1999 Annual Report,
Provincial Auditor
Ministry of Community and Social Services
Mr Kevin Costante, deputy minister, Ministry of Community and
Social Services
Ms Cynthia Lees, acting assistant deputy minister, children,
family and community
services division
Mr Duff Sprague, policy analyst, children's services branch,
children, family and
community services division
STANDING COMMITTEE ON
PUBLIC ACCOUNTS
Chair /
Président
Mr John Gerretsen (Kingston and the Islands / Kingston et les
îles L)
Vice-Chair / Vice-Président
Mr John C. Cleary (Stormont-Dundas-Charlottenburgh L)
Mr John C. Cleary (Stormont-Dundas-Charlottenburgh L)
Mr John Gerretsen (Kingston and the Islands / Kingston et les
îles L)
Mr John Hastings (Etobicoke North / -Nord PC)
Ms Shelley Martel (Nickel Belt ND)
Mr Bart Maves (Niagara Falls PC)
Mrs Julia Munro (York North / -Nord PC)
Ms Marilyn Mushinski (Scarborough Centre / -Centre PC)
Mr Richard Patten (Ottawa Centre / -Centre L)
Also taking part / Autres participants et
participantes
Mr Erik Peters, Provincial Auditor
Clerk / Greffière
Ms Tonia Grannum
Staff / Personnel
Ms Elaine Campbell, research officer, Legislative Research
Service
Mr Ray McLellan, research officer, Legislative Research
Service
The committee met at 1045 in committee room 1,
following a closed session.
1999 ANNUAL REPORT, PROVINCIAL AUDITOR: MINISTRY OF
COMMUNITY AND SOCIAL SERVICES
Consideration of chapter
4(3.03) child and family intervention program, and chapter
4(3.04) transfer payment agency accountability and
governance.
The Chair (Mr John
Gerretsen): Good morning, everyone. I'd like to open the
public accounts committee hearings for today. We're dealing with
two issues related to the Ministry of Community and Social
Services. The committee decided earlier to deal with both issues
at once, so the questions may be coming on either one of the
reports.
Perhaps you could introduce
yourselves.
Mr Kevin
Costante: Good morning, Mr Chairman. My name is Kevin
Costante. I'm the Deputy Minister of Community and Social
Services.
The Chair:
Would you like to introduce the other two people, please.
Mr Costante:
Angela Forest is the assistant deputy minister of business
planning and corporate services. Cynthia Lees is the acting
assistant deputy minister of children, family and community
services.
The Chair:
Did you want to make a short presentation on the two
sections?
Mr Costante:
I have some opening remarks, if that's OK.
The Chair:
Yes, go ahead, please.
Mr Costante:
First of all, I want to say thank you for having us here today to
respond to the two sections of the 1999 report of the Provincial
Auditor. The two areas we were asked to come and talk about today
were the transfer payment agency accountability and governance
report and the child and family intervention program audits from
the 1997 auditor's report.
The Provincial Auditor plays
an important role and we very much appreciate the advice we get
from him. In these two audits, he was calling for the greatest
possible accountability and the prudent, responsible use of
public funds, a goal we obviously share with him. I'd like to say
that we've been working hard to implement these recommendations
the auditor made.
Before I respond to the
specific sections of the auditor's report here today, I'd like to
set a little bit of context by talking about the ministry
generally, if I could.
The Ministry of Community and
Social Services is one of the largest ministries in the Ontario
government. This fiscal year, our combined operating and capital
expenditures are approximately $7.8 billion, and we have a staff
complement in excess of 6,000 employees.
We plan and arrange for an
affordable and effective system of community and social services
throughout the province. Services are provided to Ontarians who
are vulnerable and in need, including adults, children and youth,
people with physical and developmental disabilities and
aboriginal people.
One of the two core
businesses is to provide income and employment supports to
Ontario residents who are most vulnerable and in need. Income
support is provided through the Ontario Works program, which is
municipally run, and the Ontario disability support program,
which enables disabled individuals to live as independently as
possible. That program is run by the ministry.
Our second core business is
to provide effective and accountable social and community
services to those in need and invest more of our resources in
prevention and early intervention services.
The social and community
services that we provide include funding for child welfare,
children's mental health and young offender services; funding for
child care services for low-income families with young children;
funding to help support children and adults with developmental
disabilities; and funding for adult services such as support for
people with disabilities and for victims of domestic violence and
their children.
Most of the social services
are provided by community-based, mostly not-for-profit agencies
run by volunteer boards of directors. They're commonly known as
transfer payment agencies. They receive funding from the
government, but they are independent organizations that must meet
the requirements of the Corporations Act. Some of our services
are also provided by for-profit organizations.
In 1998-1999, the ministry
worked with more than 3,100 transfer payment agencies, including
child care agencies. Together they received about $2.1 billion in
funding, and that excludes transfers to municipalities for social
assistance costs.
As members of the committee know, municipalities are
now the primary deliverers of Ontario Works and, soon, child
care. As of January 1, 1999, municipalities have assumed delivery
of Ontario Works, and by January 1 we'll have transferred our
child care responsibilities to them.
Transfer payment agencies
include a range of organizations and groups, such as women's
shelters, hostels, group homes, associations for community
living, First Nations groups, municipalities, children's aid
societies and child and family intervention programs.
The ministry is accountable
for the services transfer payment agencies provide with our
funding, but we do not manage the individual agencies or the
employees of those agencies. I should also point out that a
number of the transfer payment agencies we support also receive
funds from other sources, such as other levels of government, the
private sector, foundations or through their own internal
fundraising activities.
In the past several years
there have been many changes to the activities of the Ministry of
Community and Social Services. Much of this change has been as a
result of the fundamental reform of the social assistance system
with the creation of the Ontario Works program and the Ontario
disability support program. The second major change has been the
reform of the child welfare system to provide better protection
for children in the province, and this has included legislative
changes, funding reform, increased resources, training for the
staff in the societies as well as the board members, new
technology and better procedures to assess and track the services
they provide. We are also in the process of restructuring social
services for children and adults with developmental disabilities
to better meet client needs. We're doing this by implementing our
multi-year Making Services Work for People initiative, and we are
introducing changes to make the system more efficient and
effective for the people we serve.
