that might give some hope that people would realistically look at the priorities.

The one caution I have been given, particularly by consumers from disadvantaged communities, is that they are afraid that because they're not as articulate they may not be able to fight for their rights as well as other communities that are better prepared. I think their feeling is that they're not against the idea of envelope funding, but they are feeling that they're going to need some supports to use it well.

Mr Hope: One of the things that was brought out -- and I was listening to some of your conversation, how we get the working family -- I mean, when you talk about the issue of quality time aspect, I'm running into that difficulty myself with a young family and being an elected member. They certainly don't rate me by the pay I get, rest assured. Others will say that the pay we receive is not the value.

How do we get communities to really understand the important value when they're dealing with their own lives and their own issues? You brought up the issue about job transition that takes place in today's society. There isn't such a thing as 30 years' seniority any more.

Dr Steinhauer: I think that's one of the reasons that we have set up the Coalition for Children, Families and Communities, to try to keep getting this picture out, to keep saturating the media with the kinds of ways that society is changing, with the needs of children, with the different problems that are coming up and potential solutions.

One of the other things that we hope to do, when we can get some funding for it, is, we want to set up a program of sector advisory groups, where we will take, for example, leaders of a group of seniors, leaders of the business community, leaders of the labour community, leaders of the medical community, the teaching community, the youth communities, the religious community, each of the multicultural communities, and we will get leaders of each of these natural communities looking at the question of "What do you think of what we feel are important for families and, if this makes some sense to you, how do you feel you people can best get this across to your natural community?"

At the same time, one of the things we're thinking of doing, and again this is when we get the funding for it, is approaching the private sector, because we find that (a) we're more likely to get it from the private sector and (b) we're more likely to be free to do what we think is important in the private sector rather than being so tied down that we lose our flexibility.

The other thing we would like to do is run a series of community forums, but rather than just having a one-night forum, we would like to go into that community, establish ties with a group of natural leaders in that community first and have a package of materials that we could send on to them, so that we try to open things up for them and they will carry on from that point.

This plus the saturation of the media is the direction in which we're trying to go.

Ms Jenny Carter (Peterborough): This is really an issue where we're down to the basics of society and I think we're finding from all these hearings that you have to go back and back to the causes and prevent them.

It seems to me there's still a basic dilemma in our society which women face, which is that if they stay home and are good parents, they're dependent on their husbands. They have no economic existence, and this makes them very weak in the sense that they don't have independence, they're very subject to their husband's whims, if he's the sort of person who has whims. They don't have any status; whereas, if they go out to work, then how are they going to bring up the kids? I think somehow we have to tackle it at that level, because it's partly poverty and it's partly this dilemma that women are in.


Dr Steinhauer: Let me say one thing, and I'm really glad you raised that, because I was trying to condense a larger presentation down. I'm not for a moment suggesting we should go back to the 1940s or 1930s and just tell women to stay home. For a number of reasons, that wouldn't work.

What I'm saying is, I think that men have to take a more important role and I think we have to recognize that if 60%-odd of the parents of preschoolers have all their parents that are in the home working, then we have to have other care giving resources in the community. It doesn't have to be all licensed day care, but we've got to have a series of child care options, as was called for by the Premier's Council, so that kids get good child care, not poor child care.

I think what's happening now is that the families that need good child care the most are often the ones that are least likely to get it. Bad child care, in addition to stressed parenting, is a disaster and we're inflicting that disaster on too many of our children. We can't afford as a society not to get kids good, consistent care giving, and it can't, for a number of reasons, always be because there's a stay-at-home parent.

Mr Owens: On a point of order: I just want to clarify a rumour with Dr Steinhauer. I understand that in the home women do the housework and men help with the housework. Is that true?

Dr Steinhauer: Yes. When women work, women almost always have two jobs. They continue to do the bulk of the housework and the bulk of the child rearing.

Ms Carter: Can I ask you just one single little question about this pink sheet on the basic cognitive needs? It says something about "increased competence in both boys (via increased social responsibility) and girls (via increased social responsiveness)." Why is there a distinction there between boys and girls?

Dr Steinhauer: I don't think we know why that is so. When you look at social competence as it was defined by Diana Baumrind of the University of California at Berkeley, social competence includes both social responsibility, the fact that one pays attention to the rights of others, and increased social responsiveness, the fact that one goes out and gets what one wants and one needs for oneself. All we can say is that the experimental evidence shows that boys and girls respond differently to having informed and attuned parents and care givers.

Mr Owens: Socialization process.

Dr Steinhauer: Yes.

The Chair: I'm sorry, I'm going to have to play the heavy and step in. Dr Steinhauer, we appreciate very much the time you've taken with us today, and particularly the background material that you've provided us with. We look forward as well to reading the submission to the royal commission. Thank you for coming today.


The Chair: We then move on to our next witness, Ms Lucille Roch, assistant deputy minister for children, family and community services in the Ministry of Community and Social Services. Welcome to the committee. I sense someone else is going to join you, and she is most welcome as well. Perhaps you'd just be good enough to identify yourself for Hansard and for the members of the committee.

Ms Nicole Lafrenière-Davis: My name is Nicole Lafrenière-Davis, and I'm director of children's services in the ministry.

The Chair: Bienvenue. We have received a copy of some of the remarks that you're going to make, so please go ahead, and then we'll have time for questions.

Ms Lucille Roch: Thank you very much. We've been following the presentations that have been made to this committee with great interest, obviously, because of our area of interest in the ministry. I guess there was a feeling that many of the issues that were being raised here are issues that we are addressing through the work that we're doing in our children's policy framework, so there was a feeling that it might be a good idea if we came here and summarized the work that we're doing in that policy exercise and maybe give members the opportunity to ask some questions as well. We're quite excited about the work that we're doing and thought we'd like to share with the committee.

I'll basically work through the brief presentation that we've distributed to members, and it's also my understanding that members have received a copy of the children's policy framework. It may have been part of your original package some time ago.

The framework was approved by the ministry last May and was distributed to our stakeholder groups and our area offices. You'll note, for those of you who've had the opportunity to look at it, that the goal of the framework is really to ensure that children and families receive the best possible services from the resources provided under the Child and Family Services Act.

