Assemblée législative de l'Ontario

CHILDREN AT RISK

ONTARIO ASSOCIATION OF CHILDREN'S AID SOCIETIES

YOUTH IN CARE CONNECTIONS ACROSS ONTARIO

SUSAN BRADLEY
KAREN TATARYN
LORRAINE ADAM
ELLEN ROSEN

CONTENTS

Tuesday 31 May 1994

Children at risk

Ontario Association of Children's Aid Societies

Mary McConville, executive director

Bill Charron, executive director, Niagara Family and Children's Services

Roy Walsh, executive director, Brant Children's Aid Society

Jerry Muldoon, executive director, Renfrew Family and Children's Services

Bruce Rivers, executive director, Children's Aid Society of Metropolitan Toronto

Youth in Care Connections Across Ontario

T.J. Whitley, youth liaison worker

Kim Way, youth program worker

Susan Bradley; Karen Tataryn; Lorraine Adam; Ellen Rosen

STANDING COMMITTEE ON SOCIAL DEVELOPMENT

*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

Clerk / Greffier: Arnott, Doug

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

The committee met at 1533 in room 151.

CHILDREN AT RISK

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. We are meeting again pursuant to standing order 125 regarding a designated matter, children at risk.

ONTARIO ASSOCIATION OF CHILDREN'S AID SOCIETIES

The Chair: Today we have three groups of witnesses. I invite first of all the children's aid societies, those who will be attending with that deputation. I might ask Mary McConville, the executive director of the Ontario Association of Children's Aid Societies, to introduce her colleagues.

We thank you very much for agreeing to come together. We have done this with several groups. As you may appreciate, we have 12 hours under standing order 125, which makes grouping a little more critical, and later this afternoon we have three children's hospitals appearing together as well.

Welcome to the committee. Mary, we're in your hands. We will have a full hour. You lead us where you will.

Ms Mary McConville: The Ontario Association of Children's Aid Societies welcomes the opportunity to appear before you today. I'm the director of the Ontario Association of Children's Aid Societies. I'd like to introduce my colleagues, who will follow me with some remarks.

With me are Bill Charron, executive director of the Niagara Family and Children's Services; Mr Roy Walsh, executive director of the Brant Children's Aid Society; Mr Jerry Muldoon, executive director of the Renfrew Family and Children's Services; and Mr Bruce Rivers, executive director of the Children's Aid Society of Metropolitan Toronto.

Just to make it easy for you, if you'd like to follow along with what we're doing here, on the right side of your package is each of the presentations that are being made today. On the left side is reference material you might want to use at some other point in time.

We would like to begin by congratulating the committee on its timely decision to consider the subject of children at risk. Our social climate is changing rapidly, as reflected in the dramatic changes in family structure and lifestyle. The economic climate can only be viewed as more hostile towards young families raising children.

We face two enormous challenges with respect to our future. The first is the need to support the healthy development of all children through effective public policy, a "first call" on society's resources and a shared responsibility for their welfare. Secondly, we must ensure that children with special needs and those at risk receive effective and timely intervention to support their individual needs and to reduce the risk of maltreatment. All these children must have equal access to support services that encourage healthy adjustment to their communities.

The committee has had the opportunity to hear from many others about broad strategies to support the healthy development of children. We wish to speak to you today about the particular role of child welfare in our local communities.

The mandate of children's aid societies is expressed in section 15 of the CFSA. A full description of the mandate is in your package, but to summarize, the function of a children's aid society is to investigate allegations of child maltreatment; to protect, where necessary, children who are under 16 years; to provide guidance, counselling and other services to families to protect children; to provide services for the prevention of circumstances requiring the protection of children; to provide care for children admitted to care under the CFSA; and to provide adoption services.

Child welfare is not simply about investigation of allegations of child abuse and neglect and taking children into care. It is about the early identification of risk and the amelioration, to the greatest extent possible, of the conditions which lead to child maltreatment. It is also about galvanizing communities and a whole range of other support services to strengthen troubled families and to assist in the protection of children where required. We passionately believe that child welfare's prevention role must be supported and funded accordingly.

Children's aid societies have been in existence in Ontario for more than 100 years. Over the past century, we have developed an expertise in dealing with abused, neglected and abandoned children. At the same time, we have learned about the causes of maltreatment of children and have developed an understanding of prevention strategies to assist families in crisis.

Some of the social conditions frequently found in families on protection case loads are poverty, social isolation, inadequate housing and high-risk neighbourhoods, a family history of abuse and addiction to alcohol and drugs, to name a few. It is the compounded effect of such conditions that creates the highest risk for children.

We have also learned a great deal about the nature of services that support an early identification of problems that reduce unnecessary admissions to care and shorten lengths of stay for temporary placements. We have learned about the needs of children in care, the traumatic effects of separation and the necessity to provide support for the developmental needs of these children through the significant transitional periods of their lives. We have, last but not least, learned that the parenting role does not cease on a child's 18th birthday.

For some 4,500 children who are crown wards of the province, we have a special responsibility that should be viewed in the context of this complex and changing society. These young people also require the support and care of their communities and of the state as a whole, not just the Ministry of Community and Social Services.

Child welfare services are not uniform across the province. This is the result of funding inequities and a lack of common understanding of the role of child welfare. But we have been highly successful in developing new approaches to our work, some of which my colleagues will share with you today.

Our vision of the child welfare services of the future would include a spectrum of support services to enable families; closer service links with mainstream service delivery systems through innovative programming; community-based service delivery directed at targeted high-risk populations; mandatory use of alternative dispute mechanisms; access to protection services for children up to 18 years; and a more integrated approach to delivery of specialized services.

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Some obstacles to effective child welfare intervention, which we won't dwell on but would like to mention, are judicial interpretation of the least-intrusive principle; lack of universal access to alternative court measures such as mediation; the unproclaimed sections of the Child and Family Services Act -- for example, the section on confidentiality and records, the use of intrusive procedures and the use of psychotropic drugs; the absence of a legislative link between family violence and the harm of children; and the lack of protection and intervention for 16- to 18-year-olds. There are other obstacles, including the inadequate funding policy, which we've spoken to on other occasions.

The context within which child welfare functions is extremely important. We support the adoption of a population-based approach to the healthy development of children as proposed by the Children and Youth Project Steering Committee of the Premier's Council on Health, Well-being and Social Justice; that is, the Yours, Mine and Ours document.

Following the presentations by my colleagues who will provide you a unique window on prevention programs in child welfare intervention, I will refer to our recommendations.

Mr Bill Charron: I welcome this opportunity to share with you our thoughts concerning the important issue of protection of children and children at risk.

Niagara Family and Children's Services has a vision that every child will be in a caring family. The program I am going to outline for you captures the spirit and intent of our vision and, in doing so, provides the community with an excellent opportunity to ameliorate the conditions that lead to the need for protection.

The program that I'm going to profile is called the day nursery parent enrichment program. It's been operating in the Niagara region since 1980. Currently, the program is being provided in six locations in the region, serving well over 300 children and families per year. It's funded by the Ministry of Community and Social Services under the Day Nurseries Act.

This program began as a community response to a concern identified by our regional health unit nurses who were concerned that a number of young, single parents were struggling to raise their children without adequate income, support or resources. It was felt, and their view was shared by our local children's services committee, which is our coordinating body, and ourselves, that these children and these families were particularly vulnerable to health, behavioural and parenting problems. They were at risk.

Our agency was asked to operate the program. You may ask, what is a children's aid society or a child welfare agency doing in the day care business? It's our belief that child welfare must work to prevent the need for future involvement and, more importantly, to prevent the need to protect children from harm and potential risk from harm, either physical or emotional. The feelings of the task force on child care were particularly relevant to our decision to move ahead. They said, "A system of child care aimed at providing quality care to all children would be the primary prevention mechanism to provide early detection and treatment."

It goes on to say, "Good child care could also provide parental training and support for families at risk while providing positive role models for their children." This is certainly something that we emphasize in our program, as you'll see.

The funding provided to child welfare agencies does not generally support preventive initiatives. Thus, we saw an opportunity, through child care funding, to demonstrate what could be accomplished.

The program that we developed is unique. It has three components. The first is that we provide affordable preschool education for children from disadvantaged families in high-risk neighbourhoods. We were able, through the help of our community partners, to isolate those neighbourhoods and indicate clearly that these were the areas that were most in need in our region.

The second is that we make the program accessible by providing transportation for children and families to and from the school setting. We have removed a major barrier that prevents families from accessing good child care.

The third and, I think, the key component is that we provide through extra staff an opportunity for parents to improve their parenting and child-rearing skills through weekly group meetings and individual support. We also emphasize enhancing motivation of parents and supporting directions needed to improve their personal lives. There is something for the parents. Use of this, and linkage to community partners, is an essential part of this component.

The benefits to the child in this type of setting are enormous. These children now have an opportunity to take part in quality preschool education designed to ensure normal growth and development, as well as to build social skills and self-esteem. The program also identifies and addresses deficiencies with the goal of helping these children be at par with others entering school. For example, developmental delays and speech problems are assessed, community intervention planned and services provided. These normally, if they were outside of our parent enrichment program, would not be picked up, in many instances, until the child attended kindergarten or grade 1.

The Children and Youth Project Steering Committee's report Yours, Mine and Ours tells us that in the transition years leading up to entry into the formal school system in grade 1, it is imperative that early childhood education be available in order to "give children the healthy start they need and produce children who are socially and academically prepared when they get to grade 1." It is our experience that the chances of social success, and ultimately employment and social responsibility, are greatly improved. As well, the children benefit from improved parenting skills developed by their parents in the program and a more positive home and family situation.

The parents, through the weekly group meetings that we provide, learn life skills; they also have parent training; information is provided regarding community resources, and there is group and individual support. The result for many is improved self-confidence, better self-esteem, better parenting, enhanced coping skills, a supportive network and knowledge of available community resources that they can access, that they don't have to do through an agency. Many of these moms have found the strength to escape abusive situations and have become more effective parents and also have entered either retraining or educational programs. We've included in your package a number of comments from the moms regarding their experience in the program.

The response to the program in the Niagara community has been overwhelmingly positive and is demonstrated by the commitment of our partners. We, as a child welfare agency, manage the program and direct the program. Education provides classroom space and special service support. Public health nurses provide education, individual support and in-school health services, and there are many other partners I have not listed here, depending upon the individual school. Public health nurses, educators, family physicians, child protection, social workers and courts depend on the program as a preventive support measure.

Our agency's experience and the research we've done suggest that the program works. Assessment data demonstrate significant positive changes in the children. Admission to care from this risk group is limited and child wellbeing data suggest significant reduction of risk factors.

The research in the field of preschool programs for disadvantaged children suggests that programs of this nature are an excellent investment for the taxpayers, returning $6 for every $1 invested in a one-year program. We've provided a summary of those research findings for you.

The care and safety of Ontario's children is not only the responsibility of the children's aid society; it is the responsibility of the community. Programs such as the one described, we believe, demonstrate how a community response can work, preventing the circumstances leading to child maltreatment.

Early intervention promoting health and wellbeing of children at risk is a necessary component of child welfare. Child welfare agencies view this type of program as an investment, an investment in the future. Thank you.

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Mr Roy Walsh: "My experience during the three years since the formation of the society is that constant care and watchfulness is necessary in order to successfully do the work at which it aims." These are words from the founding executive director of the children's aid society in his annual report to the society in 1897. It's in this tradition of constant care and watchfulness that on behalf of the society we express our views to you today.

In support of the assumptions in the Yours, Mine and Ours document, our society in 1991 opened up a unique child welfare resource in the province of Ontario. Our family resource centre is staffed by early childhood educators and social workers along with the active participation of community professionals. It provides a wide variety of family support services which are designed to promote and enhance family living and to foster independence and health among the at-risk participant member families and youth.

In 1993 our annual report celebrated our community partnerships with 12 different partner agencies participating in more than 30 group programs per week, offering services to 250 families with a child membership of over 600.

Family support programs are designed to assist families to cope successfully with the obstacles in their lives that place their children at risk. The provision of this help is family support. Does it work? Yes. In cooperation with Brant, London and Waterloo children's aid societies, the centre for social welfare studies at Wilfrid Laurier University conducted a three-year outcomes research project on mutual aid organizations in child welfare.

Their findings: The participants had one half to one third less children come into care than did the comparison group. When children came into care from the participant families, their length of stay tended to be four to eight weeks shorter than the comparison group. Participants in a mutual aid group showed significantly less involvement with formal services than did the comparison group. In a number of other factors including social isolation, coping skills, self-esteem, family violence, personal health, the mutual aid participants scored significantly higher than did the comparison group after a three-year intervention.

The cost-effectiveness of this kind of intervention was as follows. If 40 families were served over a year in a mutual aid group, the result in annual savings by reducing children coming into care would range anywhere from $16,000 to $34,000. This would represent the saving necessary to provide a measure of professional support to the program.