Making Services Work for
People is about making the best use of our resources to ensure
that people get the right help at the right time. It will help us
move from a service system that is often complex to one where
people have easier and better access to information and services
through better coordination. Along with these changes, we have
also been putting an increased emphasis on programs and services
that will prevent and intervene early to help children at risk.
By investing in prevention and early intervention, our goal is to
avert more intensive, expensive services down the road.
These and other changes have
had an impact on our transfer payment agencies, both in what is
expected from them and what we provide to them to meet those
expectations.
I'll now deal with the
specific items, if I can, the first one being the recommendations
on transfer payment agency accountability and governance. The
provincial audit on that topic, which was completed in the
1996-97 fiscal year, raised a number of concerns about the
accountability and governance of transfer payment agencies, and
that audit made a number of valuable recommendations.
Since that time the ministry
has been taking steps to carry out the recommendations made in
the report and to ensure that the transfer payment agencies use
provincial funding in an accountable and responsible manner.
While we acknowledge that more remains to be done in this large
and complex program area, we are pleased to report that we've
made significant progress in response to each of the
recommendations of the Provincial Auditor.
In terms of the overall
accountability and governance in the ministry, in June of this
year we approved a governance and accountability framework that
will provide a strategic context for coordinating existing
governance and accountability initiatives and the development of
new initiatives. The purpose of the framework is to guide work on
governance and accountability in the ministry and to ensure
there's consistency and clarity in the way work is done.
Historically the ministry has
many accountability approaches in each of its various programs.
However, we had no overall framework that was consistent across
all of our various business lines.
Once the ministry's framework
is implemented, we are confident it will result in a strategic
policy umbrella for all ministry initiatives affecting governance
and accountability. It will bring into place broad principles and
mandatory requirements to guide governance and accountability
initiatives; create clear statements of results that the ministry
expects to be achieved with the expenditure of public funds;
performance measures to enhance the reporting and monitoring of
results will be in place; and lastly, there will be an
understanding by all parties receiving transfer payments of the
corrective actions that need to be put in place to ensure that
funds are spent in a manner that is consistent with
expectations.
As a first step in
implementing the framework, we are developing requirements for
governance and accountability for the ministry's transfer payment
agencies, municipal partners and other service providers. These
new and enhanced requirements will establish clear expectations
that the ministry has for transfer payment funding and will
ensure that we're in compliance with the Management Board
directive on accountability by April 1, 2000. We expect that full
implementation of the framework will take us several years to put
in place.
I can't stress enough how
important the implementation of the ministry governance and
accountability framework will be in bringing together all the
work that has been done in the various program areas of the
ministry.
A good example of the kind of
work that is being done to improve transfer payment agency
accountability and governance is in the area of child welfare
reform, where accountability has been built into all of our
welfare reform initiatives. The work on accountability is clearly
focused on the protection of children and fiscal accountability,
and these two goals are directly linked in the accountability
framework.
The expectations for protecting children and
effective stewardship of the public funds accountability approach
in child welfare are supported by clear roles and
responsibilities for everybody; service agreements or contracts
with children's aid societies; standardized eligibility for
service consistent with legislative and regulatory requirements;
an improved and streamlined approach to monitoring, which will
result in an annual report card on each CAS; a funding framework
based on unit costs; and a comprehensive approach to training and
capacity building for CAS staff and boards.
In addition, research has
been completed on what outcomes should be tracked in child
welfare. In particular, Human Resources Development Canada, the
Bell Canada research unit and directors of child welfare across
Canada have selected 10 important indicators to monitor. Ontario
will be the first province to begin pilot testing and
implementation of data collection on these indicators. Data
collection on three of the indicators will begin in 1999-2000.
Information on client outcomes will provide the ministry and
agencies with comparative data to assess the effectiveness of the
services provided.
In the interests of time I
won't go into further detail on the specific actions we have
taken on each of the recommendations, and I'll leave that for
questions.
I'd like to turn to the
second report, and that's on the 1997 recommendations on the
child and family intervention program. Again I'll provide a brief
bit of context for that program.
First of all, effective and
accountable mental health services for children are a priority
for the ministry. The Ministry of Community and Social Services
is the lead ministry for children's mental health, providing
assessment and treatment interventions, as well as prevention and
early intervention programs for children up to the age of 18.
These are children experiencing social, emotional, behavioural or
psychiatric problems.
In 1998-99, the ministry
provided $263.7 million annually for children's mental health
services in the province. About 100,000 children and their
families received mental health services from over 90 children's
mental health centres that were funded by the ministry.
In addition to services
funded by our ministry, the Ministry of Health and Long-Term Care
funds children's psychiatric hospital beds, child and adolescent
mental health clinics and fee-for-service physician and
psychiatric supports to children and their families.
Within children's mental
health services, the child and family intervention program
provides for a range of services for children and families who
have social, emotional or behavioural problems. In 1998-99,
funding for child and family intervention totalled $199.7
million.
As the auditor noted, under
the provisions of the Child and Family Services Act, the child
and family intervention program provides transfer payments to
approximately 200 community-based agencies that deliver such
services as psychiatric therapy, counselling, skills training and
education, as well as residential services to children who
require more intensive assistance.
We value the recommendations
made by the auditor and we are responding effectively to the
issues raised.
I am pleased to report that
the ministry is making dramatic changes to client and service
outcomes in children's mental health, including child and family
intervention, through the mandatory implementation of a
standardized client intake instrument and a standardized
assessment and outcomes instrument. Working closely with the
Ministry of Health and Long-Term Care, the process of selecting
these instruments involved a review of clinical intake and
assessment instruments currently in use in Ontario and other
jurisdictions to determine if any were suitable for
implementation across the entire children's mental health
sector.
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The selected instruments
after that review were a standardized client information system
developed by Hamilton Health Sciences Centre and the Centre for
the Study of Children at Risk with the support of Children's
Mental Health Ontario; the second instrument is the child and
adolescent functional assessment scale, developed and widely used
in the United States. It is currently being tested in a project
managed by the Hospital for Sick Children here in Toronto and
involves several agencies funded by the ministry.