The framework, as you will have noted, sets out six broad policy directions. It talks about the integration of services, better access, local planning, targeting resources to priority groups, the equitable distribution of resources, and quite a focus on accountability, on the benefits to children, youth and families who are actually receiving the services.

I'd like to underline that the framework is not about constraint, but, as I think some of the people who have made presentations to you over the past couple of weeks have noted, constraint to a certain extent, the limited resources available, does put a bit of pressure on all of us to look at what we're doing and how we're offering and delivering services.

The framework is all about making a difference in the lives of children and their families. It's about building a system of supports and services that are centred on children. It's about building services and supports that work together. It's about fostering healthy development and building on the strengths of children, their families and their communities. I think all of these directions are quite consistent with the recent Premier's Council report, Yours, Mine and Ours, which I'm sure you're all familiar with as well.

We released the framework in 1993, but obviously that was just the beginning of quite a long process. We had to develop clear and implementable policy directives that would support the implementation of this framework. In order to do that, we undertook quite an elaborate process with many of our partners in the children's services area, I think a process which will yield some very good results but a process which, because it included so many people, ended up taking a little longer perhaps than we might have taken had we just proceeded on a ministry basis alone.

We set up a steering committee which included many of the provincial associations I've spoken to you about, including the Ontario Association of Children's Aid Societies, OntChild, the children's mental health centres and many others. We included the Institute for the Prevention of Child Abuse; we included OPSEU and CUPE as well as area office staff. So we had quite a large steering committee.

As well, we established six different working groups to address the six directions that are identified in the policy framework. So we had about 75 people who were directly involved in trying to bring some concreteness to this policy framework. We also set up focus groups of many other groups, including parents and children, ethnoracial groups, francophone groups and children's services coordinating committees.

We've recently put together in one policy document the results of the work of the steering committee and the working groups and have presented a number of recommendations to our minister. These have been approved. The next step will be for us to set up some very clear directives that will go out to our area offices and our stakeholder groups, transfer payment agencies, over the summer. What we wanted to do was kind of highlight for you the kinds of directives that we will be sending out to our transfer payment agencies.

The Chair: Sorry to interrupt, but are those directives public or are those still internal to the ministry?

Ms Roch: At this point in time they're still internal to the ministry.

The Chair: I just wanted to be clear. Just more information that we were going to grab hold of, but we'll wait until it's public.

Ms Roch: The policy directives will set out, I guess, some clear directives to the area offices as well in terms of what we expect from them.

In terms of local planning we want to make it clear that we want our area offices to work with local planning bodies. We want to emphasize the importance that these bodies have as key vehicles for making progress towards integration, access and priorities.

We'll also be very directive in terms of who we think should be involved in the local planning exercises. We want to make sure that parents, youth and community members are part of every local planning body. In fact, we'll be asking area offices in these bodies to ensure that at least a third of their membership includes consumers, parents and community members.


We want to ensure that all of our CFSA-funded service providers are represented on the local planning groups, as well as bargaining agents. We also want to include child care services. They are funded under the Day Nurseries Act; however, as you've been made aware of by many groups, the early childhood intervention and good child care services are very important in this whole spectrum of services. So we'd like to make sure that they're at the table as well, and of course area office staff.

The other message that we want to reinforce with our area offices as well as our service providers is that they need to involve the other community partners in their communities. They need to involve the schools, they need to involve health services, the police, whoever else in the community is involved in providing services to children.

We're also going to require that individual agencies develop service plans in the context of the community service plan, which will set out local goals to make progress towards an integrated system of services and supports, help focus the resources on children and youth who should receive priority services and use existing resources more effectively and efficiently.

In terms of the meaningful involvement of parents and consumers, we'd like to ensure that parents and youth are involved in the decisions about the services and the supports that they receive, as well as being involved in the planning and the evaluation of the spectrum of services at the agency and the facility level.

I guess one of the things we've learned through our experiences with Better Beginnings, Better Futures is the importance of meaningful involvement of parents and consumers, so I think this is one of the themes that we'd like to reinforce. It's one of the lessons we've learned from Better Beginnings, Better Futures.

In terms of better access, we're going to require that an information and referral mechanism be set up in every community to provide children and their families with current and comprehensive information about the services and the supports available in their communities. A lot of parents tell us they don't really know where to start if they need support, if they need help.

The agencies, I think, have also come to realize that they need to provide some kind of mechanism where people know who to call first. Some communities have set up one-stop telephone services which will link the caller to the necessary and appropriate service. That's being done currently in Kent county and the Northumberland area.

Another thing that we will be requiring is that our agencies set up interagency service responsibility agreements with the other agencies involved in their communities, agreements that set out standards and protocols regarding matters like case management or waiting lists or referrals. These agreements are currently being developed -- in fact the Durham Children's Services Council already has such an agreement in place -- so that families will not have to shop around, as they have in the past.

Ultimately we're hoping that families, with one person who can help them put a package of services together, will be the way that the services are provided. As people move from one agency to another, as they move from one service to another, they won't be required to keep changing in terms of a case manager. Ultimately we're hoping that families won't have to wait for the services and the supports that they need.

Our directives will also call for the coordination of access to specialized residential services in communities. We've got existing mechanisms that can show us the way in that area. For example, the London Children's Services Network has such a mechanism, and there's also one currently operating in Toronto.

We're also going to be developing a common intake form and a common assessment tool. Some of these tools are already being piloted in the child welfare and children's mental health area. Basically, we'd like to ensure that children and their families don't have to repeat their stories every time they need a different kind of service.

We're also going to require our agencies to provide guidelines for improving access to disadvantaged groups, such as persons with disabilities, lesbian-gay-bisexual youth, persons living in poverty and ethnoracial communities.

In terms of priorities, the directives will require scarce resources to go to those who need them most, particularly children who are the province's legal responsibility; children with serious and chronic needs and their families; and children at high risk. We will require that a range of services and supports be made available for these children, with the emphasis on prevention and early intervention.

We're also going to require agencies to share their resources and their expertise, based on the needs of children and their families. You've had presentations from Better Beginnings, Better Futures, and we also have another program called integrated services for northern children that is already into this mode of making the best use of existing resources.

We're also going to focus on accountability, trying to focus on outcomes. I think agencies are quite interested in demonstrating that the services they provide make a difference to children and their families, and as a ministry we're also very interested in ensuring that the money that's being spent is being spent on services that do help.