Permit me now, if you wish, to borrow a few of the voices from the women who were involved:

"I'm a different person than I was six months ago, and I'm a different person than I was a year ago. I'm a lot stronger, healthier, and I can handle...problems...they are not the end of the world like it would have been a year ago."

"I'm bonding more. I told the children that...which I'm not fully bonded yet to those two...but the bonding didn't start until I actually came to the parent mutual aid organization."

"Just having someone to talk to when I need them...if I need to talk I know I can talk to someone."

"What can I do? I don't know anything. I'm dumb. I'm stupid. I have no skills, no abilities, no nothing. I just take care of my kid. I cook and I clean house. Well there's now many skills and abilities right there.... Being involved" with this group, "being on committees, doing things for the group, it's like `Hey, we can do something.'"

"If someone is going to a lawyer for the first time and they are scared...one of the members will go with them...going to court with each other, supporting each other, providing child care support, monetary support, housing support, even providing food to each other, having someone to talk to at 2 o'clock in the morning when you can't sleep."

"And the kids have been changing a lot. They feel more responsible...they're not fighting like" they used to be, "they are not as scared, they are talking. And the parents feel more confident and secure, and they know really what they are doing with their children."

These results have been most encouraging, and building upon this evaluation from the university we've utilized this model now with the local family violence women's shelter and we've also developed this model in three high-risk neighbourhoods in the city of Brantford. This has been managed all the while the Ministry of Community and Social Services has been placing increasing pressure on the whole field to restrict ourselves to the investigation and monitoring of families of children at risk.

We've funded this program at the local level, primarily through the Day Nurseries Act and through the local area office, accepting the fact that this was a viable child welfare alternative, but funding policy tends to restrict us to our monitoring, investigating capacity.

The causes of child maltreatment spring from isolation, poverty, inadequate housing, health and education and pathology. It's only in providing a range of services that we can reasonably carry out the mandate vested with us over 100 years ago.

Additionally, I would like to focus the little time I have left to bring to your attention a number of issues that bear a legislative response. These will be spoken of specifically by Ms McConville in her recommendations.

The child-serving and health care professionals, as well as the general public, have for a number of years been well aware of the impact and the effects of family violence upon children, yet the Child and Family Services Act does not find that a child exposed to family violence is a child at risk and in need of protection. Social workers' hands are tied unless the child is physically injured or abandoned. We feel very strongly that a child who is subjected to a history of family violence is a child in need of protective services and that the CFSA should be so amended, with reference to the emotional harm provisions of section 37(2)(f).

Furthermore, I'd like to address a number of legislative changes that you may refer to at length, which are appended. We believe that 10 years after the introduction of the Child and Family Services Act we're not very much closer to defining a child's best interests than we were 20 years ago. We submit that the courts currently have no special ability to fairly determine what the best interests of a child are, because the act relates primarily to the provision of rights of procedure rather than to the right of substance as those relating to the necessities of life.

Furthermore, the civil court system is slow, it's expensive and it's emotionally painful for the parties involved. In short, an adversarial courtroom is probably the least desirable forum to determine a child's best interests. It's time to learn from other jurisdictions like Great Britain, the Netherlands and New Zealand, which utilize lay tribunals and family mediation as a more appropriate, effective and inexpensive form to address the best interests of children at risk.

Mr Jerry Muldoon: Mr Chairman, members of the committee, I work as the director of Family and Children's Services in the county of Renfrew in the city of Pembroke. I am very pleased to be here. I suppose to some extent I can represent the great northeast.

I have very few minutes and with those few minutes I would like to speak to issues and concerns with the service structure in the province, and more specifically about the concept of service integration. The reference for your attention is the burgundy one.

All of the members of the committee I'm sure are familiar with references to the social service system as fragmented, disjointed, poorly understood, turf driven and impeded by multiple barriers to good service. These negative references are in many instances accurate portrayals of a service system which is, however, highly committed, in my opinion, to children and to families and I believe capable of the kind of major transformation which some of us believe is essential for this system in the immediate and short-term future.

References to transformation of the service structure mean that systematic, accessible and effective services must be seen by users and the general public as the routine expectation. Multiple agencies, multiple systems and multiple mandates have served to divide the client into many pieces to the point where the service system is as complex as the major problems it is intended to broker and to resolve.

During the past five years in the county of Renfrew we've managed, I believe, to successfully integrate the non-teaching services of boards of education and the child welfare functions of a children's aid society, and I use this particular model to demonstrate what I mean by service integration. By integration, we quite frankly mean more than coordination, we mean more than collaboration and more than rationalization, those words that we hear a great deal about. By integration, in this particular model and in others that I'll describe, we refer to a mixing of the mandate and function, to restructuring the existing service model and to blending in a businesslike partnership the delivery of a service. I'd like to demonstrate that.

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In this blended or integrated model, the mandate of a child welfare agency is combined with the mandate of an educational authority, like a board of education, and the resulting social service is delivered from full-time school-based social work staff. These staff are jointly funded by a board and by a children's aid society. They're employed by a children's aid society, but they're operationally controlled by the principal of the school.

The delivery of child- and family-based counselling services for mental health and child welfare purposes in the model I've just briefly described I think achieves a number of objectives.

(1) The costs are shared, so duplicating and competing interests and services to some degree are removed.

(2) The community, through the school, assumes many of the powers and responsibilities of child safety and child protection rather than having a children's aid society operate in isolation from the rest of the service system.

(3) The social and financial costs of apprehending children are dramatically reduced because early identification of problems and risk reduces the real rate of apprehension. Quite frankly, we've found, particularly in the high schools in which this model operates, the rate of admission to care has been reduced by about 80%. That's over the course of four years, so it's a statistically significant and I think consistent finding.

(4) The rate of school suspension is dramatically reduced because family-based contact is initiated by social workers who essentially work for the school but they have the powers of a child welfare agency or a child welfare system at their disposal.

(5) An education/child welfare partnership emerges which allows these systems to jointly use their best skills and to focus their attention on child-centred services rather than the needs of the system.

(6) Last but not least, it's a simple approach. The user quickly accesses what we would call a transparent system, gets what he or she needs and leaves the system with all of the parties, including the user, well informed rather than wondering what happened.

In the next phase of this particular model, the school support counsellors, who are social workers who are employed by the board, will gain direct access to child welfare resources and avoid the intake and assessment process, which is often duplicated and lengthy in many of our systems. We propose to entrust child welfare resources to educational staff and deem that definitive of integration. It's basically premised on a philosophy that the agency I work for holds resources for the community. We don't own those resources.

There are many examples of service integration and a great deal of recent literature and policy documentation from government on this topic. Despite that, it's my experience that there's tremendous resistance to the concept. The idea that services, mandate and function and resources should be shared seems somehow difficult to achieve. I'm quite concerned that without some further achievement in service integration in a systematic, ministry-directed examination of services to children at risk, the system will basically expense itself beyond capacity and beyond the willingness of the public to pay for it.

There are a couple of examples I'd like to briefly reference that speak to service integration. For example, integration of family-based agency foster care resources with private home day care would tremendously expand the pool of community resources available for day care. That's more particularly true in rural areas, where institutionally based centres are sometimes very difficult to access. The segregation of day care from the services stream, in my opinion, only enhances the increasing probability of at-risk children entering school and failing, and failing very early.

Another example: The integration of child witness preparation programs in crown attorneys' offices and child protection efforts in societies through joint funding would enhance the successful prosecution of abusers and the effective treatment of abused children, and there are demonstrations or examples of that particular model in a couple of areas of the province.

A third: The integration of prenatal and early postnatal care services in child welfare with those offered by health units would early identify risk, would intensify services and to some degree would integrate the mandate of child development with that of child safety.

Another example: The integration of vast portions of the children's mental health and child welfare service systems through single case management, commonly accessed foster care resources, for example, and full utilization of jointly held resources would, in my opinion, dramatically reduce service duplication, and there's a great deal of it, and contribute to the equitable distribution of dollars across communities.

I wonder in this brief why a family should have to shift agencies, which effectively means shifting systems, because a child or a family requires temporary care in a foster resource owned by a CAS. That would perhaps be the case if that client started out in a children's mental health centre and required some form of temporary care.

Another example referenced earlier by my colleague: The integration of family violence and child welfare services really would respect the reality that domestic assault can't be isolated from child maltreatment. That a police officer refers a domestic matter to a women's shelter, to a children's mental health centre or perhaps to a child protection agency and then hears nothing until the next occurrence is in my opinion cause for concern.

Service integration isn't a simple amalgamation of agencies and of their governance structure. I think that's a misnomer. The solution to the complexity of services and the proliferation of agencies over the past 10 years does not address the service dilemmas which really have been created by public policy. The service system, or as some would say non-system, is really a creature of public policy, and resolution of current problems will result only if strongly placed interministerial venues are given the mandate to be innovative and to create new service structures.

In my opinion, the child welfare system for which I work is quite ready for change, and I think it's to a large degree a potential leader. It's a system that sees quite frankly probably the most vulnerable and many of the most disadvantaged children and families in the community and it's quite committed to some significant restructuring.

In conclusion, I might suggest there's a need for a couple of things:

One is innovative funding directed exclusively at children's services, funding which includes the day care system, but funding which is designed to achieve intersystem service integration. That's involving health care, education and social services.

Another suggestion is that there's a service requirement stipulating that children's mental health and child welfare agencies, the two larger systems really in the social services children's system, systematically explore service integration, including common data collection, joint residential occupancy, joint case management and outcome measurement research.

Finally, the creation of ministerial strategies in addition to broadly based frameworks might serve to better guide boards of directors in these various systems, many of whom are quite confused about future roles and future mandate and how they might save money and achieve efficiencies by combining, amalgamating or, as I suggest, integrating their mandate and some of their services.

All this being said, in the concluding paragraph I note that the diversity of the social services system is a strength as well as a weakness. I hope that the solutions which you in the field eventually bring to bear respect that diversity and that indeed we don't see service elimination as a necessary outcome. Thank you for your time.

Mr Bruce Rivers: The Children's Aid Society of Metropolitan Toronto believes that prevention is an essential element in the child welfare service continuum. Prevention programs offer the least intrusive method of supporting, strengthening and empowering families, children and youth. We see them as essential to supporting Metro CAS's goal of keeping children and youth safely at home and in the community, thus preventing admissions to foster or residential care.

Not only is this the preferred way to serve children and youth in our community but it's also the most cost-effective. For example in 1993, we know that the average cost of providing service to a child or youth in the care of our agency was approximately $1,500 per month, while the comparative figure for providing service to a child or youth in their own home was $94 a month.

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As you may know, there has been a continual debate as to whether or child welfare should be in the business of prevention or should simply stick to protection. We respond to the debate by pointing out the following:

To draw an analogy, it is critical to address the smoke and the fire. Our mandate and responsibility is to not only address individual cases of child abuse and neglect in order to protect children and youth but to also address the root causes of these problems in order that steps can be taken to prevent child maltreatment in the first place.

Secondly, child welfare has a community presence. It is one of the few remaining service sectors that visits families within their own homes and communities. We call that a home visit. Providing community-based social work enables child welfare professionals to assess community trends and issues affecting the families they serve, particularly those that place families under the kind of severe and prolonged stress that causes family breakdown.

In an era of service integration, it makes no sense to fragment child welfare protection services from prevention. Prevention programs complement the child protection mandate as they reduce risk factors for children, youth and families by providing more supports in the community. The intent is to reduce the risk of maltreatment, strengthen their resistance and promote a sense of competency by helping the community to develop the skills and resources required to improve the quality of life and reduce the risk factors that we know contribute to their maltreatment. By risk factors, I am referring to poverty; poor housing; homelessness; unemployment; social isolation; single parenthood, especially teen parents; substance abuse, especially crack cocaine, as well as mental illness.

Metro CAS's belief in prevention and early intervention as part of the continuum of child welfare services has been operationalized within our agency for many years now through a variety of primary prevention, early intervention and family preservation programs.

In addition, 15 years ago the board of directors of the society, recognizing the community's responsibility to address the growing problem of child maltreatment, established a foundation. Today the Children's Aid Society of Metropolitan Toronto Foundation raises approximately $1.2 million a year in the private corporate sector, which it annually grants to child abuse and neglect prevention projects in a variety of geographic, ethnoracial, first nations and other communities of interest across Metropolitan Toronto.

Many of the funded projects have benefited from the involvement of the six community development workers who are employed through the children's aid society. These funds are startup only, and I want to underline that point, because sustaining responsibility must be built into the core operating budgets of agencies like children's aid societies.

Now I'd like to bring some life to the concept of prevention. A list of projects has been provided in your package, but I would like to speak to one in particular. It's called Babies Best Start, which was initiated by the Metro CAS Scarborough branch and developed in partnership with a number of other child-servicing agencies in Scarborough, such as the Catholic children's aid, the Metropolitan Toronto Housing Authority, Scarborough public health, the preschool Discoveries Child and Family Centre, Rosalie Hall maternity home, Bethel maternity home and Cliffcrest Parent-Child Centre, as well as with a lot of involvement from community volunteers.