Once these instruments are in
place, every child and family who calls an agency for service can
begin the intake process immediately and hopefully finish within
20 minutes. Also, when children and families move between
services, the completed intake and assessment information can be
transferred with them.
For agencies, the instruments
will provide client data and outcomes that can be used to improve
their intake and service delivery, and at the ministry level the
instruments will allow us to collect province-wide data for every
child receiving mental health services, including the type of
service being provided, at what cost it's being provided and with
what result. This information will help guide future policy and
program development.
I'd like to emphasize that
this represents an unprecedented step forward in the area of
children's mental health in Canada. No other province in the
country uses standardized intake and assessment instruments, nor
is able to gather the kind of comprehensive data these
instruments will provide.
Both instruments will be
implemented in stages, beginning this fiscal year. Phase 1 we
will be implementing in 20 sites. The information gathered during
this first phase will guide our development of implementation
guidelines and a user handbook. By the end of March 2001, all
children's mental health centres will be expected to use these
instruments.
The government has also
listened to many voices concerned about children's mental health
services and has responded with an investment of $20 million
annualized, which was announced in last spring's budget.
The initiatives that will be
funded by the $20 million reflect our discussions with children's
mental health centres,
psychiatrists, parents and others on how the new funding could be
spent to best serve children with mental health problems. Also,
our investments will be guided by Minister Marland's findings and
recommendations based on her consultations with mental health
stakeholders across the province.
Our priority is to improve
and enhance children's mental health services through increased
resources. We want to develop a clear policy and a collaborative
approach that involves the funding ministries and all children's
mental health service providers. There are three main objectives
for the new funding: to collect and analyze the information
necessary to increase the effectiveness and efficiency of the
system of services and supports for children and families; to
improve access to services for children and families using
innovative, evidence-based initiatives; and to increase the
flexibility and coordination of agencies funded by our ministry
and the Ministry of Health and Long-Term Care.
It is our expectation that
early in the new year the government will be making an
announcement on further specifics as to how this funding will be
used to improve children's mental health services in Ontario.
The ministry will also be
improving accountability by conducting a baseline study of the
children's mental health service system. This will be completed
by March 2000 and will inform us on such service issues as hours
of access to services and the ratio of office-based counselling
to community-based support.
To conclude then, I'd like to
acknowledge the important role the auditor plays and express our
commitment to following through on the recommendations he's made
to this ministry. We recognize that the public has a right to
expect increased accountability from government, and assurance
that taxpayers' money is used efficiently and effectively.
Thank you for this
opportunity, and I look forward to your questions.
The Chair:
Thank you very much. We have approximately an hour left. What I
propose to do is give a 10-minute session the first time around
and then we'll divide up whatever time is left after that. We'll
start with the government side for 10 minutes.
Ms Marilyn Mushinski
(Scarborough Centre): The transfer payment agencies
accountability and governance portion of the report indicates you
have about seven areas where the ministry has transfer partners.
Could you tell me how in how many of those areas you use either a
base budgeting system that's adjusted annually or some other
mechanism, in how many do you have an open competition or a
tendering process, and in how many do you budget based on
benchmarking mechanisms?
Mr Costante:
I'll start with the areas we do base budgets from.
If I can start with Ontario
Works, that program is very much based on the number of clients
served, and it's a kind of per-client type of payment. The
administration of cost tends to be set on the number of clients
served, resulting in so much administrative cost. The approach
tends to be the same in the Ontario disabilities support program.
Again, it's based on the number of clients being served and the
rates they are eligible for.
In the child welfare area, we
have developed a new funding framework, which again is based on
volume but also benchmarks what we expect agencies to spent in
relation to the services they provide. Really, that's a type of
model that we would like to move across many of our other service
sectors.
Ms
Mushinski: So, looking at child and family intervention
services and young offenders' services and other programs, you're
looking at bringing a uniform base-budgeting process across the
board?
Mr Costante:
I think what's needed increasingly, and it takes some time to
develop, is budgeting based on benchmarking costs, not just
paying historic costs. Obviously, there are volume indicators in
the services. If the number of young offenders referred to us by
the courts goes up, we need some way of recognizing that.
Similarly, when the volumes
are down, you need some way that you're not spending money when
there are not kids in service. I think we want to go that way in
each of our areas.
Your second question had to
do with competitions. I think that is increasingly the way we are
going. We use an RFP approach to contract for new services. We
have not gone back and said to all our service providers that
we're going to start from ground zero and do an RFP for all
services. But increasingly, when new services come out, we are
using an RFP approach.
The Chair:
RFP, for the record, is request for proposals.
Mr Costante:
Yes.
Ms
Mushinski: Thank you.
Mrs Julia Munro (York
North): With regard to child and family intervention, it
seems to me that some of the points you have raised today need a
little more explanation, when we look at the original auditor's
follow-up, which described them as "limited progress." Can you
explain the difference?
Mr Costante:
I'm sorry?
Mrs Munro:
What you described to us today with regard to child and family
intervention seems much more than the limited progress that was
described in the auditor's follow-up report. I wonder if you
could explain the difference.
Mr Costante:
I'm assuming-and I don't want to put words in Erik's mouth-that
by "limited progress" he was saying that some of the things we
are doing are not yet on the ground. Our assessment tools are
about to go out; we have selected them. We have the new
investment of money for children's mental health. Again, the
announcement hasn't been made yet. So we've spent the last couple
of years getting a lot of things ready and providing the
groundwork to do some very exciting work in this area. But-the
comment about limited progress-it's not actually there yet.
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Mrs Munro:
As citizens of this province, we have been made, in many cases,
painfully aware of the need to reform the child welfare system. I
wonder if you could outline for us some of the key areas of
progress that have been made.
Mr Costante:
I mentioned it briefly in my remarks, but I can say a few more
words about that. I won't go through the elements again but, in
terms of progress, we did legislative changes. Those changes have
been incorporated into our new risk assessment tools. Those are
in place. We're working with our partner ministries to clarify
changes so we can help professionals who relate to the child
welfare system understand their roles and the important roles
they play in terms of reporting potential abuse.
