Human resources

Introduction

Residential services across sectors rely substantially on human resources for the purpose of meeting the needs of young people. From a budgetary perspective, human resources account for 80% to 85% of operating expenditures (Gharabaghi, 2009). Evidence with respect to quality of care considerations strongly suggests that relational practices, based on highly skilled human resources, provide for the best and most sustainable outcomes for children and youth living in residential services (Holden, 2009). Over the course of the past ten years, demands for ever more complex evidence-based interventions, inter-disciplinary collaboration and family systems-oriented approaches to being with young people in residential services have accelerated across sectors, and service providers across sectors are working hard to embed such practices and approaches within their programs. This places significant pressure on human resources involved in residential service provision to keep pace with the increasing complexity and demands of the work.

Outside of the directly operated youth justice sector, the lack of standards for hiring qualified staff members in residential care settings has resulted in significant variations in the qualifications, levels of experience, compensation, training, and employment conditions of front line staff across sectors. In many instances, this leads to the recruitment of under-qualified individuals as staff members. This frequently results in poor retention and high turnover rates of those under-qualified individuals, creating further instability for the children and youth in their care. Across all of the sectors of the residential service system, promotional standards are often unclear and supervision, in the context of relational and clinical practice, of staff members is inconsistent and inadequate. In addition, training is often limited to in-house mandatory training related to health and safety, policies and procedures and other themes and issues that are not directly related to the everyday experience of young people in out-of-home care.

The human resources typically associated with residential care services include the following:

• Residential care front line staff (group care) – individuals hired to provide group therapeutic intervention, implement treatment plans, develop and support Plans of Care and use every day support and nurture as a foundation for developing pro-social, healthy and stable norms, behaviour and capacities amongst young people as part of a team of such workers. In the context of youth justice, these workers also provide supervision and security related to the legal status of custody or detention. Such positions are either full time or part time and typically operate on a rotating shift schedule.
• Relief or casual workers – individuals hired to replace members of the regular team on shift when the latter are sick, on vacation, attending training or otherwise unavailable.
• One-to-one workers – individuals hired to specifically support identified young people (often with developmental needs in need of arm’s length or in sight supervision, often for safety reasons and sometimes with therapeutic goals attached).
• Residential Supervisors – individuals with responsibilities related to the staffing and scheduling of the program, the supervision (variably defined) of front line, relief and one-to-one staff, and the administrative and programmatic elements of the program. These positions typically also are the main conduit of collaboration and communication with clinical and other services either internal to a larger agency or external in the community.
• In-home foster care support workers – individuals hired to support parenting, caring and behaviour management in foster homes, often to prevent placement breakdown, but sometimes as planned and on-going support. These positions are typically based on set number of hours allocated to individual foster homes.
• Foster parents – individuals who provide care and a home (sometimes temporarily and sometimes with a view to adopt) in their own homes for between one and four young people in care.

Many other kinds of positions play significant roles in residential services, including management staff within the larger agency, owners and operators in the private sector, as well as clinical staff, teaching staff, administrative staff and custodial, maintenance and kitchen staff.

Issues

In Ontario, there are currently no legislated pre-service educational qualifications for residential staff in group care settings (other than in directly operated youth justice secure custody settings) or foster care settings. Residential services (other than youth justice custody services) can hire any person, regardless of educational credentials, who can pass the police record check for the vulnerable sector (only required at time of hire), and who has the capacity to complete a series of mandatory orientation and training requirements.

The orientation period and on-going in-service training of residential staff in group care settings (other than directly operated secure custody settings) are largely unregulated, with the exception of the following mandatory annual or triennial certification requirements:

• Completion of an MCYS-approved crisis intervention package, including physical restraint components (Preventing and Managing Aggressive Behavior - PMAB, Understanding and Managing Aggressive Behavior - UMAB, Therapeutic Crisis Intervention - TCI, Crisis Prevention/Intervention - CPI or Behavior Management System - BMS) and annual re-certification. The minimum training hours for the initial certification is eight (8) hours, and for the recertification is four (4) hours.
• Standard First Aid and CPR certification, in practice required for all front line staff but technically (as per licensing regulations) only for specified ratios of staff teams, with triennial re-certification.
• Completion of on-line Workplace Hazardous Materials Information System (WHMIS) certification.
• Completion of review of residential Policy & Procedure (P&P) manual within the first 30 days of hire, and sign off that P&P Manual has been reviewed annually thereafter.
• Training in the use of fire extinguishers.