We've got a project accountability working group that's working on defining generic client benefits and client outcomes. We're looking at things like personal safety, public safety and enhanced functioning. For each of these three outcomes, we will need to define some more generic indicators, and we're also developing an assessment scale. Hopefully, both of these will be finished by the end of June. We would like to pilot-test these this fiscal year in three different sites in the province, hopefully starting in September.

The other direction that's all part of the policy framework is the funding equity issue. We've got a funding working group that involves associations and service providers which has been developing options for a geographical equity formula.

We've also asked them to develop some implementation strategies along with developing a formula. This is a very important area for a lot of our service providers. It's also a very difficult issue, and we need a fair amount of buy-in and a fair amount of consensus around whatever formula gets implemented, so we've asked them specifically to address the issue of implementation strategies and staging strategies.

Basically, these are the six areas we're working on with our service providers. We see this very much as just a beginning. We're basically looking at changing people's attitudes, changing the way our agencies provide services, and change is always difficult. It's also threatening in many areas.

Having said that, because of the process that we set in place, this quite elaborate process which involved all these people, there is a fair amount of buy-in -- I'd say a lot of buy-in -- in these directions and the way we're proceeding. I think that was demonstrated at the annual convention of the Ontario Association of Children's Aid Societies, where there was a workshop on the policy framework. There were representatives there from OntChild and the children's mental health centres, who made it very clear that there was, as far as they were concerned, a lot of buy-in among their agencies to pursue these policy directions.

We need to continue, obviously, to develop some of the elements of the directions I've identified. We also need to work with the other ministries to obtain their support and their involvement in terms of service and planning mechanisms. We know there's a lot going on at the local level. We know school boards are sitting down with our child welfare agencies, for example, to support many of these directions. Having said that, at the corporate level I think we perhaps need to catch up to a certain extent on what's going on in some of the local areas.

We also need to do more work around best practices. We need to define what they are and what we need to promote and encourage out there, and we need to identify more effectively what prevention services are, what exists out there and try to translate them into practice.

We believe the implementation of the framework will make a real difference in the lives of children and youth and the families we serve.


Mr Owens: I appreciated your presentation, having had some level of involvement with children's services. I guess it was my entrée into the world of being an MPP when a mom presented herself and her two catastrophically disabled children at my constituency office, needing services. It was then that I discovered the kind of good things that are going on with respect to the consolidation and the one-stop shopping that's happening. Michael Ennis, who is not, I gather, part of your group as such, was extremely helpful in terms of bringing the kinds of services this family needed.

What happens, and what are you doing about it, if a family such as the one I just described moves from Durham to Scarborough? We're not talking about a long trip down the 401. Wire files are not transferred and, as you say, a case manager briefing another case manager because you'd be clearly crossing boundaries -- why is it that people would have to go through the whole reapplication process when basically all they have done is change an address? What are you doing about fixing that kind of crack that families can fall into at a time when they really need to have continuity of service?

Ms Lafrenière-Davis: One of the things we're doing would be under facilitating access. If we do develop a common assessment form, a common intake form, it is to avoid the family having to repeat when she moves to another geographical area.

Mr Owens: That's right. In terms of the kinds of cultural sensitivities that we are quite aware of in the province, how are you going about designing a system that can respond to those kinds of cultural differences so it's not the kind of homogenous or mixed service that's provided, even in Metropolitan Toronto? There's a great variation in what's required with respect to children's services, so what kinds of things are you doing around cultural sensitivities?

Ms Roch: One of the things we've begun to do is engage in some dialogue with our transfer payment agencies about the nature of the province and how it is changing. We're also looking to provide them with some more direction in terms of our expectations around that. We're looking at some directives around ensuring that the boards of directors, for example, of our transfer payment agencies clearly reflect the communities that they represent, that they're part of, and also trying to ensure that staffing at the agency level is also reflective of the community, as well as trying to ensure that the services themselves are sensitive to the needs of their community. That's part of the process. We're not there yet, but that's part of the process that we want to --

Mr Owens: That's part of the goal at the end of the day, the consolidation, the one-stop shopping and sensitivity to various cultural groups.

Ms Roch: Yes.

Mrs O'Neill: Thank you very much for the presentation and bringing us up to date. I have seen one improvement, and I should acknowledge it, in the youth in care. They have been able to finally come together, express their concerns and articulate them. I would hope that they would be used as a model to involve other youth. We have had youth before this committee, and I don't think that with the present government or perhaps parliamentarians in general, they feel they have real contact with the process around Queen's Park.

I have some difficulty with the presentation you've made in that, if you were here earlier, and I think you were, Dr Steinhauer and many others who have come before us have talked about the involvement of other ministries. I still feel that's a weak part of this document.

I have been working on developing children's policy within my own party in the last year. I visited one of the areas that you suggest is a model area, Northumberland, and I feel they have a lot going for them there, but even in my meeting with those I considered the leaders, and there were 15 of them at the meeting, they still told me they have to contact seven to nine different agencies or ministries if they find a child in real difficulty. That is a problem. That was an educator who brought that to me.

I don't know whether you want to respond to that, but I still think there are weaknesses that perhaps Better Beginnings, Better Futures can lead us out of.

I also wanted to ask you this direct question: Is this model really leaning towards regional funding envelopes? You talk about structures that are regional or community-based. Are you talking about a regional funding envelope as well?

Ms Roch: We're not talking about regional funding envelopes at this point in time, which is not to say that this may not evolve towards that.

I would acknowledge some of the weaknesses you've identified. Our feeling was that we had a number of issues within the services provided in our own ministry that needed to be resolved. We have quite a fragmented system out there and felt we needed to bring it together somewhat. While acknowledging that these directives don't apply directly to Health or to Education, we felt that as a first step we would try and get our own services working perhaps better and more effectively.

Having said that, there are two things I should add. The policy framework makes it very clear, I think, and it's a message that we've reinforced -- it's a question I get asked a lot myself when I go out. We've reinforced this notion that they have to be working with their local partners. It's a notion that I have as well reinforced with my own ADM colleagues in Health and Education. We've started to meet again and want to clearly identify some priorities for action over the next year. But clearly our own policy framework initiative has to be very much part of the discussion with the other ministries.