The program is designed to use early intervention activities and parent education to promote the optimal potential for growth and development of new and/or isolated parents and their infants. The anticipated outcomes are many, most importantly the reduction of infant mortality; a reduction in low birth weight; the promotion of childhood physical, social, emotional, behavioural and cognitive development; improved parenting capacity; a reduction in child abuse; improved school readiness; greater access for families new to Canada to existing resources; and building the community's capacity to support parents during the prenatal to school-age period.

There are three components to this program that I'd like to reference. Together, they help to minimize the risk for children and they create jobs for women who need them. The first piece is the home visitor program, whereby parents from the indigenous, local and ethnoracial community are recruited, trained, supervised and paid an hourly rate to carry out a friendly home visiting service to new parents living in Scarborough.

The second piece is the Nobody's Perfect program, a six- to eight-week parent education program designed specifically for isolated, at-risk new parents. The final piece is the Mother Goose program, which over a 10-week period uses nursery rhymes and games to enhance parent-child communication, enjoyment and bonding to promote motor development, the child's communication skill development and an early appreciation of reading for pleasure and personal development.

The home visitor program is a voluntary, friendly, flexible and non-intrusive service that involves building a trusting relationship with parents and helps to inform and teaches them about infant growth and development, stimulation, nutrition, health and hygiene, safety, women's issues, sex education, understanding and adapting to Canadian culture and child-rearing practices, and how to access community resources.

The results of Babies Best Start in preventing child abuse and neglect have exceeded our expectations. It has received national attention and acclaim. This program, which was created by the CAS, has been passed over to the community and has received ongoing funding of approximately $400,000 a year through the federal Brighter Futures program.

The best persons to give testimony to the program's impact are the users of the service. In the following video clip, you will hear from one of the young mothers about the benefits she has derived from having a home visitor in her life. It's important to note that this program has responded beautifully to the diverse needs of the Scarborough community through its efforts and the 20 home visitors who have been specially trained and are capable of delivering service in 30 different languages. If we could have the video please. I'd like you to meet Donna and Lorna, who are home visitors, and Cathy.

Video presentation.

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Ms McConville: We'll conclude with some recommendations for the committee:

-- That the government make children and youth a priority on the public policy agenda. The views of children, youth, parents and service providers must be considered when developing public and policy positions. The entitlements of children as articulated in the Children First document and the UN Convention on the Rights of the Child must form the foundation of public policy that impacts on children and families.

-- That children's entitlements be merged into the best interests section of the CFSA.

-- That all political parties affirm and support the implementation of the recommendations made in the Premier's health council document Yours, Mine and Ours.

-- That the government take a lead role with other partners in a public education strategy that is directed at negative attitudes towards children, reinforces positive parenting and encourages community support to the parenting role.

-- That public funding policy support a spectrum of child welfare services that include remedial services and services directed at the prevention of circumstances leading to child maltreatment.

-- That families in every CAS jurisdiction have access to alternate measures of dispute resolution, such as mediation, and these be incorporated into the rules of procedure for the Ontario Court (Provincial Division) and be the first course of action in non-consent proceedings.

-- That government proceed with the outstanding amendments to the CFSA and support a legislative amendment to allow child protection intervention for children who live in families where family violence is substantiated.

-- That the "least intrusive" principle now contained in the CFSA be modified to include language which values decisive intervention with children and families at the earliest possible age.

-- That the government amend the CFSA, consistent with the UN Convention on the Rights of the Child, to ensure protection and substitute care to children who require it up to 18 years.

-- That the government transfer the jurisdiction and funding for young offender services to children between 16 and 18 to the Ministry of Community and Social Services. Diversionary approaches and alternate measures are needed to support the intent of this legislation.

-- That public policy and government structures be developed to facilitate service integration, interministerial collaboration and a pooling of resources to ensure equal access to public services for all children in Ontario.

-- That a provincial fund be created to finance new strategies that promote the health and wellbeing of children and support primary prevention and early intervention programs directed at children at risk.

-- That government ensure that all ministries share responsibility and are accountable for the health, wellbeing and transition to adulthood of those children entrusted to state care.

-- That a report card on the wellbeing of children in state care be developed and implemented.

-- Finally, that a review of the full spectrum of services available to children at risk, and funded by all ministries, be conducted to identify service gaps and barriers to the integration of services.

Thank you. That concludes our presentation.

The Chair: Thank you. In the time we have available for questions, we will in no way be able to do justice to all of the thoughtful ideas you have presented. We will take all of these ideas and be considering them, but let us try, at least for a few minutes, to get into some dialogue on some of the points. We'll begin with Mr Owens.

Mr Stephen Owens (Scarborough Centre): I'd like to address my comments to Mr Rivers. I had the pleasure of touring Babies Best Start and I met with some of the moms and the kids and the providers. I share your view, that it's such a pragmatic, commonsense approach to providing moms and dads with the kinds of skills that they need to give baby the best start.

I was further impressed by Roscoe the Bear, which sits on my credenza at home. For those who haven't had the pleasure of knowing what Roscoe is, Roscoe is a toy bear that's been designed to provide for maximum tactile stimulation so that there's that touch, that stimulation that the child needs to thrive. I appreciate your comments on that and they're quite true and I continue to be impressed with the program today.

In terms of amalgamation and, I guess, rationalizing in the positive sense the services that are provided, I have just a bit of concern with respect to putting this service into the educational system. If you speak to constituents and your neighbours, the one thing that people will agree on is that the educational system doesn't work, that it needs changing. Our minister, Dave Cooke, is in the process of trying to determine ways with the royal commission of how we can do that without reinventing the wheel.

I'm wondering where you see the accountability of a system like that. If we put it into the educational system, what would be your expectation of the teachers? There are currently programs that are supposed to identify children at risk, but it's been my experience that the level of efficacy is clearly dependent on the motivation of the teacher, the principal, the parent or the parents. How do you see that kind of a system working?

Mr Rivers: Thanks very much, Mr Owens. We were delighted to have you as a guest at Babies Best Start. I'd like to extend a similar invitation to other members of the committee. Any time you'd like to join us, we'd love to have you.

To begin with, I want to make a comment about the program Babies Best Start in that we would not see that particular program necessarily being integrated with the education system. I think that part of its success, quite frankly, is based on the fact that it's been community-owned and community-driven at a very basic level by the mothers who live in the housing developments that have been targeted throughout Scarborough.

However, I think there are other members of the committee who could speak more effectively than I to some current initiatives with the boards of education. My only comment, based on my experience in Toronto, is that as education systems are currently configured your comments are right on. I don't think the investment would work. We have to rethink how education is offered and how the community itself can participate in the delivery of education and create services that can support families and children at risk through that system. Mary or Jerry might have something they'd like to add to that.

Ms McConville: I don't want to speak on behalf of Mr Muldoon, but I don't think Mr Muldoon's intent was to suggest that the education system completely subsume child welfare. I think we were using that particular initiative as an example of how specialized services can become linked more closely to mainstream services. Mr Muldoon's agency is still a child welfare authority that has to link to a whole variety of community programs and work collaboratively with them, only one of which is the education system. But I think it's a good and innovative model in terms of how --

Mr Owens: The question is, where is the point of access? Who acts as the gatekeeper, is my question.

Mr Muldoon: In practical terms, the gatekeeper becomes resident in the school. It might be the social worker who is assigned full-time to Walter Zadow school in Arnprior by the agency. Gatekeeping becomes, in my opinion, a shared task in the sense that these child welfare people and these educators begin to develop a common sense of child protection and a common sense of child safety in a school, probably at a much earlier stage than might normally be the case. I think it becomes very much shared. The reality of the experiment or the demonstration to date is that, with that gatekeeping, one is then able to deliver the services directly from the school. I'm not sure that I understand the dilemma.

Mr Owens: In terms of the system as we know it today, it creaks along and turns out "graduates," and everybody agrees that it needs changing. Given that, I'm concerned about where the accountabilities are. Who will be accountable for that child ultimately if we move that into the system, if we move some services or whatever services? I understand that you're not talking about moving everything into the educational system, but where will the accountability lie? As a parent, whom will I call?

Mr Muldoon: I think accountability has been a problem in the system because case management has been a problem. Who is responsible for a case throughout the duration is a constant complaint that comes from the people who use our services, or educational services, for that matter.

In this particular project, the accountability is via the social worker in the school, who assumes the case management responsibilities through the duration, whatever length of term is required to resolve a difficulty that's brought forward. The case management never changes. Under normal circumstances, a social worker in a school would transfer case management to a mental health worker, who subsequently might transfer it to a child welfare worker. In the process of referral, quite frankly, many of the services break down. This particular model attempts to integrate the case management along with the services.

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Mr Ron Eddy (Brant-Haldimand): Thank you very much for coming and giving us very important information on children's services at a time when the need is very great and getting greater all the time. The needs of children and families are so very important. I appreciate hearing about the several important special projects you're getting into. I expect you have a clearinghouse, so to speak, to tell each other about it and get into different areas.

Unfortunately, the need has never been greater at a time when funding restrictions are getting more crucial. I want to talk about the funding. I know that many children's aid societies, if not all, experience shortfalls in income to be doing the things they are mandated to do, without the extra things you're working so hard to do.

I don't know whether the funding system is included under number 3, but I understand the present funding system is what could be termed a mess. It should be changed and improved, and how do you see that? Because that is the basis of the service, isn't it?

Ms McConville: That's something we're presently negotiating with this ministry, but we've also been negotiating this with the ministry for years now, and other governments, and don't seem to be making substantial progress. I think one of the barriers has been a lack of clarity about the role of child welfare, and that's one of the reasons we've chosen to speak so clearly to that today and at such length.

The old funding policy and funding mechanisms or processes to get money to children's aid societies have not really supported the kind of service delivery structure and mandate that we're trying to describe for you today.

With respect to what can we do about the funding pressures, what we're trying to say very clearly is that this kind of service delivery model is a heck of a lot more effective and less costly than a model that forces us to move in with too little, too late. The mandate that restricts children's aid societies solely to intervening with the highest-risk families at the latest possible moment is the most expensive and least effective service delivery model for child welfare. So we're not saying we're going to need a massive infusion of funds to support the demand. We're saying that public policy needs to reflect the broad strategies that are laid out in Yours, Mine and Ours to ensure that more children get a better start. With respect to children at risk, we need funding policies and public policies that support this model of service delivery instead of the old model of service delivery.

Mr Eddy: And you've noted that the expenditure funds for children and families is an investment?

Ms McConville: Absolutely.

Mr Tony Martin (Sault Ste Marie): I wanted to talk to Mr Muldoon, because I am certainly interested in the model you present. I don't know how you got there, to be honest. My experience in my neck of the woods, which is northeastern Ontario too, Sault Ste Marie, is that it's really difficult to bring people together even within the same ministry, never mind bringing ministries together. There's a lot of resistance, even where the ministry itself is interested.

I've worked with folks over the last three and a half years, and I was on the social planning council before I got here, trying to integrate and have people working together. There's still a tremendous sense of territory out there. To get where you are, even if the government gave its blessing, would still, in my mind, take years and be really difficult.

I have a couple of examples in my own area. When I first got this job, we were trying to amalgamate two associations that were delivering services in Algoma to the developmentally handicapped. It's now almost four years later, and I think we finally got to it; April 1 was the date. But I inherited that. It took us four years, and now we're doing it. It's such an arduous task.

I sensed in your presentation that you were laying some of the blame or the blockage on the ministry and the government. I suggest to you that my experience has been that the ministry wanted to do it, but they can't get the folks down there in the communities to get it together and start to work together.

Mr Muldoon: The ministry will advise the field that indeed the planning should take place in the community, that the community should look after itself. No one could dispute that. We in the community will look at the ministry and suggest that we need some more decisive position taken by ministries; we suggest strategies rather than simply frameworks. We tend, perhaps, to sit and blame each other.

The experiment I described was driven in large measure by issues of quality, not by issues of finance. It's been my experience that with the current climate, we see a real retrenchment rather than a willingness to innovate, at a point in time when, if we ever needed innovation and restructuring, it's probably now.

I credit two innovative and creative directors of education in the county who were willing to risk the image of child welfare in their schools because their primary concern was for good, quality service and their concern was for partnership. With those themes, this kind of service model emerged.

Quite frankly, and I don't know whether my colleagues would support me, there are days when I wish the ministry was a little more decisive and a little more willing to invest in innovation, as Mary suggested.

Mr Rivers: I'd like to add to Jerry's comment that there's an opportunity here for the committee to make a recommendation that would be very practical and would bring about change; that being that funding to players like ourselves, to boards of education, be contingent on people working together differently. I think then you're going to see the behaviour start to change. It's very simple: Make the funding contingent upon a different way of doing business.

Mrs Yvonne O'Neill (Ottawa-Rideau): This has been an outstanding presentation. I particularly like the last four recommendations you made. I think those are fundamental. I hope in my lifetime I will see those.