We have also developed a
comprehensive training strategy, and we have recently contracted
with the Ontario Association of Children's Aid Societies to
provide that training. We have developed a case recording package
for field workers. We also have new child protection standards
that will come into effect upon proclamation, and we have
implemented guidelines for the children's aid societies.
In terms of funding, as you
know, $170 million in increased funding was provided over three
years. We're in year two of the phase-in of the funding, and
we're in the process of preparing allocations for the next fiscal
year.
We're working on trying to
make improvements to our foster care program. Right now we, in
conjunction with the Ontario Association of Children's Aid
Societies, are seeking a sponsor to do a recruitment program to
get more foster parents. We're also doing research to select a
new foster parent training model, and we're also looking at a
children-in-care model that the OACAS is piloting.
In the area of technology,
all 54 children's aid societies have a new, fast-track system
that allows them to see whether cases were served elsewhere, and
that has been a large effort. Over 3,000 new computers have been
distributed to children's aid societies, and we've just completed
the Y2K testing. There is also a 1-800 number to help workers who
are working on the computers in off hours.
As I said, in terms of
training we have awarded the contract to OACAS, and we're also
working on a manual for board members. If that manual is
successful, we will look at developing it further for use in some
of our other six sectors, because a lot of the training that
board members need is generic to the sector; it doesn't
necessarily have to be specific to children's aid societies.
That's a bit of an update on progress.
Mr Richard Patten
(Ottawa Centre): Deputy, you began with a bit of an
overview. Could you give me a picture: Where are your pressures?
What programs have you got less resources for now and which
programs do you have new resources for, and what's the landscape
of your ministry?
Mr Costante:
I'll start with the landscape. On Ontario Works, we have
declining case loads and declining budgets. I think the pressures
there are to work with the municipalities to get our community
placements and our employment programs, our training and stuff,
launched and help more people exit welfare.
On the Ontario disability
support program, that's a program where the numbers grow slowly
but it's a steady growth, a couple of per cent a year in terms of
caseload. We're also putting into place on a voluntary basis an
employment support program for people with disabilities so that
any who want to try can get fairly quick assistance. We're just
launching that.
In terms of the Ontario
disability support program, the volume of referrals in the first
year was quite beyond our expectation. We had a lot more people
applying than we had anticipated. So we were dealing with volume
pressure and staff pressure there.
In the area of children's
mental health, as I mentioned, there is more money. There are
high needs in that area. In the consultations that were done by
Minister Marland and through our own ministry, people in the
children's mental health area are looking for crisis
intervention, for more supports for higher-needs kids, for
supports in rural and northern areas where access to children's
mental health services is not as good. Hopefully in the
announcement we'll address some of those pressures.
In the area of child welfare,
there is a very strong increase in the number of referrals by
professionals and by the general public to the children's aid
societies. I think children's aid societies are really struggling
to keep up with that volume. It's resulting in more kids in care
and more services being provided by CASs. That's a strong
pressure area, both service-wide and financially. Our funding
framework has a volume indicator on it so we can help respond to
that volume increase.
In the area of developmental
services, last spring there was a $35-million infusion into that
area. There's a lot of need in terms of families trying to keep
children, or even adult children, at home. Our most popular
program, likely one of the few programs we as a ministry get
cards and letters of thanks on, is the special services at home
program, which provides money to individual families directly so
they can get their own services. Some $10 million of that
$35-million increase went into that program. Again it's an area
where we're under pressure. There is a lot of demand.
What have I missed? We also
fund violence against women shelters. There is pressure on beds.
Through Ontario Works, we also fund municipalities for hostels.
On the news this morning you likely heard the city of Toronto
talking about more hostel space, and we provide funding for
that.
I've likely missed a few
areas, but that's an overview.
Mr Patten:
It's my understanding that the pressure on children's mental
health services is really quite severe, and exacerbated somewhat
by cuts in other areas. I know the Minister of Education says
there was more money in special needs. That may be true across
the province but it certainly isn't true for the big boards that
probably handle the bulk of the big urban areas.
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I've had calls from
hospitals from other areas that are seeing what the school can no
longer handle because they don't have the psychiatrists, the
psychologists or the social workers any more that they used to.
That pressure is now being moved out to the community. Do you
concur with that? By the way, what kind of new funding are you
talking about for the children's mental health services?
Mr
Costante: We have about $20 million in new funding. To
answer your first question, I don't think there's a good handle
on what the need is. We don't have a province-wide waiting list.
Often families will go from agency to agency and therefore it's
hard to get a good fix on the size of the demand.
Mr Patten:
Do you get information for your purposes from other
ministries?
Mr
Costante: We are in touch with the Ministry of Education
on what they're doing and their programs. That's kind of a
general keeping in touch in terms of making sure our programs
work together well.
Mr Patten:
Each board will tell you their waiting lists; they'll tell you
the nature of the assessments, the need deficiencies etc. My
question would be, is that made available to you on an ongoing
basis or is that integrated into your information system?
Mr
Costante: We certainly don't have it as part of our
information system. I'm not aware that we regularly get that
information. We may have got it from time to time.
Mr Patten:
One last question before my colleague asks his: Under your
program cost comparisons with the child and family intervention
programs, you talked about a research study that was done and
completed in 1998, and then an advisory group of stakeholders
reviewed the findings and recommendations of the research study
and issued its final report in December 1998. Can you share with
us your findings on that, please?
Mr
Costante: Is this for the new instruments that we're
bringing in in children's mental health?
Mr Patten:
This is under "Program Cost Comparisons" under the section
"Current Status," "Agency Funding and Budget Requests," page 2.
The auditor's recommendation number 2, and then the ministry's
response was that there was this research study done and an
advisory group reviewed it and there was a final report in
December 1998, but it didn't elaborate.
The Chair:
It's page 260 of the auditor's report; you're referring to page 2
of the research.
Mr
Costante: I'm sorry, we're having a little problem
finding it.
Mr Patten:
Page 260, under "Current Status," just above "Annual Program
Expenditure Reconciliations," under "Program Cost
Comparisons."