Mrs O'Neill: They have to take some ownership for this.

Ms Roch: Yes, they do.

Ms Lafrenière-Davis: It's important to state that before the policy framework was released for publication, the minister at that time had asked the ministers of the partner ministries, including Health and Education and several others who were at the table at the time, to sign off on the policy framework. So the copy that you have was actually signed off on by our partner ministries before it was released. As we've moved on firming up our policy directives and recommendations, we've gone back to them again recently to share with them what these recommendations now look like concretely, in the form of implementable policy. So again, we're bringing them along with us.

It's important to state as well, and I think the policy framework does mention that and clearly says, that the broad goal is a system of services that's integrated across ministries. This is mentioned in the policy framework. If you were to imagine a road map, what we're saying in the policy framework is that there are some communities that are very close to that goal and are way ahead on that road, and they'll need to continue and we'll do everything to support them. There are others who are quite far back, and we're going to make our directives clear and monitor their progress on the road.


Mrs Dianne Cunningham (London North): I'm looking forward to the next presenter, who is going to be speaking on behalf of the Ontario Association of Children's Mental Health Centres, where she looks at and refers to the major report of the Premier's Council, Yours, Mine and Ours. I'm wondering where at least three or four of the recommendations that I'm aware of in that report are taken into consideration in this one, in the framework.

Ms Roch: The Premier's Council report puts a lot of emphasis on the integration of services, a lot of emphasis on early prevention and intervention and a lot of emphasis on community involvement. Those are all themes, they're all very much a part of the directions of the children's policy framework, so we see them very much as being very supportive of one another.

As well, the Premier's Council recommendation around developing a report card would be very helpful for our local planning groups in getting a handle on where their own children are at and getting a handle in terms of evaluating the kinds of services they are providing. So we're quite supportive of the council report.

Mrs Cunningham: One of the statements that was made that maybe hasn't been made to the same extent in the past is the role that the community will play in the nurturing and raising of children. In that regard, I'd like you to think about what that really means, because I think it means more than coordination. I think it means direct services to families in some way, some respite, more foster care, those kinds of things. It probably means working very closely with the schools, because all of us heard a presentation from Mr Lougheed last week with regard to the kind of children-at-risk programs they have here in Toronto.

My only other observation is this: You refer to London, which is my city and I've been involved in the services, I suppose, ever since I've been there, for 25 years, and you talk about the one-stop. We started, and I think others on the committee will relate to this, coordinating committees for children and youth 20 years ago, so saying that communities have to work together is not new; it's been a recognition, at least of the agencies I've been involved in, for at least 20 years.

You refer to the London Children's Services Network as such a mechanism to make sure the right child is in the right resource, and yet last week, when I was at the district health council meeting, I think they had just been defined as the one-stop, overriding agency for long-term care, which Mr Owens was asking about, and that long-term care does include children's services, does it not, at this point in time? It's for all services.

Ms Lafrenière-Davis: Long-term care will include children with disabilities, children with chronic needs.

Mrs Cunningham: Okay, except that that is one of the disagreements on behalf of the London community, that those special children, especially children in mental health centres and other services helping kids with disabilities, don't want to be part of that. I'm just leaving that with you, because they don't want to be part of it. They have their own access. They've worked on it, they've established it and they do not need another roadblock to getting their services. They've taken a very strong stand in that regard. I have a number of letters in my office and I think others would be getting the same kind. Maybe you could look at that, because we're talking about children at risk, and if we're talking about one place to go or make a phone call or whatever, it doesn't have to be the same place you send seniors.

Mr Owens: That's the purpose of the multi-service agency, particularly --

Mrs Cunningham: It doesn't matter. It's just words to these people --

Mr Owens: I know it doesn't matter, but "Don't confuse me with facts," Is that what you're saying?

Mrs Cunningham: -- but I'm just putting it as a complaint. I think it should be dealt with specifically in the framework.

Mr Hope: Just check out the Kent county model, Dianne. You'll find a good one there.

Mrs Cunningham: I'll tell you one thing, and I think all of us would agree here, there are models that work across the province, but they change, in my view, with regard to not only the kinds of children's special needs, but they also change with the people who are doing the work, the front-line workers and the dedication. Without them, it doesn't matter what you put on paper, nothing's going to happen.

What we need is accountability in the system. Where services are really being provided and people are doing a good job, we should be rewarding them, and where they're not, we should send them somewhere else where they can be useful. There are a lot of communities where people are paid to do the work and they could be doing a much better job, but we have so little accountability in the system.

If I had to underline anything that was missing in this, it's the accountability part. If I had your job, I'd be moving very quickly on that one now, because there are far too many agencies that take on far too many families, huge case loads, and they could deliver their services in a very different way, even given the system we have now.

Ms Roch: One of the areas we hope to be piloting in September is the whole area of accountability.

Mrs Cunningham: I would say make the pilot project very short and very sweet.

The Chair: I regret that we're at that point where we've run out of time. Can I just ask for one clarification, as we go forward and get to working on a report? Firstly, on page 4, when you were talking about the recommendations made to the minister -- then those are going to be worked on with the areas. I take it, though, that what you have generally described fits in with that approach so that we can, as a committee, assume that those are the general directions that are being provided.

Ms Roch: Yes.

The Chair: Secondly, when you are making reference to a local planning body that would be set up, are you thinking here of something that is new? Is this similar to a multiservice agency in long-term care, or is this bringing together existing bodies?

Ms Roch: Many communities already have local planning bodies. Ms Cunningham pointed out that in her community it has been active for over 20 years. Other communities don't have them and we need to set them up. We don't want to reinvent the wheel; we don't want to fix something if it isn't broken either.

The Chair: Thank you both very much for coming to the committee this afternoon.


The Chair: I call our final witness for this afternoon, Dr Freda Martin, who is the executive director of the C.M. Hincks Treatment Centre here in Toronto. Dr Martin, I believe you're here both in your capacity I've just named, but also representing the Ontario Association of Children's Mental Health Centres. Is that fair?

Dr Freda Martin: Yes, thank you. I principally represent the Ontario Association of Children's Mental Health Centres.