The quality of staffing, both with respect to pre-service education and in-service training, has been cited consistently by reviews, reports, inquests, and other studies of residential services in Ontario as inadequate. In 2006, the Bay Consulting report noted:

The report went on to recommend that MCYS should “clearly define quality requirements to help shape staffing considerations such as competencies and training. This might require financial support, particularly in regard to levels of compensation.” (p.83).

Also in 2006, MCYS released A Shared Responsibility: Ontario’s Policy Framework for Children and youth mental health. The framework identified the strengthening of human resources in children and youth mental health and addictions across service settings as a core priority. Ontario’s comprehensive mental health and addictions strategy, Open Minds, Healthy Minds, released in 2011 as a follow up to A Shared Responsibility, again cited training, and also the “building of attractive career choices and pathways for people who work in mental health and addictions” as important strategic directions.

The Blue Print for Fundamental Change to Ontario’s Child Welfare System, released in 2013 in response to My Real Life Book produced by youth in collaboration with the Provincial Advocate for Children and Youth, repeatedly cites the skills, competencies and related education and training as priorities. The Blueprint outlines the competencies required for caregivers (and other professionals) (p.10), and specifically with respect to residential care, cites the proper training and qualifications of staff as an essential priority (p.18).

The Ontario Centre for Excellence in children and youth mental health (2013) conducted a review of evidence related to best practices in residential care settings, and identified a range of approaches that are supported by research evidence, all of which place great emphasis on staff qualifications and on-going training in complex contexts, including trauma-informed care, developmentally-focused programming, comprehensive and integrated programming, and relationship-based programming. Evidence-informed approaches include Positive Peer Culture, Sanctuary Model, Stop-Gap-Model and Teaching Family Model (p.7-8).

The Foster Parents Society of Ontario (2015), children and youth mental health Ontario (2016) and major TPAs such as Kinark Child and Family Services (2015), Robert Smart Centre (2015) and Youth Services Bureau (2015) all have emphasized the increasing use of evidence-based practices in residential services, and the significant complexity of the everyday work. As a result, they all have cited staff development, training and education as core priorities.

Research literature and various reports and documents are replete with emphases on the importance of pre­service and in-service professional development. Whenan, Oxlad and Lushington (2009) demonstrated that training caregivers before and during care is one of the most important indicators of a caregiver’s well-being. According to several studies, group care workers must create an intricate balance of moderate control, therapy and community involvement to achieve the best outcomes for child and youth behavioural development. In order to achieve this balance, workers must possess the adequate training and skills as well as supports (Knorth, Zandberg, Harder, & Kendrick, 2008). Gharabaghi (2009) points out that there is enormous variation in training amongst private residential service providers in Ontario, and that much of the training in children and youth mental health and child welfare is not focused on the life-space context of residential care service provision.

In another study, Gharabaghi (2010) reviewed training events at 130 discreet residential group programs in Children and youth mental health (CMH), Child Welfare and Private Residential Services in Ontario, and found continuous training related to specific disorders or pathologies, as well as safety-related procedures, but very infrequent training opportunities related to therapeutic alliances, team work, residential milieu work and family dynamics and parenting, amongst other themes (p.99).

The Panel raised questions about human resources through the consultation process, and received feedback in this respect from all levels of the residential service system, including young people, front line staff, supervisors and middle management, and executive management. Overwhelmingly there is concern in all sectors about the capacity to attract well qualified staff due to comparative employment conditions in non-residential services such as schools and hospitals, and to retain such staff given limited training and professional development opportunities and ad hoc career mobility processes. Residential group programs in the North and in rural areas in particular are challenged to attract qualified staff.

The Panel heard repeatedly about the inequities in the compensation of residential staff working in directly operated, transfer payment funded and private per diem operated programs. Public sector (children and youth mental health and child welfare) hourly compensation is sometimes as much as three times higher than in the private sector, where such compensation is near, and sometimes at, minimum wage. Benefits are scarce in the private sector, with some service providers not covering sick leave, providing minimum vacation allotments, and no extended health coverage. In many settings front-line residential care positions can be described as precarious employment, generally characterised as poorly paid, insecure, unprotected and with insufficient income to support a household. In the public sector, residential staff members are generally covered for extended health care, receive well above (between three and six weeks) minimum legislated vacation allotments and are covered for sick leave. As one front line residential staff in the near North put it, “if I wanted to make money, I would work at Tim Horton’s”.