Mrs Munro:
Could you repeat your question.
Mr Patten:
Yes. My question was that it identified that the research study
was done, that there was an advisory group that reviewed the
findings, and recommendations of the research study were issued
and its final report was in December 1998, but I don't have the
content of it. I'm just asking what were the major findings of
that.
Mr
Costante: We're looking for that. Perhaps we could come
back and answer that, if that's OK.
Mr Patten:
Sure, OK.
The Chair:
Mr Cleary, you've got about a minute and a half.
Mr John C. Cleary
(Stormont-Dundas-Charlottenburgh): Deputy, you mentioned
foster care and getting more parents involved. How are you going
to do that? I know our community has been working on that for
many years through a number of agencies. How do you plan on
getting more parents involved?
Mr
Costante: We've been working jointly with children's aid
societies to develop a strategy. We're encouraging the children's
aid societies to come together in groupings, as opposed to each
one being out there trying to encourage parents to come forward.
A lot of them are doing much more in the way of advertising in
the area, trying to have parents come forward, trying to get
information out through the media that foster parents are needed.
As a good and valuable thing, they often bring the parents
together to provide them with briefings as to what it involves
and how to get involved and to try to do an assessment of
individuals and families that would make good foster parents.
I don't know, Cynthia, if
you want to add something on foster parent recruitment
strategy.
Ms Cynthia
Lees: I concur with what the deputy has said. I think
partly what we're trying to do is to encourage, certainly, our
societies to develop some creative ways around recruiting and
promoting foster care within their own communities. We have
several best practice models that we are now looking at from
different agencies across the province which have been very
successful in recruiting and retaining foster parents.
I think also part of our
funding framework addresses incentive and increases payment to
foster parents. We think that will also assist us in the
recruitment of foster parents.
The Chair:
Thank you. We'll get back to you later, Mr Cleary. Over the 10
minutes.
Ms Shelley Martel
(Nickel Belt): Thank you, deputy and staff for coming
today.
In your comments with
respect to the intervention program, you spoke of the work you
were doing to try and respond to the auditor's recommendations
and you focused particularly on trying to develop instruments to
deal with client and services outcomes. You referred both to the
child intake instrument and the assessment instrument. Could you
give the committee some fuller, clearer ideas of what those two
instruments will do in order for you to be able measure
outcomes?
Mr
Costante: I would like to ask Duff Sprague, one of our
staff who has really been involved in this and is very
knowledgeable, to perhaps come forward and talk about that
more.
Mr Duff
Sprague: I welcome the opportunity to speak to these two
instruments, and it actually answers the question that was asked earlier. These two
instruments stem from about a year and a half to two years' worth
of work that involved two projects that eventually came together.
Both of them involved the Ministry of Health, WPPIS, and they
also involved stakeholders. Those stakeholders were eight
provincial associations. The one project looked at standardadized
instruments that were used in other jurisdictions and in Ontario.
It was an independent academic researcher making recommendations
to this committee as to which would be most suitable for
implementation across the children's mental health sector.
I think the research
project that was being referred to earlier, and we were unable to
answer, has to do with the eight provincial associations, the
Ministry of Health and us looking at our information collection
systems to see what is the information between the two ministries
we collect and whether it is sufficient to promote good funding
and policy practices. Those concluded in February and March,
respectively, and out of that came our working towards the
selection of two standardized instruments for implementation
across the sector.
I can't emphasize enough
how unprecedented this is and how much information we'll be able
to have that is unavailable to other provinces and how it will
position us to improve children's mental health services for
service providers and for certainly the children and families
that use them.
The first instrument is
called the standardized client information system. It was
developed several years ago by the Hamilton Health Sciences
Centre, Children's Mental Health Ontario and the Centre for the
Study of Children at Risk. It was a very large instrument that
involved three questionnaires that were filled out. These were
clinically based and reflected back to the Ontario mental health
norms established by the Ontario Child Health Study in 1989.
The instrument involved
three questionnaires, one filled out by parents, one by the
teacher and one by the youth/adolescent themselves. That
instrument has evolved over the years it has been used and it is
now in a very exciting software format. It's called the modified
modular branching standardized client information system. This is
what we are putting in as a standardized intake instrument across
the sector. It involves an intake worker on software, taking what
the primary problem is that the family calls about, entering that
information, and they go along, the software cues them to areas
that research has shown might also be worth pursuing with regard
to this child and family.
It also will have within it
fields of data that we will be able to collect on a provincial
level, so for the first time we'll have some sense of the
severity of disorder of children and families seeking
services.
1130
That sort of feeds into the
next piece, which is the assessment instrument. I'll make the
distinction. One is an information intake instrument. It has some
clinical values, indicators which let us know what service might
be best for this family, certainly, what type of disorder, and
the level of severity. The nice thing about this is that intake
stands, so when this child and family has called agency A, even
if they're not the most appropriate service provider, this intake
information can transfer with them to agency B-they don't have to
start the process from square one-anywhere in the province,
regardless of where they move.
The second instrument is a
clinically valid assessment instrument that was developed in
Michigan and is used throughout the United States. What it does
is, it measures a child's functioning on five scales and the
caregiver's functioning on two scales. Through periodic
reassessments, outcomes through the use of that instrument can be
measured. There are many states in the US where children's mental
health funding is totally tied to the use of this instrument. It
was brought here by the Hospital for Sick Children. It's being
used with a great deal of enthusiasm and success by about 10 of
our MCSS-funded agencies.
We're poised now to have
these implemented across our children's mental health sector. The
fields of data will give us a measure of outcomes and which
service interventions are providing the best outcomes for which
disorder. It will just be a wealth of information that we can
build our future policy and funding practices from.
Ms Martel:
I appreciate the information. I apologize. It's not clear to me
how that is dealing with the auditor's primary concerns, which I
took to be that there is no way to measure need or no way to
determine if the appropriate levels of funding are going to
agencies. I'm not diminishing the value of the information you're
going to receive, but it's also not clear how those two
instruments deal with much of what he talked about, which is a
fiscal concern and how money was flowing. Was it appropriate? Was
it coming back if it was not needed?