As the last speaker of the day, I'm assuming that over the course of your hearings, although I haven't heard them, you'll have heard very ample evidence from those much more competent than I am about a variety of sociological and epidemiological factors and the changing nature of society and the increasing risk factors, so I won't really focus on those at all, without meaning not to agree or to support those. Because I represent children's mental health, I'm going to focus narrowly down on that area and try to talk with you a little bit about why those of us working in the field are becoming increasingly more concerned.

I hope it's worthwhile to give you some background information, because it's our perception in the field that children's mental health isn't well known or understood. Hopefully, I'm not wasting your time in just giving you some background.

In 1992-93, all of the centres together served about 66,000 children and their families and employed about 4,600 staff. Children come to our centres at every age, from a couple of months to the end of the time at 18 years, and because of a very wide range of problems. A few of those are inborn, but most, the big majority, of them are heavily influenced by the environment: the family, the school, the early nurturing those children receive.

They include everything from failure to thrive in newborns, excessive crying, difficulties in sleeping, to the ones you're probably more familiar with in school age: problems with language and other developmental difficulties, violent and disruptive behaviours, school achievement falling way below potential and children with very excessive anxiety, which really interferes with their academic and social life. In adolescence, we see all of those, plus the beginning of the major mental illnesses: depression with suicidal tendencies, schizophrenia.

The C.M. Hincks Treatment Centre where I work is perhaps a good example of one of the larger centres. We offer a pretty full range of service. We have two long-term residential units serving the most severely disturbed adolescents, and perhaps in the province are the only places that offer long-term psychiatric treatment for youngsters with severe disturbance. One of those is located on a 100-acre working farm in the Collingwood area. The kids actually run the farm, and that's part of their rehabilitation.


Just as an aside, because I was interested in your question about long-term care, somehow we wouldn't really feel included in that district health council long-term care. We haven't been consulted; there have been no representatives from us on that. The district health council really doesn't seem to think that children's mental health is part of their mandate and we're hardly represented on it at all. That's really just an aside because I was interested in your question.

At the other end of the spectrum, coming back to the Hincks, like many centres, we've recently deployed about 10% of our outpatient budget and created something we're really very excited about, which is a model early intervention prevention program for all children under the age of five in the neighbouring very high-risk area of St James Town.

This program is a collaborative one between ourselves, the city of Toronto public health department, which has seconded a number of nurses to us, and the Board of Education for the City of Toronto with its parenting programs in the Cabbagetown Youth Centre. Our objective is to visit, assess and offer a range of services to every child and their parents who are born in that area. The services will be a full range and they'll be onsite, everything from a paediatric developmental clinic to a range of parenting groups, child-rearing groups and a community advisory board.

At the site on Jarvis Street, we offer the usual full range of individual, family and group therapies, day treatment programs, some onsite and some in the school. We are a university unit and have a lot of input into training and research.

Because of the emphasis on residential programming, you need to be aware, though, that across the province only 5% of the children the association serves are in residential programs. The vast majority are in community-based programs.

I guess it's also not news to you that the demand for help far outweighs the availability of services. Although most agencies have made major changes in an effort to reduce or eliminate waiting lists, the association's surveys continue to document that as many as 7,000 children are waiting for services across all the centres.

This really regrettable situation is no surprise when you think of the Ontario Child Health Study statistics that 18% of all school children suffer from a psychiatric disturbance, and of these only one in six receives any form of help. So that's a situation in which it's unlikely there won't be a lot of people waiting for help; 18% of all our children is a large number to have a diagnosable psychiatric disturbance. I'll be coming back to that in a minute.

In that situation, and I again was interested in the comment of the need for integration across ministries, because I think nowhere more than in children's mental health do we experience that fragmentation.

First of all, children's mental health is not a priority -- it's not a mandate, in a sense -- for any ministry of the Ontario government, and I think it's always in danger of falling between the cracks. Education is currently reducing its support for special-needs children. Health overtly takes no responsibility for children's mental health, although it does fund some 20-odd centres across the province which are physically located within hospitals.

The Ministry of Community and Social Services designates itself as the lead ministry. However, in today's fiscal restraints, they make it clear that mental health falls into a non-mandated or discretionary category of service. That, in a sense, makes children's mental health a very different priority from physical health, because it's not mandated by anybody.

In the current economic environment there is, of course, concern that everyone is focusing on their highest priorities, and this creates concerns for children's mental health centres. As an aside, I guess I think it's a much bigger concern for society than for individual centres.

This brings me to the main point of my evidence. You're probably fully aware of the kind of cycle of risk that goes on, and I'll come back to it. In summary, the points that I want to make today are that, first of all, I think we have to face that children's mental health is deteriorating to the point where it's not dramatic to talk about a crisis, and that this situation matters profoundly to all of us because of its effect on both our social fabric and on our economic development.

The other point I would like to make is that we do actually have the necessary knowledge. We know what children need for healthy development as much as we know what they need for healthy physical development, and we know the essentials of effective intervention programs. But there is an enormous gap between that knowledge and current social policy; between what we know and what we do. The recently published Carnegie Corp report makes that point very strongly, that there's a big gap between knowledge and social policy.

To come to the end at this point, our association would want to make to you two basic recommendations: one, to underline that we strongly support the work and the recommendations of the recent report of the Child and Youth Project Steering Committee of the Premier's Council, Yours, Mine and Ours. If any of you have not had an opportunity to have a look at that, I strongly recommend it to you. At least read the summary.

The other thing we'd want to say is that these recommendations shouldn't be carried out at the expense of current treatment and intervention programs.

To expand a bit and to underline the point, because I think we have to think about public awareness and where we're going to put dollars, it's true that physical health has improved in the last 30 years in our country. Nevertheless, children's emotional wellbeing has deteriorated. For example, infant mortality rates have dropped from 40 per 1,000 infants to seven in the last 30 years, and life expectancy has increased. So in terms of physical health, we're supporting children reasonably well. But the incidence of emotional disturbance has increased quite significantly during that time when physical health has been improving.

The most authoritative study, by Professor Michael Rutter, in 1970 would have indicated an incidence of emotional disturbance of about 4% to 10%. The Ontario Child Health Study in 1986 was documenting 18%. A couple of more recent studies in the 1990s: a study that studied every single child from zero to four in the small town of Brockville documents something like 23% of three-year-olds whose parents or teachers or day care workers were seriously concerned with their difficulties in managing aggression; and a very similar study by the Canadian Institute of Advanced Research in Montreal has documented something like 26% of seriously aggressive four-year-old boys. We also know that those same boys will then be at risk for dropping out of school. If you're documented at that level, then the chances that you will drop out of school before you're 13 or 14 are high.