Training in residential services appears to vary significantly. Some service providers are very focused on staff development and provide a range of in-house and external training opportunities, often focused on current client profiles. Others, however, cannot afford to pay for training, whereby the cost of training is primarily related to the replacement cost of the staff who are unable to work their shifts while in training. In general, there is a great emphasis on in-house training, with much less external training provided across all sectors. We heard from the management groups of several service providers that evidence-based practices were in place, but then were unable to confirm this with staff groups, who seemed unaware of what such practices might be. In several instances, the representation on human resource development given by management groups did not match the responses of front line staff.

This was also true in the context of supervision. Many front line staff described supervision as infrequent, and when it took place, as not very organized or targeted toward any particular goal. Many supervisors and even senior managers across all sectors were unable to describe a ‘supervision model’, nor were they able to describe the skills or attributes of an effective supervisor. In Child Welfare, Children and youth mental health, and Privately Operated Residential Services, no agency we spoke to identified a well-defined process for promotion to the supervisory level other than frontline experience, and no agency required qualifications for supervisor positions that exceeded those for front line positions. Training for supervisors, across systems, is limited and we did not hear about initiatives to develop or find training related to providing supervision to staff.

Of particular concern to the Panel is what we heard about relief and casual staff as well as one-to-one staff hired under Special Rate Agreements (SRA). These staff are often exempt from the same level of agency-specific qualification required of regular staff, and are almost always excluded from agency training programs, clinical staff meetings, and the supervision process. Even in settings where SRAs are common and several young people are subject to one-to-one workers at the same time, these workers often appear to not be part of any development or oversight regimen of any kind.

In the context of foster care, the Panel heard from foster parents that support provided by most CASs to their foster parents is minimal, and in the case of several CASs, such support is decreasing due to budgetary pressures. Foster parents in private per diem operations had more positive assessments of the supports they receive and also of the responsiveness of their agencies in the context of special circumstances that might arise from time to time. While we heard many compelling stories from foster parents in both public and private organizations that speak to the level of commitment and dedication to young people, we also heard clearly a very high level of frustration on the part of foster parents with respect to their feelings of disempowerment, peripheral roles in decision-making about the young people they care for, and institutional processes and requirements that make it impossible to care for young people in ways that reflect family contexts.

During the Panel’s consultations, foster parents regularly stated that rules for “parenting” are agency-dependent and therefore vary. For example, some foster parents claimed that their foster children were unable to participate in class photos at school and others claimed this was not an issue. In addition, some foster parents were allowed to take their foster children boating or let them drive a golf cart and other foster parents were not permitted to do the same. Foster parents indicated that such rules sometimes come from their agency (either a private per diem operator or a CAS) and sometimes from the Children’s Services Worker from the placing CAS. The inconsistency of rules and regulations across agencies in relation to the responsibilities of foster care parents is of concern to the Panel.

From management groups, we heard that foster parents are aging, and the recruitment of foster parents continues to present major challenges. Eligibility criteria for who can foster, and in particular criteria related to the capacity to provide foster children with their own bedrooms, results in challenges for some cultural communities, in particular Aboriginal communities. This is also the case in regions where real estate costs are very high, and therefore extra bedrooms are scarce.

With respect to training requirements, the Panel heard that while CASs-based foster caregivers must complete the PRIDE training modules, OPR-based foster caregivers are not required to complete this training, and may in fact be denied access to this training if they chose to complete it. While some OPRs provide an alternative, typically in-house developed training schedule, others do not. There is no consistency across OPRs or between OPRs and CASs in terms of the training required of foster parents. In-service training opportunities appear to be more available and better attended in OPR foster care than in CAS foster care.

Compensation for foster caregivers also varies significantly across CASs, amongst OPRs, and between OPRs and CASs. Typically, OPRs provide higher per diem compensation to foster parents than CASs, and furthermore often provide additional funds for foster parents who can then purchase supports as needed, usually with the assistance, and sometimes through the resources, of the home agency.

Implications for recommendations

The Panel is concerned that ever-increasing demands related to the claim of greater complexity of child and youth profiles in residential services, the evidence-based interventions required, and the challenges associated with navigating systems both within larger organizations and between service providers embedded in different sectors are incongruent with the current lack of regulation in terms of pre-service qualifications for residential staff. The evolving context of residential care service provision in all sectors demands more highly qualified staff with an in-depth understanding of the fundamental models, approaches, theories, children’s rights, cultural and system contexts of residential service provision. After many years and many calls for the introduction of formal, pre-service post­secondary educational qualifications for residential staff, it is time to make a move in this direction.