Mr
Sprague: These two instruments address the auditor's
concern about the program accountability and the service
accountability and outcomes and are they being effective? The way
it relates to cost is that we'll know who's coming into every
service door, what level of severity, we know the funding at a
cost per child for each of those agencies, we know the service
types that will be applied to remedy the child's situation and
we'll know the outcome in the future as to whether it has been
effective or not. In that way, we can look at cost and
effectiveness of service for specific types and levels of
disorder, so we'll know what the money is doing and who it's
doing it for.
Ms Martel:
OK.
The Chair:
Anything else, Ms Martel?
Ms Martel:
I do. Do I still have time?
The Chair:
Yes, you have two minutes.
Ms Martel:
Can I ask the auditor something? I'm assuming you caught most of
this. Does that respond to the concerns that you've outlined?
Because you were certainly critical in your review this year of
limited response, as you put it, with respect to what had gone on
from 1997 to now with
respect to your recommendations?
Mr Erik
Peters: Yes, I think this goes a long way.
Ms Martel:
Your concern would only have been then that most of this, as you
said earlier, was not out the door, that it's in a developmental
stage or the pilots will start in the year 2000 in 20 sites? Is
that correct?
Mr
Costante: Yes.
Ms Martel:
Can I ask about the broader transfer payment agencies? You
referred to your government and accountability framework. I'm
wondering if you could explain to me what the difference would be
for an agency now that delivers children's services or family
intervention services and what you foresee the difference would
be in terms of their financial reporting, performance reporting
etc once you have that framework fully implemented. I know you
said it would take a couple of years, but can you give the
committee an idea of what would be required now, generally, by a
transfer payment agency and what would be the changes required
under the framework?
Mr
Costante: Let me start with the framework and then I'll
move back. I think what the framework would do is clearly
establish what their roles are, clearly establish performance
measures, clearly establish how we are going to monitor and
follow up on what they did, clearly establish the accountability
mechanisms through a service contract that's put in place in a
timely manner and clearly establish that we will monitor and
follow up and take corrective action. I think those are the
basics of it.
What we have now is, we
have elements of those in place and we have gaps in some of these
elements. I don't think we're really clear in some cases about
expectations. We're in the process, then, of getting performance
measures in place for each program. Some of those didn't exist in
the past. We've been developing those in the last couple of
years. Through the business planning process, we've been putting
performance measures in place, so I think there will be further
development of that.
In many of our areas,
particularly as we've gone through reform, we have tried to
clarify roles and responsibilities. We've done that in child
welfare. We recently sent out a manual to municipalities on child
care which spells out roles and responsibilities. We've done that
with our Ontario Works and our Ontario disability support
program.
In terms of monitoring and
follow-up, I think we want to clearly establish that it's going
to be done, set some standards as to frequency and make sure that
we document our follow-up. Often criticism comes that perhaps we
monitor but we don't write down what we've found, and then we
don't write down what action the agency has taken. That's been
some of the auditor's criticism.
We need to clearly
establish where we need licensing and where we don't need
licensing.
Really, it's putting in
place a more systematic and comprehensive framework. You don't
have to do the same thing or be as intensive in every sector, but
the common elements need to be there and they all need to be
there. The transfer payment agencies need to know what their
responsibilities are and our workers need to know what they're to
do and when.
I'll give you a current
example of one of the things we're doing. Previously, we used to
wait until the budget was done before we would send out our
budget packages to transfer payment agencies, which meant they
were doing their budgets in the spring and they would then get
negotiated in the summer and into the fall. That meant, for many
of them, they were halfway through their fiscal year. Some of
them had a calendar year. They were almost fully through their
fiscal year before they had their approved budget. This year we
intend to send out our budget packages in January so that we can
get the budgets largely done and in place by the end June. That's
our intention.
We are looking at this more
systematically and trying to have common elements in place in all
the sectors, not just hit and miss. I hope that explains it.
The Chair:
Thank you very much. That finishes that time. We'll now go back
to the government side. I've got about 10 minutes left for the
government side and eight minutes for each one of the opposition
sides in order to balance the time and to allow the ministry to
respond to the questions and then a little overtime.
Mr John Hastings
(Etobicoke North): I'd like to deal with the issue of
accountability within the terms of coordination for mental health
services, not just by the Ministry of Community and Social
Services but with education and training and health. I think
you're making some good progress with respect to the tools for
helping these kids. What I find is a concerning situation is
what's happening at the front-line with service providers from
either the agencies, the municipalities, these three ministries.
What I'd like to know, sir, is to what extent we can get better
coordination for providing service to families who have kids with
problems, whether they start in the schools or in the homes.
What I find right now,
having been directly involved with a few of these situations, is
that the parents who are looking after these young folks-some of
them are not over school age-can't get the services or can't get
the coordination in place to even get people meeting. I'd like to
see whether you could work with your fellow deputies in the other
ministries and some of the players down at the municipal level,
where this is going, so for the parents who are trying to get
problems solved-some respite care, whatever it happens to be-we
can have the barriers removed, if there are any, of a specific
instructional or procedural nature. I found that in MET
particularly. Can you get the players together and get a case
situation moving? Is there some way you can look into that? It's
not a matter of money so much as being somewhat creative in the
coordination of providing these services and getting the
front-line players, whatever the issue is. Sometimes there are
many issues involving these disadvantaged kids or younger
adults.
1140
Mr
Costante: I definitely think there's a lot more that can
be done. We have taken some steps. Let me tell you what we have
done. In terms of our front-line offices, we and the Ministry of
Health have recently made our boundaries co-synchronous. Over the
next few years, as opportunities present themselves for leases,
we're going to be moving our regional offices of the Ministry of
Health and the Ministry of Community and Social Services together
so our workers can work-the person is not at a different building
or whatever. There are no excuses; we can work together and look
at some greater coordination on the ground.