We know aggression is something you don't grow out of. Of all the characteristics, apart from your IQ, your tendency for aggression is the most stable. If you measure it across the lifespan, this is not something we can afford to take lightly.

Suicides in youth have increased threefold in this last 30-year period. Our functional illiteracy rate stands at 20%.

I want to put to you that if I gave you those sorts of figures in relation to a serious physical illness, we'd be talking about a tragic epidemic and there would be a real cause for immediate action. Certainly they point to a public health problem. The recently published Carnegie Corp report refers to it as a "quiet crisis."

Sometimes -- I didn't really mean to say this, but I will -- when I really get going, I say, "You know, in emotional health we have a public health problem that is about comparable to the one we had in physical health at the turn of the century." And we know how to do differently. What I mean is, emotionally we don't pasteurize the milk, we don't clean up the water, we don't ensure adequate nutrition, and then we wonder why we've got problems. But we could do those things. We really could. We know how. I guess my feeling is, we need to, because this is getting out of hand.

So the next point comes: It matters. I referred you to the two major reports that have just come out this month, the report of the Premier's Council and the report of the Carnegie Corp of New York, Starting Points. If you can get a look at that one, it's worth looking at too.

These two major reports are in substantial agreement. Both of them point to the seriousness of the situation. Both point to the importance of facilitating emotional and cognitive development in the first four years of life. Both agree that the research evidence is now conclusive: that much more than we used to think, those neuronal connections are laid down in the brain during that first three years and you're wired, just as much as your bones are developed with calcium and your lungs function and your heart functions. These connections determine to a large extent creativity, capacity for industry, capacity to take initiative and probably long-term affectional relations. In addition, these connections are largely environmentally determined. You're not born like that; it depends what kind of stimulation you receive, what kind of neuronal connections are laid down. It's too bad that we have to wait for the physioneurologist to scare us to what was open to anyone's eyes to see, but anyway, the neurological evidence is in.


Maybe I won't, to save time, tell you what children basically need, unless you want to hear it. You can read it. We know the basic ingredients, and I've summarized them there for you.

I might make some comments as to why we think this has really reached a kind of crisis proportion. But before that, just a comment that when we talk about risk factors -- poverty, single-parent families, women working -- I think it's important to look at what the pathways are. Those things aren't in and of themselves bad, and I think in our country in fact it's rare for physical poverty to be a cause of a problem. Otherwise, we'd see infant mortality rates increasing and we wouldn't see us living longer. The point is that those things go along with and underpin chaotic living conditions: children who then get broken relationships, who get moved about from pillar to post and don't have the opportunity for one of the basic things they need, which is to form long-term, continuous, supported relationships with one or two people. So it's because of the things they do.

It's also because parents who are poor often give their children a sense of helplessness and hopelessness. Those parents themselves feel hopeless and ineffective so they cannot impart to their children the necessary experiences that make a three-year-old feel effective.

So there are clear pathways, and I think the more you understand the pathways, the more you can think of what would be effective to do to change that. At some point, other people may want to give you more, but I think that kind of stuff is in, and we know what needs to happen.

So why have we gotten into this difficult place? First of all, I think mental health has never been a public priority nearly as much as physical health or technological advances. We just don't spend 1/100 of the money on it. Emotional health has been seen perhaps to be almost more of a private, almost kind of a moral matter, and only recently is the hard information available to tell us that this is a mistake.

As I think Dr Steinhauer was saying, the recent changes in society -- poverty, the role of women and so on -- mean that, increasingly, individual parents and families cannot provide what their children need by themselves.

Second to that, we're making increasing demands on our emotional well-being and adaptability. Society now requires not a lesser degree of emotional health, but more. We have a rapidly changing pace, diverse cultures, we need longer learning. We know that in the next generation, with the information age, the human brain is going to be our greatest natural resource, not fossil fuels, so if we don't do something about it, we'll end up economically very disadvantaged.

There's a third factor that you're probably aware of as well: Our increased technological capacity means that we have a greater power to destroy things and do damage. So if you're an angry, impulse-ridden, somewhat self-centred person and in your culture at school things aren't settled by fists but by knives and guns or bombs, you can just wreak a lot more havoc than you used to be able to. I'm not sure if children are more angry than they used to be, but they certainly have a greater scope to express that. We need to think about how to help them with that.

So you put all those three things together -- decreased ability to give nurturance, increased need for flexible and creative individuals and increased capacity for destruction -- and you've got a real explosive mix.

That brings me just finally to my recommendations. The association has voted, as I said, to strongly support the Yours, Mine and Ours document: that we take a population-based public health approach; that we emphasize prevention and emphasize the early years; that we do need objective outcomes, we need to document how our children are doing. We certainly support the need for the report cards on achievements outlined in page 61 of that report and we certainly support the recommendation for a province-wide community mobilization campaign and active support for the development of a range of programs created by and specific to each community. Children's mental health centres would certainly expect to be active partners in this process.

However, our second recommendation would be that this shouldn't be achieved simply at the expense of current treatment intervention programs, because of fiscal restraint, and that's because we do believe that many, if not most, of those programs -- even the ones at the Hincks, which are probably among the mid-range of expense for residential treatment -- play an essential role in damage control or in containment of the problem.

These children and youth aren't going to disappear; they're going to remain, rather like the carriers of germs in an epidemic, a source of contagion, and I believe by their non-productive and often violent and anti-social behaviour they would cost the country very much more untreated than treated. That is, if they're just let go, the cost to the welfare and the penal system and perpetuating this risk will cost more than the year's treatment they might need to have.

One thing I'd like to emphasize is that although I believe that, I don't absolutely know it, and that's because we haven't really had sufficient support to do proper outcome studies. Coming back to the report cards, that's one thing we really do need. I can say that I believe we prevent more in prison sentences and in welfare and in helping these kids to earn money rather than to be a drain on it, but I don't 100% know it.

One of the reasons I bring this to you as a policy thing is that one of the most difficult things technically about it, or subjectively, is that you need to be able to track these kids for five or 10 years to demonstrate that, and for that we need some policy that would encourage them to stay in touch with us. We've been trying to mount this at the Hincks for some time with some success, but our biggest problem is that we lose the kids and we can't keep track of them.