I wanted to ask you a couple of things. First of all, is this philosophy that you bring today right across the children's aid societies, or may I ask very bluntly if this is your best face shown? I've met with other associations that have a different attitude about collaboration, particularly with children's mental health. I have to ask that question, just for the record.

Ms McConville: I think it would be fair to say that the approaches to service delivery that you've been exposed to today could be described as the best and most innovative and, we believe, the most effective kinds of service delivery that you could see come out of a child welfare authority. But I also said in my presentation that the service delivery was not uniform across the province and gave an indication of some of the reasons.

There's no question that we've got funding inequities. There's no question that we've had ongoing and chronic debates with the ministry about the role and the interpretation of the mandate under the legislation, despite the fact that we've been able to demonstrate over and over again in many places through these kinds of programming that this is a more effective use of the public resources and in fact a very legitimate role for a child welfare authority to play with respect to high-risk children. But we haven't had a rational funding formula, we haven't had consistent public policy support with respect to the interpretation of the legislation, and that's in part what we're trying to negotiate with the government.

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The other thing that needs to be said is that the resourcing for this kind of breadth of programming has to cut across ministries. We've talked many times, if you notice, about the pooling of resources. We've got day nurseries' funds present here, we've got federal grants present here. If the government wishes to support this kind of service delivery model for services to families and children whom we would refer to as high-risk, we have to think more creatively about how to fund those programs, and the MCSS dollar is not the entire solution. We need some willingness on the part of other ministries and other levels of government to collaborate with respect to supplying resources, both people resources and funding resources.

Mrs O'Neill: I'm very pleased that you've been so practical and that you have really shown what's possible. Are the Babies Best Start program and the mutual aid organizations programs in those cities in some jeopardy at the moment? I have to ask you that again as a very direct question. I know you have mandated services, and these are beyond the mandate or are a different interpretation of the mandate, because I suppose they are not totally reactionary but are much more progressive. I'm concerned, and some of the other associations I've met with, maybe even some of you whom I've met with, have suggested that prevention is in some jeopardy at this moment.

Ms McConville: It's in jeopardy in the sense that we don't have clear funding policy that supports the preventive role, but it's not beyond the mandate. It is part of the legislative mandate, very clearly. The funding policy is not clear, though, to support that piece of the mandate.

Mr Walsh: It's a matter of what comes in the front door. If more come in the front door than what you're able to accommodate with your existing resource base that goes to mutual aid or day nurseries, promotional kinds of programs, if more come in the front door in terms of straight protection and investigation, you're very much obliged by the funding policy to take it out of the other end of your service delivery. It's really cutting off your nose to spite your face. We've demonstrated, in terms of identifying the clients -- and they all are child welfare clients, it's not like it's the general population; it's a child welfare client, it's a family at risk -- that unless you serve these people in an empowering kind of way, you're going to be putting the Band-Aids on later on, and very expensive Band-Aids.

Mr Charron: I'd like to make one comment as well about the funding issue. Our day nursery parent enrichment program was in jeopardy. It was originally funded by the regional municipality on a purchase-of-service agreement. The region decided, because of its economic pressures and what they called downloading, to take out its 20%. We were fortunate to get the cooperation and the support of the ministry and go to corporate status; otherwise that program would have been dead.

Mr Rivers: Could I speak to Babies Best Start? As I indicated, the program was initially funded by the corporate community, approximately $300,000 through the Children's Aid Society Foundation, and is now being sustained by a federal government grant called Brighter Futures. There's no funding currently available within children's aid societies to initiate and sustain the kind of program that we described as Babies Best Start. We would encourage you to make that recommendation.

Mrs O'Neill: Is Better Futures a very time-defined program of the feds, or is it a pilot project? I don't know it; I'm sorry.

Mr Rivers: Sustaining.

The Chair: I'm afraid I'm going to have to be the heavy and bring this to a close.

One of the things that is very clear to me is that we have talked -- and when I say "we," I mean various governments -- about the role of the children's aid society, and while the mandate doesn't preclude prevention or the kinds of programs you've discussed, it's probably fair to say that all governments have tended to emphasize the protection part, particularly in more difficult times. When one looks at both the Children First report and then Yours, Mine and Ours, it's how do we get out of that mindset and, together with other players in the field, bring about more of the kinds of programs you're talking about?

Would I be correct in assuming that you are interested in the funds the Minister of Community and Social Services recently underlined, I think $6.8 million? I was at a meeting of the Metro school board that had a number of people, and they were interested in working together. The minister expressed at that point that school boards, as part of a community presentation, would be acceptable. You'll be looking at that, perhaps, for some innovation?

Ms McConville: Yes.

The Chair: Good. Thank you again for all of these recommendations and thoughts.

YOUTH IN CARE CONNECTIONS ACROSS ONTARIO

The Chair: I call on our next presenters, representatives from Youth in Care Connections: Kim Way, youth program worker, and T.J. Whitley, youth liaison worker. Do we call you T.J.?

Ms T.J. Whitley: That would be great.

Ms Kim Way: We brought Diane Cresswell, the manager of communications, with us.

The Chair: We're always delighted to have her with us at the table.

Ms Way: Just to outline, in our package we have our annual report so you can get some idea of what Youth in Care Connections has done over the past year; a youth discussion paper that was prepared in 1992 that also highlights some of the things we'll be highlighting today; a brief information sheet about Youth in Care Connections; summaries the youth have provided feedback for over the past year, which we will be referring to and taking information out of; and the September issue of The Journal highlights youth information on extended care maintenance, which they have been highly involved in.

I'm Kim Way and I'm a former crown ward of the Perth County Children's Aid Society, and T.J. is a former crown ward on extended care and maintenance with the Hamilton-Wentworth Children's Aid Society. We are youth representatives of Youth in Care Connections Across Ontario, which we call Con-X-Ont, just to shorten it a little. It's a network of youth in care of children's aid societies in Ontario.

Con-X-Ont's goals are to identify and advocate for the needs of youth in care; provide input and feedback to interested organizations that are researching programs that affect youth in care; provide support to youth in care, especially those who have had a chance to work with the adults in the agencies; and provide youth with the opportunity to develop, strengthen and evaluate services.

Since the summer of 1993, we have been able to meet with youth from many of the 50 children's aid societies at various conferences and activities that youth have been forumed at and we've been able to discuss some of the services youth receive. We've also been able to gather written feedback from youth -- and you have the summaries in your packages -- through the assignments we have developed to investigate youth issues: their ideas, feelings and recommendations on the issues that other organizations are wanting to hear more about. We'll be presenting information we've gathered from these consultations with the youth, as well as information from our own personal experiences of being in care.

We realize that in a time of economic restraint, there is a priority to keep children and youth out of the care of children's aid societies and that the focus of the dollar may be moving towards reducing support and prevention programs in child welfare. However, it is important to recognize that there is a number of children and youth in the CAS system for whom becoming a crown ward will not be preventable. These youngsters will be cared for by CASs for most of their lives, and for these children and youth another type of support program must be stressed and provided while training them for adulthood.

Training youth for independence means preventing us from becoming dependent on the child welfare system and social assistance programs in the future, helping us become productive members of society, and providing us with parenting skills and resourcefulness that will prevent our children from re-entering the system. I think you will hear in our presentation that some of the recommendations and programs youth are asking for will fit in nicely with the presentation you've just heard.

T.J., you want to talk a little bit about independence.

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Ms Whitley: The children's aid society's goals for a child who enters care from any age should be to train and help this child to become a productive member of society who is able to be interdependent with the community and the services it has to offer.

Relying on situations from our own experience of being in care and from other youth we have heard from, we know there are many services that we should receive as we're growing up in care. Services should be provided to us not only in the last few years before leaving care, but should begin and continue from the moment we enter care.

Youth in care who have been removed from their biological families need support and services to deal with separation and loss of the natural family; support and services to deal with the abuse we've suffered while in our natural families; workshops and activities aimed at building self-esteem and confidence; also, there is a need to be able to form relationships that support the learning of social and communication skills that demonstrate healthy alliances and act as resources and teachers.

Youth living in stable natural homes have the opportunity to learn skills such as cooking, cleaning and job skills through family interactions and modelling. Through the family network, youth have resources and gain information such as jobs and skills, housing and much more.

However, youth in care often miss learning these skills because they have not had stable or appropriate relationships due to changes in workers or placements. The service providers often are too busy concerning themselves with our family crisis, school adjustment and our problems with siblings and overlook our need for basic skills to become independent.

For a youth in care, these basic skills are even more important than for a youth who has a stable support system. When a youth moves away from the care of the children's aid society at 18 or 21 years of age, they must perform simple tasks, such as cooking, laundry and cleaning, for themselves. As well, they must engage in the job search, pay bills and investigate investments for the future. There is no one to do it for them and there is a strong possibility that there is no one to direct them to services that could help them.

Even when a youth has left their natural family, there's always that security and that support system behind them that if there's something they need or if they're short of money that month, they can go back to their family and they have that support system behind them. For a youth in care, once they turn 21, that's it. There is nobody there. It's not the responsibility of the social worker or the past foster parents to be there, to be a support system to them any longer. So it's a very scary thing.

Those youth in care who are able to get the needed supports and services provided to us through the CAS are more likely to become independent and be able to access resources in the community; finish high school and pursue post-secondary education or vocational training; have valuable job skills and be able to find and keep a job; avoid the need to rely on social assistance in the future; be partners in healthy relationships and become nurturing parents; and generally just be more happy, more secure, more productive people in society.

Youth who do not receive the necessary supports while growing up are more likely to drop out of high school; become criminally active; become dependent on social assistance programs shortly after they leave care or immediately after they leave care; live on the streets and become involved in self-damaging activities such as drugs and prostitution; become parents at an early age and be unprepared or unskilled while raising children, therefore returning to the cycle of abuse they were once removed from; and be generally unhappy, non-productive, unresourceful members of society.

Ms Way: Many youth in care do not have contact with their natural families after coming into care. The only support network youth in care have is the CAS, the CAS staff or former foster parents who the youth have been cared for by and grown up with.

When a youth moves out of a foster home to move to independence, the relationship between him or her and the foster parents changes. The foster parents now have a priority to care for the new child or youth who has moved into the home and who has replaced the older child once living there. Youth in care feel this when they move out of the home and a new child moves in, and they're reluctant to go back to the old foster parents because that relationship has changed and the foster parents no longer have the resources or the time and don't feel responsible necessarily to take on that youth who is now living out of their home.

Youth have expressed concern for many years that they feel abandoned and neglected when the CAS removes emotional or financial support when they turn 18 or even 21 years of age. Youth feel that it is at this time in their lives that their future is starting to take shape, when they need the most support and guidance. We feel it is necessary to continue to provide support to youth until the age of 21, and ideally beyond that age, especially if the youth are furthering their education.

The Minister of Community and Social Services has recognized the importance of CAS support for youth in transition to adulthood. In 1993, the Ministry of Community and Social Services began a policy review on extended care and maintenance which involved both CAS staff and youth in care of CASs in Ontario. After much hard work, sharing of personal experiences and the identification of needs by youth, the minister announced the addition of $3 million to current extended care and maintenance funds to support youth on extended care and maintenance.

Although guidelines and eligibility criteria still need to be revised, the changes will be put in place in the summer of 1994. Although this service has not been revised to be a mandatory service, youth accept the idea that it will no longer be acceptable to turn youth to welfare upon turning 18, with no support or guidance through the transition to adulthood.

Youth who have been able to receive care from the children's aid society until the age of 21 are grateful for the support but still find themselves with many adjustments to make as they move towards very few support networks. If the youth is continuing school, he or she must face the remainder of school alone. If the youth has finished school, he or she must face OSAP loan debts that may be thousands of dollars, finding and paying for residence, finding a job and paying for basic needs. The youth must deal with this without a home base to work from or to support him or her. In fact, at times, between moves from school to a new apartment, the youth may find himself or herself with no place to live until he or she gets settled.

Just recently, I've had that. I've just finished university and had to move out of my current apartment. Unfortunately, I've had some difficulty trying to find a new apartment in Toronto. I was lucky enough that I had developed an older friend who would let me live at their house for the past month. I kind of crashed on their floor. But for many youth in care, we don't develop those relationships with people who can help us, and we can't rely on friends our own age because they're probably living in their own homes with their parents or haven't even thought about moving out.

Over the past year that Youth in Care Connections Across Ontario has been recognized, Youth in Care in Ontario have been involved in the following consultations: extended care and maintenance; reducing the risk of abuse in foster care; Ministry of Community and Social Services children's policy framework; worker contact and other supports to youth in care; foster parent training, evaluation and disclosure; rights and responsibilities and complaints procedure; residential placement advisory committee; the Royal Commission on Learning. The summaries we have got from the youth are included in your packages, if you'd like to brief over them later.

Youth have been able to evaluate the services they receive as well as to identify services they feel are necessary but do not receive currently.