The second thing we've done
with the Ministry of Health and the Ministry of Education is set
up a joint project called the office for integrated services for
children, with an ADM who reports to the three deputies. The
deputies meet on a regular occasion, I believe it's monthly, to
look at issues of coordination. We've had some successes through
that office in terms of coordinating initiatives. The Healthy
Babies, Healthy Children program is one where the ministries
worked quite well together to implement that and get it out. We
weren't tripping over one another or leaving people with
gaps.
I think that mechanism can
be used much more broadly. We need more of those mechanisms,
particularly in the area of developmental services. We are coming
from a situation where-sad to say, but it happened-even within
our own programs within our own ministry there was not a lot of
coordination. The Making Services Work for People initiative was
meant to bring that coordination even between things like child
welfare and children's mental health, which are both funded
through the same ministry. We've been making those efforts and
trying to bring the community together. Often, where this
coordination works the best and most effectively is not at the
ministry level; it is actually out there with all the community
agencies around the table dealing with the issues of a particular
child in a particular family.
I think you're right; we
have to show leadership in that. If they see all of us working at
cross-purposes, the community doesn't come together well either.
I agree, there's more that can be done. I don't know if I'm
answering your question.
Mr
Hastings: Can you supply us with the assistant deputy
who is the coordinating arch for that effort, afterwards?
Mr
Costante: The name?
Mr
Hastings: Yes.
Mr
Costante: The individual's name is Jane Bartram. She's
an acting assistant deputy minister.
Mr
Hastings: In your ministry?
Mr
Costante: She has a joint reporting.
Mr Bart Maves
(Niagara Falls): Just two things, quickly. In Making
Services Work for People I concur with Mr Hastings. I think what
we need to do ultimately is have a single point of access for
someone from zero to 21 who has a need in this area. They have a
doctor refer the parent to somebody, and then when they get to
school the school refers them to somebody, and they too often
miss the appropriate service. I think we really need to get to a
single point of access. Most people could then be directed to the
appropriate service.
When you were talking to Mr
Patten about funding pressures, you talked about child welfare
services. The budget for child welfare services has gone up
dramatically, though, hasn't it, in the last three years? Is it
not up $191 million and now it's over $500 million or something
to that extent?
Mr
Costante: I don't have the numbers with me but it has
gone up. There has been a substantial investment in child
welfare. The budget commitment from two years ago was a
$170-million increase. And you're right, it is over $500 million
this year-about $545 million this year.
Mr Maves:
OK. Thank you.
Ms
Mushinski: Could you just tell me what the ministry is
doing to ensure that workfare is fully implemented by the
municipalities?
Mr
Costante: The Ministry is doing several things. The
minister announced several weeks ago a new package of initiatives
to encourage the creation of more community placements. I believe
it was on November 22 that our minister, John Baird, announced a
package of initiatives on Ontario Works. Part of the package was
an incentive plan that would bonus municipalities for achieving
their Ontario Works targets that would provide I believe a $1,000
bonus for every placement exceeding the target.
Second, there was a
$10-million fund available for innovative proposals that would
create more community placements.
Third, within the ministry
we are setting up a community placement secretariat to be out
there encouraging and working with municipalities to create more
placements.
We're also looking at some
additional marketing that would go particularly to agencies to
create these placements.
The other thing we're doing
is looking at additional placements within the Ontario public
service and within my own ministry, to lead by example and have
that done.
As well, our funding
formula is set up to pay municipalities for achievement so they
get paid on a per unit cost type of approach, and we have staff
in all of our regional offices whose job is to monitor
municipalities. We are also trying to improve our data collection
in this area and get more information in. That's kind of the
general package of things that are going on.
The Chair:
OK. Is that it? One more?
Mrs Munro:
Yes. At the very end of the auditor's report, which deals with
the issue of professional services, I just wanted to know if
you'd care to comment. The question was raised about the ministry
establishing guidelines, and I just wondered if this has been
done.
Mr
Costante: The ministry will be establishing guidelines
early in the new year and it will be along the lines of what the Ministry of Health
and Long Term Care uses. We'll likely be adopting that
guideline.
Mr Cleary:
Getting back to the foster care, you mentioned earlier that you
had new ideas of how to get more parents involved. We got cut off
at the last round. I'd just like to ask the question again.
Mr
Costante: I'm sorry, I'm not sure that we have more. The
lead for the work is primarily with the children's aid societies
themselves. We are trying to work with them, provide them
money.
One thing I didn't mention
which I should have mentioned is, part of the new funding
framework for child welfare also increases the per diem paid to
foster parents, which we hope will encourage more foster parents
to come in. We think that will be a big selling point as well. I
think it had been about the same rate for many years prior to
that.
1150
Mr Cleary:
OK. Another question I have is, what age is the cut-off? Is it 16
or 18 for young people in foster homes?
Mr
Costante: The age is 16.
Mr Cleary:
Did you ever consider increasing that age? In my community we've
had some bad incidents happen lately, especially with teenage
girls who had left their foster parents.
Mr
Costante: I know it's not under current consideration,
and I'm sorry but I can't give you very much in terms of whether
it's been under consideration. Some of the elements you would
need to look at: It would require a legislative change, I
believe. It's potentially quite costly. Also, I think you'd have
to look quite carefully at whether children aged 17 and 18 in a
foster parent situation can work in terms of the willingness of
somebody at that age to want that type of arrangement. They tend
to have amind of their own.
Mr Cleary:
Another question I have is about the employment support program.
I would like more information on that.
Mr
Costante: Is this the one in the Ontario disability
support program?
Mr Cleary:
Yes.
Mr
Costante: The budget for that program is about $35
million. The program is actually run by coordinators within each
of our regional offices. Individuals who are interested in
seeking employment, if they need some sort of technical aid, can
work through the program to get those aids to help them get the
work. If they need a job coach or some particular training around
that-I'm sorry, I don't have the guidelines with me-there's a
whole series of eligible expenditures. We've tried to keep the
program and the assistance quite flexible, because needs can be
quite different depending on each individual. If you would like,
I can arrange that a package explaining the program in more
detail than I'm able to do here today is available to you, Mr
Cleary.
Mr Cleary:
I'd appreciate that. Is this something new that's coming out?
Mr
Costante: This would have started in June 1998, so it's
about a year old.