I'd like to see some policies that would say to children and their families when they come into these expensive programs, "One of the things we expect you to do is stay in touch." It may be as simple as that, because otherwise I don't think it would be that difficult. We're not looking at sophisticated research outcomes; what I only want to know is, have you got a job, did you stay out of prison, did you complete school? I mean, they're pretty concrete things that would give us those kinds of results.

I also don't think it makes much sense, and there's a bit of concern in the MCSS policy directives that the last presenter gave to you stopped treating the middle group of children, because they're the ones we can treat. So to say, "Well, we'll put everything into prevention and we have to treat these high-risk kids, so the middle group of children with the ordinary run of children's mental health problems, we won't treat them until they get so serious that we have to," that doesn't make any sense. Most of those children can be treated and turned around very inexpensively, and it also discriminates against mental health in relation to physical health.

The Chair: Thank you very much for your presentation, and we'll move to questions. I just note for your own information that the committee did spend a day with the Premier's Council --

Dr Freda Martin: Oh, good.

The Chair: -- and they presented their report to us. The other report that you mention, the Carnegie Corp, I think would be useful for members to get a copy of that, so perhaps we can get the reference for that.

Dr Freda Martin: What I could do is, I have it. It's hard to get from New York; it takes a bit of time. Since I have it, I could have a copy sent over to you and then maybe you can just have copies made.


Mr Tony Martin (Sault Ste Marie): Thank you for a very interesting and worthwhile brief. As I sit through these hearings and hear people come forward and listen to the presentation of the Premier's Council and others, one thing that kind of jumps out at me that I'd like to know a little bit more about, because it doesn't necessarily jibe with my experience and understanding of some of the mental health challenges of communities, is the question of the contribution that poverty makes to this whole question. The assumption is that poverty is one of the significant factors in it all, yet I know of families who were poor who didn't have mental health problems. In fact, they were some of the healthier families in communities that I lived in, and kids from those families went on to do some really tremendously wonderful things with their lives.

In some of the work that I've done before I got to this place, as I tried to get a handle on what was happening in the community re the mental health of the kids whom I was dealing with, there was no consistent stratum of people who came into my area with difficulties. They came from all walks of life, and the reasons were myriad as to why they ended up in difficulty with the law, doing drugs or having difficulty with their parents.

The question I would like to explore with you a little bit further is this whole question of poverty and your response to some of my comments. The other is how we get the community more involved in this whole question, because I get the feeling that we've abdicated responsibility to professionals, who can't do it by themselves.

Dr Freda Martin: Absolutely.

Mr Martin: Until we get everybody together around this and we all begin to take some responsibility, we won't resolve it. Again, in my previous life and since I've been here, we talk about needing to bring people together around these questions, needing to be working more collaboratively, yet we seem never to be able to get there. What, in your mind, is the major obstacle?

Dr Freda Martin: Let me talk about poverty first. I'm glad you raise that because I agree with you. I know lots of very poor who are perfectly healthy, and we see very many children from good working-class families, as it were, and in the middle classes and in the well-to-do who are very unhealthy kids. Poverty in and of itself does not cause mental ill health. It has been associated as a risk factor. I think it's sometimes not noticed, because people are concerned about poverty, that in the Ontario Child Health Study poverty in and of itself was not a risk factor. What was a risk factor was living in subsidized housing. That's a different thing, and it starts to point you in the direction of what I was talking about, that it is chaotic parenting which is associated with poverty but not just with poverty: parents who themselves feel hopeless and ineffective and somewhat outside of society, not valued and not contributing, who then create the kinds of conditions in the first five or six years of life which are not healthy for children.

But it isn't not having enough to eat or enough to wear or a roof over your head that is the issue in this province. The issue is to have parents and communities who feel active and something they can do about it and effective and to have the stability, particularly of relationships in the very early years, for children.

I was just looking at another study which you might like to look at called Staying on Track, which is just out. It is also a report of the Premier's Council and is the study of all these children in Brockville who were looked at over the five years of their life. In that study, which looks only at younger children -- the Ontario Child Health Study starts with school-age children -- from birth to age five, poverty did not emerge as a risk factor, so we challenge the literature on that a little bit. Mothers' depression, mothers' perception of children, mothers' relationship with children and mothers' level of education were much greater factors than poverty. It doesn't mean I think we don't have to deal with poverty.

The Chair: Mr Martin, I apologize. We are going to be called to the House for a vote and both Ms Cunningham and Ms O'Neill have questions, so we'll just have to move on to Ms Cunningham.

Mrs Cunningham: I'll move quickly because I'm sure that others or my colleague will want to speak to Dr Martin. I'm thrilled with your presentation. I think we've all been privileged this afternoon to hear from you, and I was looking forward to it.

The first point you made on the district health council was brought to me as a concern, so I'm glad I was able to at least get it on the record. We'll deal with the Ministry of Health, but I think through the Ministry of Community and Social Services. They ought to know about the concern.

But the other point, and I appreciated the question from Mr Martin, is with regard to how families alone cannot provide what their children need, and the points that you've just made: How do you get the community involved? There are many agencies and professionals and families and schools that have tried to get the community involved across Ontario who have had some success, and others who haven't. My observation is that we should be looking at success stories and maybe model them.

But my third question has to do with something that's close to my own heart, where you said about tracking children. I can remember working in Merrymount Children's Centre in London, Ontario, which wasn't a treatment centre but did a lot of the kinds of work that are needed to keep families together. When people wanted to work there for me, social workers, I said, "Be prepared to work with the same family for five years." We had great success. We watched the mothers gain in confidence and the children be more successful at school, and two or three of us have followed those children for 15 years.

For me personally -- it was just my own little idea -- it seemed to make sense. I have no idea why that isn't followed around the province, instead of case loads where the mothers are referred to different social workers and different case workers on almost a weekly basis in some instances.

Dr Freda Martin: There's no doubt continuity of relationship with the care giver is really important. In bringing it back to your point, I agree with you; I think parents alone can't do it any more. But no one ever thought they could, you know. That's a kind of aberration of the last 25 years to think that parents alone can.

Mrs Cunningham: You're right.