As one would note in assignment 4 in your package, the assignment called "How Youth and Children Feel About the Services they Receive," youth have identified the following services that they receive and feel are absolutely necessary: emotional and financial support; independence training; rehabilitation services; probation services; youth-in-care groups, and these groups would be buddy systems or groups that can share experiences and make friends and work on issues of concern; counselling; medical and dental care; sexual and physical abuse treatment; lawyer and court services.

Youth identified that the training and counselling they should receive as they are growing up in care should include cooking, laundry and maintenance skills; counselling and support for separation, loneliness, assertiveness and self-esteem; job skills; skills and information on accessing resources; information and training for housing searches and the Landlord and Tenant Act; budgeting and money matters information such as banking, investments, insurance; communication skills; parenting skills.

These skills are absolutely necessary if we plan on succeeding in becoming independent. with many of those skills, you will note, many of the youth have a chance to learn if they're living in their own homes. Unfortunately, many of the youth in care miss out on some of those.

Youth have said that there is a need for education staff such as teachers, principals and volunteers who work with youth in care to have more communication with the youth themselves and the CAS staff, such as workers, supervisors. Youth feel that by being a youth in care of a children's aid society, there are a number of factors they must deal with while also being a student. Many of these factors affect the youth's ability to learn or attend school regularly.

Along with the normal peer pressure, with drugs and alcohol and what to wear to school, we must also face the labelling and stigma from the other children and sometimes the teachers. Youth feel that changes in placements, family problems -- biological and foster family -- social worker changes, court and school changes, living independently at an early age, and self-esteem and sense of belonging are all factors they must deal with while attending school.

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Youth feel that for the school personnel to help them more effectively, teachers must be prepared to learn more about the CAS and its role in the community and to understand the effects of loss and separation on behaviour. Teachers must also be willing to examine alternative methods for teaching youth who are having considerable difficulties due to being in CAS but do want to learn. Many youth have found that the teachers don't necessarily know what a children's aid society is or what its role is. Then you have the other extreme, where the teacher goes ahead and tells your entire class that you're a CAS kid, which causes an additional problem for youth.

Further, Youth in Care recommend that some of the skills that are being overlooked in current living arrangements be taught in the schools. Some of those skills are social skills, study habits and communications, budgeting, bank rates and investments, income tax, lease and rent information, nutrition and physical fitness, CPR and first aid. In January 1994, this information, as well as some of the other that is listed in the summary sheet, was passed on to the Royal Commission on Learning.

All youth who are out on their own at an early age identify housing as an issue. Youth in care may not have any other choice but to live on their own as early as 16 years old, due to lack of placement homes for teens. Youth are often discriminated against when applying for housing on the basis of age, lack of references or lack of income. Youth in care again suffer from the labelling and stigma associated with being a CAS kid and many cannot give references, since they have moved out from group homes or foster homes and have never had to pay rent.

Recently, we have found out that many of these have trouble when they try to give social workers' names as references. Many landlords won't accept that. Youth and students often settle on housing that is unsafe and/or illegal because they cannot afford better or they are limited because of discrimination.

Youth in care live on very strict budgets and are disadvantaged. The recommended amount for an independence allowance is $663, which is the same rate as a single person on general welfare assistance. With housing being so expensive, youth often need to subsidize their allowance with a part-time job to be able to pay the basic bills of rent, food and hydro. The part-time job is something that is invaluable for job skills but may be creating undue stress for a youth who is working towards a high school diploma. Youth need better access to government-funded residence or children's aid societies need to work at creating alliances with home owners for youth to find affordable, legal and safe housing.

Again, housing has been an issue for me. Trying to find something in Toronto is incredible. A one-room apartment is basically $600 if you want it in a safe neighbourhood and it's well-kept. For somebody who would be receiving extended care maintenance in the upcoming years, receiving $663, it's not going to cut it. It would be very difficult to share a one-room apartment with somebody else to help with the rent. Some of the places that I've checked out, being around the $400 or $450 range, are not in very good places to live and are not very well kept at all. I think T.J. had the same problem when she was looking in Hamilton.

Ms Whitley: Yes. Hamilton is a little bit of a less expensive community. I went apartment hunting and I could not find anything I could afford. I receive less than what Kim just mentioned. I receive $627 a month. That will change once the minister's announcement goes through and stuff, but at $627 a month it's very difficult to find an apartment that is in a safe area. I live in a safe area, I did find an apartment, but it's not really suitable. It doesn't have a stove; it doesn't have a full fridge; it's incredibly small. To be in an apartment, you have to have so many square feet. There's not enough square feet in my apartment for it to be a legal apartment, and two people share it; I share it with another girl. You can't find anything in a safe area that's affordable. Anything that is in a safe area, you're looking at about $500.

Youth have much to offer. Our point of view in our recommendations will be valuable to children who will require care and protection in the future. We believe we can help. All youth feel that it is important that we be included in the review, evaluation and development for services for children and youth. No one can understand exactly what a youth experiences or needs when they are taken out of their natural homes except for youth who have gone through the upheaval of leaving their natural home.

To involve youth on issues and services that affect youth all over the provinces, Con-X-Ont is one vehicle through which youth in care can be accessed and can participate.

The involvement of youth at the local levels must increase. Over the past couple of years, youth have been hired at their local children's aid society as youth representatives. The youth have been able to gain valuable job skills and work experience while working on youth issues and activities. As well, these youth have been a resource person to Con-X-Ont and children's aid staff.

In the summer of 1993, 26 youth were hired in this capacity in their local children's aid society. These positions were made possible through the summer employment Experience funds of the Ministry of Community and Social Services. It has proved to be valuable to both youth and service providers. Youth need to be able to sit on service committees to the board of directors, on planning groups for independence training and present to new foster parents, and much more. In these ways youth can help develop and evaluate the services which directly affect them where they live.

The changes that are being made to extended care and maintenance, largely due to youth determination and commitment, are an example of youth's input through constructive approaches and sharing personal experiences and identifying personal needs.

We've brought to you today a list of recommendations:

-- That the independence training programs be made available to all youth in care, from the entrance to care until graduation from care.

-- That ministries of government that provide services to children and youth, such as the Ministry of Community and Social Services and the Ministry of Education and Training and others, work together to understand the role of children's aid societies and the needs of youth in care.

-- That the Ministry of Education and Training consider former wards of children's aid societies as a priority group for forgivable loans through OSAP.

-- That the Ministry of Community and Social Services continue to work on phase II of the policy review of extended care and maintenance to review, to develop and to fund appropriate support services for youth in care.

-- That the Ministry of Community and Social Services and the Ministry of Housing work together to create housing that is safe, legal and affordable which is easily accessed by youth in care.

-- That the government and its respective ministries providing services to youth at risk continue to consult with youth in care in the review, evaluation and development of services for youth at risk.

-- That the government provide job incentive programs and provincial funding for jobs for youth at risk.

Ms Way: If you have any questions, feel free. We'd just like to take a moment to thank you for giving us, the youth in care in Ontario, this opportunity to be able to present to you today.

The Chair: Thank you, and thank you as well for the additional documents that you've brought with you. We'll move right to questions.

Mr Owens: Ms Way, I believe you testified before this very committee approximately four years ago on the issue of children's mental health services, and I'd like to welcome you back. Some things have changed and some things have not changed for the better in those four years.

I guess my question is that you reference a little bit -- not a little bit, significantly -- in terms of the process by which financial assistance is accessed by youth in care and youth as a whole. It's my understanding that there are some pretty horrendous experiences out there in the community.

I do a lot of work with community legal clinics in Scarborough and across the city on poverty issues, and they've told me -- again, there are some fairly horrendous experiences that have happened to young people 16 years of age who are trying to access general welfare assistance, for instance -- that even children where there's suspected sexual or physical abuse are still made to go back to the abuser or the parent until the children's aid comes in and removes the child to get permission for that financial assistance to be granted.

Can you comment on that? Is this a widespread problem? Is it perhaps a local office problem?

Ms Way: I don't hear too many of the experiences from youth in care in respect to welfare, but youth are at a disadvantage in anything. They need help from many service providers, and when they are 16 to 18 and beyond, they try to access wherever they can and unfortunately they are taken advantage of because they don't know the ins and outs of the system.

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Many of the youth we deal with at 18 turn to welfare because there isn't any financial support within the agencies to support them. There is a discrepancy in some agencies as to whether they can take the youth in at 16 and 18 to give them any prevention services. I could see very much them being taken advantage of at the welfare offices.

Mr Owens: You mentioned also the issues with respect to the educational system and the fairly significant problems that young folks like yourself have within the system around confidentiality and understanding by the instructor in the classroom. Can you tell me what kind of recommendations that you made to the royal commission on this issue in terms of teacher training, teacher sensitization?

Ms Way: I will tell you to refer to the assignment 4 in the summaries, in the green sheets. Different recommendations came out from the youth that have worked. They would really like that somebody from the CAS staff, preferably the worker of their case, be in contact with the principal or one of their teachers in the school but that the youth be involved in the discussions and that it be flexible, that not every case would be handled the same. The youth in care would be able to say whether they would like the teacher to act in a certain way or to provide special assistance to them.

But the main thing was that the CAS and the education staff have more communication, because many of the youth felt that they weren't having enough, and that youth be involved and that youth be given the opportunity to say, "No, I don't want to be involved." Each youth is different. But the communication clears up a lot of different things.

Ms Whitley: I actually wanted to add to what Kim said on your first question, about youth being taken advantage of at the welfare office. When you leave care and you go to the social assistance office, it's a very intimidating experience. You've only been under the care of the children's aid society your whole life, youth in care, and then you go to this office.

You don't know the ins and outs of this particular organization; not only that, it's a different process. It's very impersonal, and with the children's aid society, when you go to them, you have a social worker. It's very, very personal. But when you go to the welfare office, it's very impersonal and can be very intimidating, and you could very easily be taken advantage of.

Mr Owens: In terms of recommendations that you would make to the minister with respect to accessing services like GWA, would it be fair to say that you would like to see some kind of a fast-track system, some kind of a bill of rights for youth or just some kind of understanding of what your rights are as a citizen of the province, whether you're 16 or 66?

Ms Whitley: Hopefully youth won't have to access GWA, because with extended care and maintenance to the age of 21 -- we'd like to see it to 24 -- you can get an education and you can go out there and you can get a job, so that you're not in a position where you have to go to GWA. That's what we would like to see more than anything else.

Ms Way: To expand on that with T.J., what we would ideally like to see is that general welfare assistance in the community be referred through the children's aid societies, so that the youth get that emotional support along with the money, so that they have the guidance and the resources to access other things in the community, so that they're not just being handed a cheque and nobody's really concerned about what's happening to them in the community, whether they're actually living in a home or whether they're in an abusive situation, but that they be able to work with the social workers of a children's aid society, if they want to, and be able to access other resources as well if the agency cannot provide them funding.

Mrs O'Neill: I want to thank you both for coming. I think you can be very proud of your presentation. You have done quite a bit of work in groups since 1993, and I've been reading some of the results of some of that. Again, I think that's been very helpful, and you definitely are learning very well to articulate what you think the main needs are.

I wonder if you'd say a little bit more about the housing, particularly your recommendation on the housing. Is the kind of housing you are looking at here housing that some people would call shelter allowance or others might call supportive housing or others may call just plain public housing? In other words, do you see yourself as getting your rent basically subsidized or do you see the housing being provided directly for people in your circumstances?

Ms Way: I think that works. It can be flexible. The youth in care we have talked to around the housing issues are willing to work on something that is within their community. There have been a number of different things.

There have been in a few children's aid societies -- I can't say the names right off the top of my head, but there have been some agencies that have bought a house or an apartment building or have worked something out with them that as the youth move through independence, they are moved into a semi-independent situation where they're in an apartment building or they're on a floor of an apartment building or they're in a house and the rent is geared to what they're making through part-time jobs as well as what they are receiving on independence allowance. One of the superintendents per se in the building would be a worker or a former youth who is willing to work with some of the youth on independence training.

Then there are other youth who have said that they would like to live in public housing, and sometimes that means we would hope that some of the basement apartments and things would be legalized and that they are kept up.

I think you have other committees that would probably talk to you about that. I think it's flexible for what the youth want, but we need something that is safe and affordable. Some of the youth have really liked the fact that moving into a house that still has some connection with the children's aid society, but not quite as much, is working well for them. Pape adolescent resource centre here in Toronto is one of those services that has offered, as well as other agencies throughout Ontario.

Ms Whitley: Actually, at the Hamilton Catholic agency there is a building with affordable housing. It's all affordable housing. They have two units, and then they rent it out to their youth in care.

Mrs O'Neill: So that's the kind of thing you're thinking about.

My last question -- I have many more but we're being quite limited today -- do the job incentive programs tie at all in with the Futures program, or is it much beyond that?

Ms Way: We haven't explored the Futures program, although there have been youth in care who have been able to work into that. What we have been working with is the summer Experience --

Mrs O'Neill: That sounds very good.