The Panel has a long term vision of designating a diploma or degree in Child and Youth Care Practice as the mandatory pre-service requirement for all residential staff. Child and Youth Care Practice is the only field that is explicitly built on the foundations of relational practices, life space intervention, and ecological and developmental perspectives. With 22 college-based diploma programs and two degree programs, including one about to be launched at the graduate level at Ryerson University, Ontario is well served with graduates in this discipline, with reasonable geographic coverage across the province. However, the Panel is cognizant that the implementation of this vision will take time. In the short and medium terms, therefore, the Panel would like to ensure that all staff in residential services across all sectors hold at minimum a college diploma in a field in the human services. The Panel would not be satisfied with lesser levels of qualifications similar to, for example, the Personal Support Worker context, where post-secondary certificates are required.

Furthermore, the Panel is very concerned that significant numbers of staff employed in relief or casual positions or in one-to-one positions to care for particularly vulnerable young people are often exempt from even the minimal qualifications currently required of full-time staff, as well as from in-service training and supervision. Therefore, the Panel seeks to eliminate any differentiation in required qualifications for any staff who are directly engaged with young people, regardless of employment context.

Given frequently high turnover of front line staff in residential group care, and the challenges associated with ensuring staff teams are able to manage the complexities of young people’s needs while also maintaining their own well­being and capacity to act as therapeutic supports, the supervisory position(s) in any residential group care setting is/ are of critical importance. The absence of any criteria that acknowledge this central importance in the appointment of supervisors in residential group care is disturbing. Supervision has long been recognized as a vital component of providing high quality residential service to young people. The potential for harm to occur to young people (and also to staff) in environments where an appropriate, child and youth-centered, relational practice informed supervision model either is absent or poorly executed is high. The Panel therefore will move to recommend standardized, high quality, and externally provided certification for eligibility to serve in supervisory positions in residential group care across sectors.

While post-secondary education requirements for residential group care staff, including relief and casual staff as well as one-on-one staff, will elevate the quality of staffing, the Panel recognizes that such pre-service education does not provide sufficient preparation to work effectively, and in accordance with the principles of relational practices, life space intervention, and an emphasis on care, therapeutic practice and the engagement of youth voice in a residential group care context. Therefore, the Panel will move to recommend, in partnership with the Ministry of Training, Colleges and Universities, the development of training modules for new workers, similar in concept to what is already in place in the directly operated youth justice sector, as well as in the context of child welfare-based child protection workers. Furthermore, the Panel is concerned that in-service training activities and professional development opportunities for residential group care staff vary significantly across sectors and service providers, and therefore will move to recommend verifiable standards related to on-going training and professional development with a mix of in-house and externally facilitated opportunities in order to mitigate the over-embedding of organizational cultures in the everyday practices of staff.

The current per diem rate setting process in the OPR sector provides for no planned increases to ensure that operators can adjust staff salaries at least in line with increases in the cost of living. Recruitment for staff in the private sector is significantly disadvantaged compared to other employment opportunities for child and youth care practitioners in residential and non-residential settings. Given that private residential group care represents by far the largest group care sector in Ontario, the structurally embedded obstacle to the hiring of qualified staff within this sector is highly problematic. The Panel will therefore move to recommend a re-assessment of the per diem rate setting process to take account of the need to address compensation inequities for group care staff.

With respect to foster care, the Panel believes that a modernization of foster care in Ontario is needed. Such modernization will require a collaborative process involving a range of stakeholders, including foster parents themselves but also young people and staff supporting foster parents, in order to ensure that fostering in Ontario is consistent with current system capacity and needs. The Panel therefore seeks to ensure that pre-service training for foster parents is consistent across the province, and additionally that criteria for eligibility to foster be considered in relation to the full diversity of potential caregivers and what they can offer to young people, without material obstacles that in effect exclude valuable foster resources from being recruited.

In addition to the modernization of foster care in Ontario, the Panel believes that a provincial recruitment strategy for foster care parents is needed. In the current residential system, the recruitment of foster care parents is agency-based. Every agency that offers foster care services is recruiting foster care parents individually and not in collaboration with other agencies. It is an inefficient way of raising the profile of foster care, and therefore of attracting new and younger caregivers to this incredibly valuable pursuit. A provincial recruitment strategy for foster caregivers will provide a consistent and meaningful understanding of fostering across the province. The Panel has confidence that this provincial recruitment strategy, along with the modernization of foster care in Ontario, has the potential to create a renewed and vibrant foster care system.