Mr Cleary:
You mentioned violence against women, and I guess we have those
facilities for women in every community. Is that additional
funding or is that just-
Mr
Costante: That's core funding within our ministry. I
believe we fund approximately 90 women's shelters across the
province, and I believe our budget is about $70 million. I should
check that last number.
Mr Cleary:
The other thing I would like to ask is, is the ministry involved
in the community living group homes, or is that mostly the
Solicitor General?
Mr
Costante: The community living group homes are funded
through this ministry. They're generally done by developmental
services agencies. Many of them are associations for community
living-that's their title. They are for adults and children with
developmental- There are also other group homes. Correctional
Services and our own ministry have open custody facilities for
young offenders. We have group homes or children's homes in the
area of mental health. So there can be a wide variety of
residential settings.
Mr Cleary:
In my community there's a great shortfall of funding. They're
always out in the community trying to raise funds for different
types of group homes. Is there any additional funding for them or
any changes that are going to be made?
Mr
Costante: Last year, in April I believe, the government
announced $35 million, which I talked about briefly. Ten million
of that went to the special services at home program. The other
$25 million went into services in the community, which would
include group homes. One area we were trying to target
particularly was aging parents who may be in their 70s and 80s
with a son or daughter at home. They can no longer look after
their son or daughter, and they need some sort of residential
placement. So the $25 million was in that sector, and some of it
would have gone into group homes.
The Chair:
We'll have to leave it at that. You didn't finish on the per diem
for foster parents. How much is that raised?
Mr
Costante: I don't have that at my fingertips. We'll
provide that to the clerk as well, if that's OK.
The Chair:
OK.
Ms Martel:
I want to return to your governance and accountability framework
for this reason: Can you give us some idea of how much of the
change will be the responsibility of the ministry and how much of
the change involved would be the responsibility of the transfer
payment agencies?
I ask the question because
if you look at your transfer payment agencies, you would know
better than I the variation among them. Some are quite large,
quite capable boards with long-standing histories, aware of
auditing practices etc. You would have a number of others brought
together to respond to a need, have a volunteer board, probably
very little training and are just there to do some good work. My
concern has to do with what burden will be placed particularly on
the smaller ones to respond. There are some reasons that they have
to respond, but what is going to be their capability to
respond?
Mr
Costante: I would answer that in a couple of ways. One,
I think a large part of this burden will actually fall on the
ministry. What we want to do, and one of the areas that we as a
ministry historically have not been good at, is have technology
in our agencies so they can do this effectively. We've
traditionally done reporting on a quarterly basis, all manually,
and the follow-up has been somewhat spotty. We think we can
provide them with much more automated tools, and we have in areas
like child care and child welfare. We now have computers in all
the agencies as well as municipalities-through Ontario Works
something like 8,000 computers have gone out.
I guess the added burden
would be that we will expect the data to be in on time. We'll
expect that the reports we have are completed, and there will be
an increased onus on us to follow up when it's not there. But a
lot of those expectations are there now. In terms of volunteer
boards, I think many of them will actually welcome our providing
more guidance as to their roles and responsibilities. Many of
them are already out seeking courses on their own. Places like
the YMCA already offer courses on board governance, and we think
we can supplement that and make it a much more fulsome package. I
guess the long and short is that we don't think it's going to be
a large additional burden.
Ms Martel:
You talked about the training you are providing for child
welfare. Can you give me an idea of what that is and whether that
type of training and costs, which I assume are being covered by
Comsoc, could be applied to any number of other agencies that
will have to meet additional responsibilities under the
framework?
Mr
Costante: I'm going to ask Cynthia to talk about the
child welfare training.
Ms Lees:
We have just spent the last year developing a training manual for
the boards. The training manual is now in the field with the
boards. We're asking the boards to give us their feedback by
January 14. So far the feedback we've received is extremely
positive. The manual is very inclusive. It clearly describes the
roles of the boards, the ministry and the executive director, and
talks about governance, accountability and reporting. Once we
have received the information from the boards, our hope is that
the manual will become part of the training package and the
ministry will be providing the training with the boards. It is
also our hope that the manual is comprehensive and generic enough
that eventually it can be applied to our other boards. That's
where we are with the manual.
Ms Martel:
May I ask a question about the computers? You referenced
computers that were going into a large number of agencies. Was
that a Comsoc cost?
Mr
Costante: Yes, it was. Often an agency would be in a
situation of having to intake a child who had previously been
dealt with by another children's aid society and wouldn't have
that information. The agency would often have to phone, and if it
was after hours they couldn't get anybody. This fast-track system
was meant to provide information on whether a family or child had
been served previously and the nature of that service. I think it
provides invaluable background information to somebody, perhaps
on a weekend or at night, which is often when these cases come
into care, information they need to do a good assessment and help
the family and the child.
Ms Martel:
Would it be your assumption that as you develop the framework and
involve more agencies, the ministry will continue to pick up the
cost of software or the technologies that some of these services
are going to need to comply?
Mr
Costante:We don't pick up the cost of their paper or
that sort of stuff, but in this case I think we picked up the
full cost of the hardware, software, installation and training.
So we did a pretty full service. Our government policy on
hardware now is to rent, and I believe most of these computers
are on a three-year lease.
The Chair:
Thank you very much for coming this morning and dealing with this
matter.
Mr
Costante: Thank you. We'll get the information that we
promised to the clerk.
1998 ANNUAL REPORT
The Chair:
The bell is ringing for a vote in the House right now. There is
still the outstanding item with respect to the 1998 annual
report. Did you want to leave that for the next meeting?
Ms
Mushinski: Sure.
Ms Martel:
No. It's one line. Can't we do it now?
The Chair:
Yes, we can.
Ms
Mushinski: As long as you've got all-party
agreement.
Mr Maves:
We have no problem with it.
The Chair:
Can we have a motion, then, to-
Ms Martel:
I move that the 1998 annual report of the standing committee on
public accounts be adopted, as amended, that the report be
translated and printed, and that the Chair be instructed to
present the report to the House.
The Chair:
Seconded by Mr Cleary. All in favour? Carried. Now we're
adjourned until next week.