Ms Way: -- and different ones throughout the year part-time. We have worked with the ministry along that, so we've been able to get some funding and that through the area offices and the youth have been able to work right in the agencies. So that's the one we've been working with. We haven't explored Futures yet.

Mrs O'Neill: You think that kind of thing should be expanded then. That's what you're saying?

Ms Way: Yes, I think so, because many youth can't get job experience through their family, because it really is becoming a time of who you know and not necessarily what you know. A youth who is living in a foster home or a social worker's doesn't have those links necessarily. This way, if some of these programs can be expanded through the children's aid society, they have some of the children's aid society staff that the youth are familiar with and the workers can oversee the program and oversee the jobs and provide youth with correction and some critical reviews on what they're doing, as well as providing them with job experience that will be useful outside children's aid land.

Mr Randy R. Hope (Chatham-Kent): Listening to the presentation -- and I have close alliance with youth in my own community -- you've talked of larger centres versus the rural, smaller centres. My close relationship is with Transition House, which deals with a lot of kids, a lot of youth, in this process.

The difficulty I always have is the communication with the broader public on the issue of youth. I hear everything from youth wanting to get pregnant and go on welfare. I hear about creating situations in a family that don't exist, and then a way of getting out of the house is going to the children's aid society.

We talk about the linkage between the education system, the CAS and general welfare and all those communications and the number of walls that are going to be difficult to tear down because we face turf protection on that issue. Housing and everything else all have their own little administrative bodies and they love to keep them but they don't want to surrender opportunity.

The biggest difficulty I find in relating to the youth issue is the communication to the broader public, to the adults who are out there saying, "Well, this doesn't exist in my community. They just don't like the rules," and so on. How do you penetrate that end of it? I hear, "We're the involvement of the youth," but I'm wondering how you then communicate to the broader public who are sitting there saying, "You shouldn't allow the youth who have access to welfare to go out on their own. They just want to be with their boyfriend," all the comments that are usually generated.

In small-town Ontario they know as soon as you apply. It's right out there in the broader community. Those are issues that I'm being faced with as an elected member because everybody says, "Where do they go?" In Kent county they know the first place to call is Randy's office and he'll be able to link them to access to permanent housing and that. It just seems like it's normal. But it's the broader public that I have difficulty explaining situations to. I've been in some very serious situations with young people who have been sexually abused and trying to balance that out. I just wanted your opinion about that.

Ms Way: I come from a smaller community as well, from Perth county, which is Stratford. Actually, I was raised just north of Stratford in a smaller town.

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What I would say for communication is that many youth, and not all youth, are not able to communicate their needs, but if you can bring in youth who can communicate the needs of themselves, as probably some other youth, they could probably say what you've been trying to say and it's coming from a personal perspective.

We think that many of the service providers are trying to do their best to look after us and to provide our best needs but, unfortunately, sometimes it takes us to say it. I think wherever you can involve youth in the broader spectrum of informing the public, do so.

The Chair: I'm sorry that we have to bring this to a close, but I do want to thank you both for all the time and effort that you've put into the presentation.

SUSAN BRADLEY
KAREN TATARYN
LORRAINE ADAM
ELLEN ROSEN

The Chair: Our next representatives who are from three different children's hospitals: Dr Susan Bradley, who's the chief of psychiatry for the Hospital for Sick Children in Toronto; Karen Tataryn, director of social work for the Children's Hospital of Eastern Ontario in Ottawa; Lorraine Adam, director of social work, and Ellen Rosen, senior director of nursing, who are with the Victoria Hospital, the Children's Hospital of Western Ontario. We welcome you all to the committee.

We have received a number of documents from you. Perhaps I might ask Dr Bradley how we will proceed and just in what order, and if you would each, the first time you speak, be good enough to identify yourselves for Hansard.

Dr Susan Bradley: I have to admit that we are not organized, so I don't think there's a rational order.

The Chair: It doesn't have to be rational. We do a lot of irrational things in the Legislature.

Ms Karen Tataryn: I'd be happy to begin. My name is Karen Tataryn and I'm director of social work at the children's hospital in Ottawa. On behalf of the children's hospital, I certainly want to thank you for the invitation to present today at the standing committee on social development.

The Children's Hospital of Eastern Ontario, as all of us are, is witness at first hand to the vulnerabilities of those children at risk on whom the standing committee on social development is focusing its attention.

As a children's hospital, our health care teams at CHEO provide tertiary level care, prevention and treatment programs for our region's most seriously ill, injured and disabled children. For children who are victims of sexual and physical abuse, CHEO offers a place of safety and a chance to heal their wounds. Our mental health services offer urgent care to children with serious mental illnesses.

In all of these situations we try to provide our care in a family-centred way, offering our support to families who frequently feel unbearable emotional stress. We strive to empower our families to join the health care team in our decision-making process.

We provide our care in partnership with other community institutions and agencies, and optimally parents, hospital and community will truly be partners. We'll be called upon for tertiary care experience. The service spectrum will be broad, sensitive to need and coordinated. Parents will be active participants in their children's care. Increasingly, however, we find it difficult. Ourselves and the entire system find ourselves to be sorely tested in our capacity to best serve and protect our region's vulnerable children.

Our observations about why this might be so:

As our resources diminish, community programs, hospitals and institutions alike re-examine their mandates and their mission statements. Financial restraint and cutbacks have forced a retreat to an increasingly focused and rigidly defined mandate. The system has therefore lost its flexibility and hence its capacity to prevent vulnerable children from falling between the widening cracks.

The care system for children lacks coordination. It's difficult to enter and it's difficult to navigate for families, agencies and hospitals alike. At any one time, in looking to discharge a child with complex needs from the hospital, CHEO may enter discussions with many of the seven different provincial ministries that have programs serving children.

The care system is struggling to meet current needs at a time when organizations such as CHEO are identifying new needs. HIV-infected children with complex psychosocial needs and technologically dependent children who live at CHEO are two examples.

We've developed a range of prevention and treatment programs directed towards children most at risk in our community. The issues which we have noted in the presentation affect our programs in worrisome ways. They restrict our planning efforts with the community and they certainly limit the number of children we can serve.

I'd like to very briefly give you a summary of just two of the programs that we have at the children's hospital, the school refusal program and our child protection program. In closing, we'd like to make one recommendation about the service network for our most vulnerable children.

The school refusal program: In presenting this particular high-risk intervention program, we realize that it goes somewhat beyond your committee's definition of "at risk." Instead this particular program targets a group of emotionally troubled adolescents who are at such high risk that they've already embarked on the slippery slope towards dropping out of life.

There is a group of school dropouts, predominantly adolescents, that demonstrate school phobia or school refusal associated with a complex constellation of factors. In adolescents, school refusal may be associated with many features, including separation anxiety, family dysfunction, medical condition, a predisposition to psychiatric disorder. Intellectually, this particular group of school refusers most often falls into the average to bright range. In general, they're quiet, anxious, depressed, withdrawn youngsters from families with similar characteristics.

In general, the group of children who seem to get most resources are those who make the loudest noise, they being the externalizers, the most acting-out children. Hence, the quiet and withdrawn student population often slips away within the school system.

In response to a perceived need, the school refusal program was developed five years ago in the department of psychiatry at the children's hospital. The program has been developed particularly to meet the needs of adolescents who demonstrate the above-described symptomatology. School refusal within our population has been associated with anxiety disorders, depression, reaction to multiple or significant trauma and psychosis.

I'm just looking for the highlights. Within our hospital, we've created a warm milieu, such as a one-room schoolhouse with all of its proven merits: the integrity, flexibility and individualized psychoeducational approach which permits the student-patient the opportunity to enjoy a corrective educational and emotional experience.

A program of this type for high-risk adolescents with its emphasis on reintegration and getting back on track is not only highly fulfilling for individual students reaching their potential, be that academic, object choices or social interactions, but is extremely advantageous to society both in terms of the adolescents' potential contribution to society and in the considerable cost savings to the welfare system for several years to come.

Our child protection program: Since it opened in 1974, the children's hospital has recognized the need as a centralized paediatric facility for a coordinated approach to child abuse and neglect. In close cooperation with the children's aid society, a child abuse consultation team was established. In 1979 our program was established.

The program has seven key elements, and I'll outline very briefly the key elements: identification of children at risk and the detection and management of all abuse cases; medical assessment, documentation of injuries or neglect and treatment and follow-up; psychosocial assessment and follow-up treatment services. I'll speak for a moment about that.

The impact of sexual victimization of children is both immediate and long-term. The therapeutic services offered at CHEO provide boys and girls, children and adolescents, the opportunity to work through their feelings about being sexually abused in a safe environment. Children and adolescents need to regain a sense of control over their lives, enhance their self-esteem and develop ways of coping with the trauma which has occurred. We offer both individual therapy and the opportunity to join structured therapeutic groups.

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The group program for adolescent girls who have been sexually abused is innovative and highly therapeutic. The exploration of such issues as body image, sexuality and staying safe within a group setting has proven to be a powerful tool in the recovery of these young women.

One of our new initiatives within this program is the development of the sexual assault acute care program within our emergency department to offer immediate care for children and adolescents who have been sexually assaulted.

In closing, we'd like to offer sincere congratulations to this committee for attempting to tackle an issue of such fundamental importance. Our youth are clearly our future, and securing their future by protecting their youth and ensuring their entitlements is therefore critical.

While we applaud your focus on this subject, "talking the talk," we challenge the committee to actively implement your recommendations, to really "walk the talk."

We make but one recommendation which has to do with integration of services. Within our local communities, regardless of funding source, all agencies providing service to children and adolescents must work in an integrated fashion, permitting a user-friendly, easy-to-access system which should be streamlined and effectively delivered.

The two CHEO programs presented to you today are programs which intersect with many of the seven different provincial ministries which serve children. There's very little doubt in our minds that an overarching ministry for children would ameliorate, to a large extent, the concerns which we've raised in the earlier part of our presentation.

Dr Susan Bradley: I am Susan Bradley from the Hospital for Sick Children. The presentation which we are making to you today is a collaboration between the director of the suspected child abuse and neglect program at the hospital, Dr Marcellina Mian, the head of adolescent medicine, Dr Eudice Goldberg, the head of support services, Ms Ruth Koch-Schulte, and the coordinator of the infant mental health program, Ms Rhona Wolpert.

Our focus is on families. The dilemmas faced by families are now front-page news. Poverty, unemployment and violence have increased to such a level that we can no longer ignore their impact on families and our children.

Two-parent working families are now the norm as parents struggle to stay even economically, and single-parent families are on the rise. Children experience their parents as less available, tired and often irritable. Few parents can turn to their extended families for support. Parents often feel isolated, having lost a sense of community and having less faith in our traditional institutions such as the government, churches and schools. Immigrant families have the added stress of cultural barriers and isolation.

These dilemmas become even more pressing for families with a chronically ill child. We know that children with chronic illness have twice the likelihood of also having a psychiatric disorder. Their siblings and families often carry a heavy load emotionally.

Now in these times of cost containment which mandate early discharge or short stays, we must also rely on families for the complex physical care of these children. We know children are being discharged home to families with inadequate community support. We know that the divorce rate increases in these families, likely a reflection of an overburdened system.

In hospitals such as HSC we can perform miracles in terms of saving lives. Ethical issues, however, often arise in terms of the quality of life of the children and their families who are the product of our technological advances. The importance of psychosocial issues is often lost in our obsession with saving lives at any cost.

Despite being able to identify parents vulnerable to abusing their children and also unable, we feel, to adequately care for their children, we often find ourselves having to hope that things will work out rather than being able to direct parents to the support to ensure that they will. Many of our child welfare agencies feel that they have their hands tied and can only intervene after the fact of established abuse, as opposed to circumstances where abuse is suspected or high-risk factors make abuse predictable even before it occurs.

The CFSA's least-intrusive measures provision is being interpreted too narrowly, from our point of view, so that early intervention to protect children, as was intended in the CFSA, appears not to be truly possible. Grisly stories of our inability to intervene and even monitor high-risk situations without parental consent make us all feel that the law is not working as originally intended.

We have become obsessed with rights -- those of parents when dealing with young children, and those of teenagers as individuals -- but in so doing we are losing sight of our obligation to protect our most vulnerable, our children of all ages. We have taken for granted the important role that families play in raising our children. Now, at the same time as families become more stressed, our community supports have dwindled. We need to find ways of supporting families, especially those in the most vulnerable situations: families with infants, especially those who have low birth weight and those suffering from a physical illness or developmental disability. Families in poverty or in which parents have been abused generally need more support.

Programs such as the public health nurse visiting programs have been shown to make a difference in terms of providing information and support to new mothers and can act as a way of monitoring at-risk families and refer them to appropriate resources. Unfortunately, some of these public health nurse visiting programs have been cut back with the current cost containment and there's been greater emphasis on providing group care as opposed to public health visiting of individuals. This has eliminated in many communities what we used to have as a way of picking up those families most at risk.