Dr Freda Martin: It takes a whole community to bring up a child. Professionals certainly can't do it, and I'm not advocating at all that more money be put into the health treatment system, mental health or any other. We know there's a big difference between the health of the population and the health care system, that those two are somewhat separate in the things that influence them. I'm really tied much more to a public health system, and for us that means a different social community connectedness.

I think we can get together parents, professionals, schools, communities, and join them into a much more connected network, which is what children need. They don't need to grow up in isolated communities where their parents hardly know the people on the street and are stressed out, if you think of the kind of network of support that a child needs. I think we can do that.

There are model programs we can look at. Staying on Track is interesting because it also was a collaboration with the public health nurse. The cost of it was something like $450 per child per annum and it was shown to be quite effective as an intervention as well as a tracking. I think 90% of the parents who were in that said they would have liked to stay in it and that it should become a permanent part of our delivery system. It's kind of the same as a kid having paediatric checks. Their parents were checked and they got information as to where their kid was, and those who were seen to be seriously at risk were referred to somewhat more specialized resources. But that's at 18 months and two years of age, and that's when it needs to happen. I think we can do those things. It isn't that we don't know what to do any more. We didn't maybe 10 years ago, but we sure do now.

Mrs Cunningham: What about the informal programs as opposed to formal? I guess I could give you a couple of examples. We see so many children now, in my view, who are totally rushed. At least six days and maybe nights a week they're rushed from one organized event to another. You used the word "chaotic" parenting. I think that was the word; it's a good one. So we have that.

On the other hand, we have preschool programs in our educational institutions, but because it's so expensive, we have rural boards sending kids on buses -- and some of them are three years old -- every second day, that kind of thing. I'm not saying it's good or bad. It seems to me, though, that we don't often think about practical programs that can help parents and children work through life together. We seem, through our programs, to make it more difficult for parents.


Dr Freda Martin: I can only agree with that. I think networks of local rural families -- there are some local rural child care centres set up that way, as home-family based -- could make a lot more sense. Probably we need to offer a lot of range of alternatives to people, because not everything suits everybody.

Mrs O'Neill: I thank you very much for coming. It's a very good closure to our study, Dr Martin. I think you said some things that I've believed for an awful long time. Maybe you didn't say them in these words. I think mental health has always been taken for granted. Whether it's our own mental health or those around ourselves or those whom we work with, we tend to have taken it for granted. At least through my lifetime, that's been my experience.

Although you didn't read it into the record, I was very happy to see that you talked about expectations for children and that high expectations do have an effect on children. I think we tend to forget that sometimes. I think you talk about parents as models of self-control also being a very important component of the family structure. Both of those things aren't talked about very much any more.

I'm quite interested in what you hit on technology, because you seem to be the only one who's mentioned that effect, the effect of technology on the home. As I mentioned earlier, I have been working on children's services quite a bit this particular year. When we met with young people, and I'm talking now about 14-, 15- and 16-year-olds, some of them said to us, and I think they were being very realistic, "There's so much TV in our house now, so many people involved in video games, computer games, nobody talks to each other any more." That really hit me between the eyes, to think that would be something they would feel important enough to present when they had an opportunity to present almost anything.

I like the best-case scenarios. I just wonder if you could close off by telling us a little bit about what must be a success story in St James Town where you're working. You're talking about a developmental clinic and home visits. Could you tell us a little bit about what that's about and why it's successful?

Dr Freda Martin: It's really only just starting. We're very excited about it, partly because Dr Sarah Landy, who did the Brockville study, is working full-time there and we've been able to get her. It is using what we know about what works, the model of prevention, to mobilize the community, to put together the experienced expertise of someone like Dr Landy with Cabbagetown Youth Centre, which is the local resource, and with public health and education.

We've been able to get premises there, which is an exciting story in itself, right in St James Town, located under the Dominion store at 240 Wellesley, I guess it is, where it will be one-stop shopping.

Initially, we'll get a birth notice for every child who is born. They'll be visited. A good contact will be made. We're particularly interested in reaching the kind of single parent who doesn't come out of her apartment normally. We will involve a range of ethnic cultures in the home visitors so that people are visited if at all possible by someone of their own culture. We've got maybe half a dozen different major cultures we have to work with there to talk with them about what they would like to do.

There'll be a whole range of groups that parents can join, some specifically working with difficulties with aggressives, some just discussing parenting techniques, some more socializing, some mixtures. We'll have a smorgasbord of things that people can go to in a local community centre, involving local women as much as possible.

With that, and what I think makes it exciting, is that we have the children's mental health people working right there on site. We're attracting an exciting range of volunteers. Some of them are community volunteers. Some of them are university students, particularly MA psychologists. The deal with them is that they can do their PhD and we'll give them a nice piece of work to do and some supervision and they'll give two days a week of counselling and training time. Actually, we've got more people than we know what to do with at the moment in terms of hands to do the labour.

There was a very interesting thing that happened. I don't know if you saw in the paper that the Sterling Foundation came up -- they're a foundation modelled on Jimmy Carter's project that refurnishes and redoes places -- there were actually 800 people registered at the local school in St James Town, about half of them from part of the Sterling Foundation and half of them were local people. They all spent Saturday and Sunday together, putting that community place in shape, like scraping the paint -- I was there too -- and painting and doing wiring, because we had this derelict set of rooms in the bottom of St James Town that had been put there but never been used. They were meant to be a community centre and the space was there.

The hope was, and the belief is, that now -- we had Tamils and Vietnamese and people like me and Spiro, who's Greek, who's head of Cabbagetown Youth Centre -- that way we'd get community participation because those people now know how to maintain that place and it's there. It's kind of a neat project.

What I like about it is it puts together the highest level of professional expertise in someone like Dr Landy with the whole community development piece. Hopefully it'll take shape.

The Chair: That perhaps is a good positive note on which to end. Dr. Martin, you are our last witness for these hearings. Thank you very much for coming.

We have 12 hours and I would just say to committee members that we have a little less than an hour left which we'll need to reserve to carry out our final deliberations and approve our report. I hear the bells ringing and we're going to have to go up to the House for a vote.

On Monday we begin our hearings into Bill 85, An Act to prevent unjust enrichment through the Proceeds of Crime.

The committee adjourned at 1757.