Lay home visitor programs such as Parents Helping Parents in the city of Toronto health department are designed with a similar focus to provide support to new mothers but cost much less. They've also had great difficulty getting support so that they can be generalized more throughout our community.

Discharge planning programs and parent support programs are also making a difference in reducing parents' sense of being overwhelmed and isolated. Again, these are not as widely available across the province as they could be.

Service providers working with high-risk families need education and support to carry out their difficult roles. Community-wide prevention programs are needed to support families and ensure optimum outcomes for children. Treatment, however, must continue to be available to those children and families who most need it.

Those of us working with vulnerable families are greatly aware of how important appropriate support services can be to help raise healthy children. Investing in this end of our health system today will mean many more happy, healthy and productive citizens tomorrow.

The Chair: Now, last but not least -- with Mrs Cunningham here, I can't say that London would ever be last.

Mrs Dianne Cunningham (London North): You're right about that.

Ms Lorraine Adam: I'm Lorraine Adam from the Children's Hospital of Western Ontario, Victoria Hospital. I will start our joint presentation and thank you again for the opportunity. I endorse both of the statements that have already occurred. In actual fact, although we've approached our topics somewhat differently and had very little collaboration, I think you'll find some of the same issues presenting in each of the briefs.

Because the children's hospital is a facility where we see a great cross-section of different types of situations in families related to the health concerns of their children, I think the children's hospitals in general are in a very unique position to get that broad perspective. Although we are in the business of health care, we do espouse the philosophy of holistic care and family-focused care, as do the other hospitals, and certainly inject into our work with children as much focus on the families as is possible. Although there are improvements that can be made in that regard, we attempt to address that.

We could have selected just a wide array of groupings of children we see as vulnerable for the social at-risk group I think your committee is interested in. We have chosen four. The main point that we want to make, as well as some specific thoughts on each of these groupings, is the fact that a serious health concern with a child in a family poses a tremendous amount of pressure and strain, adjustments to their lifestyle, adjustments in their financial status, just a number of different strains and stresses by virtue of the health concern alone and the demands that places.

In addition to that, if these families are already in a socially disadvantaged position by virtue of family breakup, single-parent families, financial problems, unemployment, poverty, poor housing, poor nutrition, all of those very broad social problems that I think we read about and see a lot of, it almost makes it a double whammy for these children and families in terms of dealing with the health concern within very strained resources already, because we know that it takes a tremendous amount of strength and coping to deal with sick children, particularly very ill children and children who are ill for a long period of time.

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We try to deal with the health part, and there are a lot of other people who have to be involved in some of these broader social issues, but we certainly see it come right home into the hospital when the two converge with a health problem and the social disadvantage.

I'll stop there and give that over to Ellen, who will highlight some of the issues related to these four groupings, some of which are similar, but there are a few unique aspects. We'll try to hit the high points.

Ms Ellen Rosen: Thank you very much for inviting us to participate in this hearing. My name is Ellen Rosen and I'm going to highlight the issues for groups of at-risk children: children with chronic illnesses, children who have suffered a traumatic brain injury, child victims of sexual abuse and newborns of high-risk parents.

The first group is children with chronic illnesses. This group consists of children with lifelong conditions, usually originating from genetic causes or perhaps from trauma at birth. Included are cystic fibrosis, juvenile diabetes, childhood cancer, cerebral palsy, muscular dystrophy and birth anomalies. Frequently, these conditions require extensive and long-term treatment and repeated hospitalizations over many years.

Obviously, the family is typically overwhelmed at the initial determination of diagnosis and immediately swept into the complexity of the health care system and the hospital, and family life as they once knew it becomes turned inside out.

The demand and emotional strain on parents, as well as siblings, is great. Frequently it's a cyclical thing, with an ebb and flow, sometimes requiring more needs from the hospital and sometimes requiring fewer needs, depending upon the progression of the illness or the disease.

In some cases, the conditions result in a death. Children with cancer really do fit the definition of a child with a chronic illness, and although some may survive for extremely long periods of time and may be cured during the period of their treatment, they are subjected to an endless array of treatments, frequent hospitalizations and endless stress on their parents, their siblings and themselves.

Other practical issues that I believe have been raised by the other presenters are costly medicines, transportation, special care arrangements, appropriate schooling and recreational and social activities, to say nothing about the extraordinary demands on what has now become common, which is two-income families.

We have 80 children with cystic fibrosis followed at our hospital and 400 children with juvenile diabetes, and each year approximately 250 children with cancer are treated. That includes 50 new cases each year, with most being treated for an average of between 18 months to four years.

A recent review of our patient admissions has showed that we have 411 long-stay patients; that is, patients who stay over 30 days. Quite a few of those stay for six months. Recently, we have had two children who stayed in our paediatric intensive care unit for over one year. This group represents 45% of our total patient days.

A subgroup within that population are medically fragile children, and we have 80 of these children per year.

What are the issues? Emotional strain on families in the care of these children and the impact on family functioning; a need for specialized education for families so that they can manage the medical condition and the developmental needs of the child; a need for early intervention stimulation programs and special education opportunities; financial assistance to help with the cost of care, medication, and transportation to and from the hospital endlessly; a need for respite care for families, so that they can have a break from time to time and pretend to be normal, even for a weekend.

Children are susceptible to additional mental health problems, such as low self-esteem, depression, psychosis and anxiety reactions, depending upon how long they survive. We've already heard about families with pre-existing social difficulties.

What are our recommendations? There need to be some innovative service delivery models which encompass a family-focused approach, bridging the hospital to the home to inject services such as support for families, care assistance, respite care and education needs on a continuous basis. We feel that it could incorporate a lot of current services but needs integration and coordination. Support the development of self-help groups for these groups of families. Explore the feasibility of small family-focused step-down units for medically fragile children in order to bridge the critical care units of hospitals and special foster homes.

Children with a traumatic brain injury are those who suffer severe closed-head injury from accident and/or abuse, cardiac arrest which is resuscitated, sudden infant death and near-drowning survivors or children with encephalitis. These children also pose special problems, should they survive the initial crisis-care episode. We see approximately 55 to 60 of these children every year.

What are the issues? The family impact and continuous strain are similar to those for other chronically ill children; in these situations, though, made worse by the fact that most of these families started with a child who was normal and have to adjust to a child who may be left with residual deficiencies as a result of the insult. Frequently, these children require specialized rehabilitation services well beyond the acute hospital phase of treatment, and many of these services are not available in all parts of the province. Community reintegration into family, school and community pose the greatest challenges for these families, should they get to the point of being able to leave the hospital.

Our recommendations are that there be the development of family support services and the establishment of community rehabilitation outreach teams from tertiary care centres to smaller communities. This would enable training and support to local professionals in addition to direct services to children and families. Of particular importance is the assistance to schools in the management of these children.

The third group are child victims of sexual abuse. These children may be physically damaged as well as emotionally damaged and psychologically damaged for a lifetime. Current estimates from retrospective studies indicate that one in four girls and one in eight boys are exposed to inappropriate sexual activity, abuse or assault. In London and county, the children's aid society reports that there were 802 cases reported to it and that it investigated in 1992, and 892 in 1993. The London police department investigated 230, an increase of 38 cases over 1992.

What are the issues here? The causal factors, disclosure processes, which we've already heard about from our colleagues, and impact on the children and their families. Frequently these situations occur within these very dysfunctional families, and children experience severe psychological problems which may recur into adulthood. Legal and forensic investigations and verifications are complicated and require substantial expertise on the part of health care and social service professionals. The treatment of the children is difficult and long-term, with varying outcomes.

London urgently requires services for medical and multidisciplinary assessment and treatment for these children and families. A request for such funding is being prepared currently by the Children's Hospital of Western Ontario for the Ministry of Health. Collaborative initiatives are required within communities, hospitals, schools and children's aid societies to deal with this problem.

Innumerable strategies are needed, including the training of professionals in identification of the occurrence, early identification, education and support for parents, pre-parenting awareness and education and adequate services following identification. Again, coordination of a continuum of services is required.

Finally, newborns of high-risk parents: These children are born into families that may be functioning marginally as a result of a variety of social problems. Generally, this is a grey area, as it is difficult to presume negligence if a mother has not yet had an opportunity to parent a newborn due to the fact that the newborn is needing to be hospitalized in a tertiary care centre.

The Victoria Hospital identifies 50 of these children per year out of approximately 3,000 births, and goodness knows how many more from St Joseph's Hospital, the tertiary care neonatal intensive care unit. With the current abbreviated stays for the parents, we are sure that we are missing some of these patients.

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The issues are inconsistency in being able to identify the situations; a need to monitor and supervise children adequately in order to prevent harm and neglect, especially where voluntary cooperation of the parents is not possible; and preventive measures.

The recommendations are: innovative services need to be devised to reach and follow these parents beyond the hospital in order to prevent abuse situations. Comprehensive services are needed to break the cycle: to provide support and teaching of the mother, improvement of social conditions for families and early intervention for the children.

In conclusion, the impact of the conditions for groups of children at risk places enormous pressures on families to manage the medical requirements for the child and to maintain stability in their family life. We feel this substantially affects the child, and often siblings, and for families who are already disadvantaged it places the children doubly at risk. Managing the child's special needs at the best of times requires exceptional skills, strength and resources within a family and its network.

Solutions are not easy. The complexity and magnitude of the issues often overwhelm policymakers and providers, and consequently only incremental change of the status quo continues. As we are faced with resource constraints and the complexity of the issues doubles and triples all the time, the challenges are great.

It may be advisable to look at flagship models in designated communities for coordinated children's services under some mandated framework of key agencies.

Then there are the macro issues to deal with, such as poverty, unemployment, housing, social acceptance, inclusion and education, all of which then still need to be dealt with at another level.

Thank you very much for the opportunity to share our concerns with yourselves.

The Chair: Thank you. Again, there is no way in the time for questions we're going to be able to deal with all of the very thoughtful points that you've made, but we will do our best in the time available.

Mr Hope: I'm curious as to the first presentation and the challenge "Talk the talk, walk the talk." In the 1980s, we found problems in our community. We went out and found funding for that problem, whether it was through Community and Social Services or through the Ministry of Health. Today we're faced with constraints, which was put forward in your presentation, and I'm hearing the word "integration" of services.

I can just see Health and Social Services -- Health, which is funded 100%, Social Services, which is funded 80% -- sharing resources. I go through that with children's services in my own community. You talk about sharing services. It's like the barricades come up and they prevent each other from participating with one another.

My understanding, and through my conversations, because I've been a strong pusher -- I'll tell you, I've faced nothing but resistance from communities that said, "Once this government's gone, our funding will be restored and our financial problems will be over with." I beg to differ with them on that issue, but I'm sitting there and I hear the word "integration" of services. I hear the saying, "The government take action." I don't hear the communities putting out plans. Yes, they're working closer together, but I don't see them -- when I look at children's services, for instance, the administrative bodies and all these agencies, the communication level.

It's easy for us to say, "I have a perfect proposal that I could put forward and lay on the table tomorrow." I'll guarantee you that those who are going to be affected by possibly losing jobs and putting more front-line workers into place are going to be right up in arms, turning the political spectrum back on the politicians, "Why are you doing this?" We've seen it with long-term care, and if we try to do it with this -- I understand the comment you made, and I agree with it, but I think the people who have to talk the talk and walk the walk are not just the politicians but those agencies that have had the benefits of the 1980s and now are faced with a structural change to deal with the social-economic issues that are in our communities, the integration and combining of acts so that we can work closer to children.

I get inflamed when I'm being told, "Walk the walk now," or, "Walk the talk or talk the walk, politician, now," but the first time I put an initiative out in the community, it's like major opposition comes from those funding agencies that say, "Don't touch me." I just wanted to respond to the first presentation, because I was sitting here patiently waiting for a chance to ask a question on that one.

The Chair: I sense some trauma here.

Ms Tataryn: I think we could probably all respond with some comments to that. I had the opportunity to hear a little bit about the comments from the earlier presentation related to turf protection and difficulties in working together, so I don't doubt for a moment that those difficulties exist in the community. But I think we do have some models in some of the communities in Ontario. Actually, I think London is a very good example where there have been extraordinary efforts to reduce those barriers, and there are other model flagship programs across the province also.

My experience is that it is a struggle between issues of enhancing service, which still needs to happen. Although there were the booming 1980s and new programs, I think you've heard all three of us speak about a need for enhanced services for high-risk groups and the need to coordinate the services.

In our community, we've attempted to streamline and coordinate some services, and there has been resistance to that. The reason there's been resistance to it, though, has not been from the perspective that we don't need to be better coordinated. It's a reluctance to put funds into administrative, coordinating bodies and a real need to move funds to the direct service level.

I'm not sure that the reluctance is always to protect what one has but I think a concern that in some way if we move towards a coordinating mechanism, what we'll see grow in front of us is yet a new monolithic administrative, coordinative mechanism which will rob the direct services from the community. That's one observation that I might have.

Dr Susan Bradley: I wouldn't mind picking that up, because in one of the recent research reports that's come out from the Better Beginnings project, which is an excellent example of the community being required to bring all its forces together, one of the main recommendations is that the ministries have to still get their act together because they are continuing to do things that interfere with program development at the local level. It cuts both ways.

Ms Adam: I'd certainly agree that it's an extremely difficult task, but I think it is possible. I might be somewhat naïve, but I think it is possible. It's like you need a few leaders within a community as well, perhaps with yourself, for example, in your area. You could start to develop that connection around communication and try to challenge a few of your agency leaders to work together.

l know we had an interesting experience in London when we were coming together with about 15 agencies around a table to put together a proposal for the quick response for the elderly proposals. We all started kind of holding on to our little bag of resources and not wanting to give too much and not wanting to say exactly what you had and that kind of thing. We realized in the end that we weren't going to get any more money. I shouldn't say that, but London probably is not going to get their proposal approved.

But what we decided to do in principle was to agree to improve our services in spite of no additional funding. I think the relationship and the communication we had in that planning group -- we are now continuing to meet and looking at streamlining services and looking at collaborating together. I think the message comes really slow in terms of "You've got to work together and partner," but it is coming. Those things can get quite exciting in terms of the planning of them.

Mr Hope: We could interestingly have a conversation about this, but I notice Mr Beer wants to move on with further questions, because the issue about envelope funding in children's services has been brought up. Human services boards are a key factor in dealing with the socioeconomic issues and the community issues, to be more flexible models.

Ms Adam: I think if you start, though, from people having to give up some of their resources right off the bat, you're probably going to meet with the resistance, but if you can start with people working towards the common goal of their services meshing together for children, I think you're going to get further ahead.

Mr Hope: Do we have enough time? That's the question.

Ms Adam: Probably not, but I guess you've got to start where you're at.

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Mrs O'Neill: I'd like to thank each of you for coming. I know a little bit about each of your hospitals. I know for sure that each of the communities that you are located in values you as one of their best resources. You have very special spots not only in their heads but in their hearts, and I feel that those have been gained through experience.

I'm going to go to Ms Tataryn because that's my community, and I have to make a choice. The McHugh school that you've brought forward, I'm very pleased that you chose that as an example and I think you've described it very well here. I wonder if you could bring us up to date on just where you see that at the moment. Is there a future for the school? Every year about this time, I start to get letters from worried parents about that facility and I just wonder if you could tell us how you see it at the present time.

Ms Tataryn: I'm pleased that you've asked that question because I can speak further to Mr Hope's question about coordination.

The issue around schooling for children who have severe emotional issues touches on the health, social service and educational sector, and it is traditionally an arena in which the ball has been bounced back and forth between those sectors.

My earlier comments related to each institution reviewing mission statements and becoming more narrowly focused, and there is no doubt that for some of the section 27 schooling programs for emotionally disturbed youngsters, when CHEO and other hospitals have reviewed those programs, they have not perhaps ranked as highly as some of the programs that we've heard described here in terms of the traditional medical needs of head injuries and chronic and terminal illnesses.

What has been put together in Ottawa-Carleton is, I think, quite a heroic effort between Health, Community and Social Services and the Ministry of Education, with funding from all three ministries to develop a community plan for the McHugh program. At this point, June 1994, we're halfway done in the development of a plan for Ottawa-Carleton for all of the McHugh programs. It has not come through any turf protection; it has come through all those ministries sitting down and meeting, literally, weekly, deciding what's Health, what's Community and Social Services, what's Education, keeping in mind that the bottom line is the numbers of kids in our community who continue to require the service, wherever it's delivered and however.

I feel very optimistic about that as one example. It came through a crisis, though, I will tell you. It came because parents protested so loudly and said, "You three sectors must work together, because we cannot bear this burden ourselves as parents; nor can the school system." So I feel optimistic that we will have a plan in our community for that McHugh program that will be truly collaborative.

Mrs O'Neill: Thank you very much. I'm very happy to hear that.

Mrs Cunningham: I just think we're so lucky in Ontario. You represent three of, I think, the more important hospitals in the world. People are usually looking to us for leadership, and one of our great strengths is that we're always looking for doing things in a better way. But given the demands in society and how things have increased in the last 10 years, it's just getting ahead of even the best of everybody.

I have two or three questions, and whoever answers would be fine. I did get the message that we'd better look into the funding for Victoria Hospital: "Children's Hospital of Western Ontario for the Ministry of Health." I noted that one on page 6, so we can talk about it.

But before I start, the different ministries do get in people's way. We spend so much time -- and this is for my colleague and friend Randy Hope -- asking people to put together grant proposals. If we had that kind of energy and we could put that into the front lines with individual families -- and I know you share my concern and you've seen it as a member of the government. That's one of my greatest beefs.

My other one stems from my work at Merrymount Children's Centre in London where I, in my professional life, would have dealt for some seven years, along with one of my great colleagues who's worked with both of you, Jan Lubell, where we saw these parents just being pushed from pillar to post. I mean, they had no idea and they couldn't get their cheque or they couldn't get their money or they couldn't get help unless they went to the doctor and the school and the Madame Vanier. There have to be models. So I was happy to listen to Dr Bradley mention that there are models that are working, and we should be building on those that are working.

I don't know where to start. I also heard Dr Bradley talk about the ministry for children, and we're seriously looking at that. But if it's more people talking and not more front-line services, we've got a problem.

There's great turf protection in London. When we get into something -- and maybe you have too in your community, Mr Chairman -- where somebody has to give us funding, even for things we've already got the money for, to allow us to spend the money, like at Victoria and St Joseph's, it's been a year of everybody's time. Perhaps you see it as well, Yvonne. So much is going into pleasing the bureaucrats and getting through the system, and there's so much red tape. I don't know if one more ministry would be helpful. Maybe if you say there's going to be another ministry but only a third of the people who are working right now can work in the ministry, or 10%, and everybody else has to get out and do what they were trained to do, it would be very helpful. I don't know.

You've heard my concerns. How do we make it simple for parents? They have to work with their children who are at risk. I am one of those parents, I have a child who's at risk, and if I had done all the things I was asked to do, I'd have to go 24 hours a day; there would be no time for sleep. I had to make a choice.

Ms Rosen: To address just part of that, one of the things we have had as part of our commitment has been to look at some of the high-risk groups and say that probably these people need a person to help steer them through the system, and we've allocated resources for what could be called case managers -- in most instances they are nurses -- people whose job it is to help finesse the way; not necessarily taking over totally from the family, because to a degree there's a certain amount of independence that should become a part of the recovery process for families as well, but just paving the way, even for referral back into hospital.

But it is very difficult, when pushed to the wall, to show -- one is not allowed to randomize the groups within each subset and say: "This part of the room is going to get this nurse looking after them, and this part isn't. We're going to follow these families for the next 10 years and see what effect it has." Because that would really be the only way you could substantiate that having the person there was better than not, it becomes very difficult to substantiate.

As we get more and more pressured and as the technology is available, thank goodness, because of medical advances, we are going to be faced with more and more at-risk populations that we'll have to put front-line care givers to because that's where it makes a difference for people, and I'm not sure where we're going to pull them from. It's a never-ending dilemma, but that's part of our dilemma in terms of care delivery, and then on top of that we have to spend time arguing or debating or figuring out how to move through the ministries and the turf.

Mrs Cunningham: Do you think the demographics of our society may be helpful? There are a lot of people who are retiring early and still have a lot to offer, and they could be doing volunteer work. Many of them come into my office who would be willing to work and retire even earlier than they are already. Heaven help us, some of our best people are choosing to go because of the stress. But they'd be happy to come in for two or three part-days and work for nothing or be volunteers. I think there could be more energy put into that area of helping, especially when we've got children. So many people are interested in helping children, but I'm looking at some people who know a lot about volunteers. Is it worth pursuing, or what can we say there?

Ms Adam: We're always more than happy to look at using volunteers, and we have an awful lot of them. Where we find a little difficulty is having the time to come up with some innovative programming so you can use them effectively.

I would just like to go back to the one point about this business of, how do you start and where do you get at it? Because the structures are so massive and there's so much overlap, with pieces of information here, there and everywhere and not everybody knows the total workings of all the departments and the services, my own training tells me that you start in some small place and start to develop there; maybe you start a few small pilot things here and there. But get the people who are in service provision together and start to figure out what it is we would change, like: If we had the miracle happening overnight, what would it look like tomorrow, and how do we start getting that in our local area? Maybe that then starts to change the policy and the structures and the bureaucracies, because if you start from the other end, I honestly think we're immobilized.

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Mrs Cunningham: I have to agree with you, because when I worked for one of the ministries it was one of the worst experiences of my life because of the red tape and not being allowed to get the work done. It was truly the worst position I've ever had in my whole life, working for a government ministry. It was a fairly high-profile job, which I've shared again with my colleague who keeps smiling at me. It was so frustrating, because the front-line people did come up with the models that would work and were prepared to do them and in fact it didn't take more money, but somebody in some powerful position just decided it wasn't worth putting it forward. I lived like that for a couple of years of my life and just had to leave. You can be assured that if anybody wants my expertise down the road, if we're fortunate enough to get into government, I would have no patience for people like that.

I think you're right. Starting all over and just saying -- and it may vary from community to community, given the resources, am I correct? There's the way you might do it in your community, and listening to Yvonne talk about a school that obviously is very successful, and Randy talk about his frustration, all of us have strengths in our communities that we should be building on. It goes back to using the models that are working and building on them.

Ms Adam: Each community has its own demographics as well in terms of the types of groupings.

Ms Tataryn: I think one example is long-term care, where there have been tremendous gains made in the area of what we might call one-stop shopping or multiservice agencies. There are models now close to being implemented, as I would understand it. What that guarantees for families is at least a place to enter the system, a place to know where to call.

An anecdotal comment about our hospital is that when people call looking for services in the area of sexual abuse treatment, once you say, "I'm sorry, we don't have any services to offer you" or "We have a long waiting list," and a parent says, "Where could I call?" or "What could I do?" or "Could you help me?" you almost de facto become their case manager and you then begin the process of trying to find services for them, to service-broker for them. There's a reluctance to do that because of the dearth of services, so people are frantically looking for the proper place to call. They have their names on waiting lists in every different program in every different part of the community because they don't know where to call.

I guess my response is a hopeful one. There have been models developed in problematic areas of care such as long-term care that could be moved over, transferred over, superimposed on an area of children and youth, with similar guiding principles that were elaborated in the Children First document: ease of accessibility, services to the hardest to serve etc.

Mrs Cunningham: I would agree with you that there have been some gains made in that regard, if other things didn't get in the way. I think the individual who is getting the service has to have some choice, and one of the great concerns we have in London is that that's not the case. People who have home care providers right now are told they can no longer use them because they happen to be working in a private sector agency. That's wrong, but we have governments from time -- I don't mean to be political, but that is a big mistake. The best service provider is the one who has to provide it.

That's the kind of red tape and stuff that gets in the way of having people be excited about their work. Right now they're very depressed and frustrated. I would agree with you, but I had to throw that in because I think it's an example of the kinds of things that stop progress for a long time. It's just one of those things that's happened.

The Chair: I'm going to have to jump in. If you would like a final response on any of that, please go ahead, but we are going to have to close.

Ms Rosen: I'll keep it short. I was just going to echo your comments. The long-term care reform in principle is a good model, but the complexity -- what we find is that to broker the services we need to enable these medically fragile children to go home often requires us to subcontract to a number of agencies, all of which have very unique expertises, and that's throughout southwestern Ontario. If we had to negotiate our way through a morass of bureaucracy to do that, it would become a nightmare and it would be far easier to keep the children in hospital. I would plead that any model that is developed has got to be an enhancement of the principles that are inherent in the one that has just been tabled.

The Chair: Probably the experience of all of us here, the longer one is at Queen's Park, and certainly my own experience as minister, is that you have to find something at the community level to solve a lot of this. You clearly need support and you need the ministries that work together, but somehow it seems that if you try to run everything from Queen's Park, it inevitably fails. The critical tension is to find the direction and the funding but then the flexibility at that local level to do the kinds of things you've been talking about.

Our discussion today has been very helpful. As we go through this, we've heard a number of interesting ideas and some themes that are starting to emerge. On behalf of the committee, I thank you all for coming here today. You've left us a lot of material, and we appreciate that.

With that, committee members, I note that we will be returning to this subject next Tuesday, June 7, but we will reconvene on Monday at 3:30 to deal with Mr Ramsay's bill, which we will deal with on that one day.

Mrs O'Neill: May I ask when we'll get the draft?

The Chair: There will be a subcommittee meeting, Mrs O'Neill. We have a number of issues we are going to have to discuss.

Mrs O'Neill: Will that subcommittee meeting be before next Monday?

The Chair: We'll work that out shortly.

With that, the committee stands adjourned until 3:30 next Monday.

The committee adjourned at 1817.