Section 4: Recommendations

Principles

The Panel identified ten principles that underpin their recommendations:

1. All young people must be involved and at the centre of their care, and given the ability to influence their care based on their knowledge of themselves and their situations. Their voices must be heard, believed and prioritized.
2. All young people must have the opportunity to learn about, understand and experience their history, culture and its customs and teachings.
3. The care of and service provision to young people, families and communities must be wholistic, prevention-focused and driven by their needs. It must ensure that the physical, mental, emotional and spiritual needs of young people are met.
4. Indigenous communities must be enabled, supported and funded to bring forward their needs and to further develop their methods of addressing their needs.
5. Indigenous communities must be enabled, supported and funded to self-govern in a nation-to-nation relationship with Ontario.
6. Caring is an action. Care must be provided with a continued sense of purpose and a focus on the young person’s future.
7. Caring is a shared responsibility that crosses organizational, sectoral, geographic and jurisdictional boundaries. Barriers between systems must be eliminated or be made unnoticeable to clients.
8. Children must be kept at home wherever possible – and when it is not possible, they must be in stable, nurturing placements for as long as required with as few moves and transitions as possible.
9. Services must be provided to young people and their families where they are, wherever possible. Where it is not possible, distances should be minimized.
10. All young people must be in school or participating in equivalent learning

Recommendations

The Panel developed five recommendations they believe would make a fundamental difference to Ontario’s young people and the overall burden on Ontario’s social service system – now and over the longer-term.

To the Government of Canada and the Government of Ontario:

1. Immediately provide equitable, culturally and spiritually safe and relevant services to Indigenous young people, families and communities in Ontario.

Specifically:

• Address structural barriers to wellbeing and ensure that every Ontarian, including those living on-reserve, has access to food, clean water, housing and education.
• Enhance service availability in Indigenous communities; specifically, the availability of safe placements for young people on-reserve, in environments identified by the communities.
• Provide equitable resources to design, develop and deliver culturally safe family care, a range of prevention and ongoing support services and to build local capacity for early response to needs.
• Enable Indigenous Child Wellbeing Societies to develop their own models of care while maintaining current models, and allow for transition period and supports while implementing Indigenous preferred models of care.
• Provide funding and programming to support family healing from intergenerational trauma in Indigenous communities.

Comments from the Panel

Eight of the young people reviewed were Indigenous. All eight were from reserves in Northern Ontario; many of those reserves are remote. Those whose families of origin were located on-reserve were notably more disadvantaged amongst the group of young people reviewed by the Panel.

In several of the cases reviewed and in feedback received from young people with lived experience, it was clear that there are stark and startling inequities and structural barriers that limited these young people’s potential. In some cases, access to food, clean drinking water, and/or adequate housing were unavailable. Likewise, access to education, recreation and healthcare was either limited or unavailable. The Panel asserts that where basic needs are unmet, the capacity of families and communities to adequately support and care for each other is severely compromised.

This capacity is further impacted by historical and current colonialism and intergenerational trauma that remains inadequately addressed in many Indigenous communities including the home communities of the young people reviewed by the Panel.

It is the assertion of the Panel that until such time as these inequities are resolved and Indigenous communities are supported and enabled to heal and implement their preferred models of care, their young people will continue to be at disproportionate risk of severe and ongoing disadvantage, harm and of admission to care.

To the Ministries of Children, Community and Social Services, Education, Health and Long-Term Care, and Indigenous Affairs:

2. Identify and provide a set of core services and support an integrated system of care for young people and their families across a wholistic continuum, to every child in Ontario. Services must include health, mental health and wellbeing, education, recreation, child care, children’s mental health, early intervention services, prevention services and developmental services. Service provision should be geared to the needs, and intensity of needs, of each young person and family.

• Undertake community needs assessments to identify service gaps and opportunities for service realignment against the identified set of core services.
• Address systemic pressures, inequities and gaps in the availability of mental health treatment beds for young people.
• Define and make public standards pertaining to the geographic availability of each core service.

Comments from the Panel

The Panel observed that none of the twelve young people, their families or communities received coordinated and integrated care from the outset of their involvement with the systems designed to protect, safeguard and help them – including child protection, children’s mental health, developmental services and other service organizations. In all of the histories it was clear that service providers were not communicating with each other or taking a collective view of the young person’s needs, resulting in gaps in care. Education did not appear to have been a priority focus and there was frequently a lack of detail regarding the educational experiences of young people. This made it difficult to determine the degree to which they had access to education or educational models that could meet their needs. The provision of mental health care was particularly infrequent, and in some cases, nonexistent in the face of obvious and identified needs.

Many of the young people reviewed by the Panel interacted with multiple systems of care. The services they received were fragmented and more often than not, service provision was driven by the structures and systems in place, rather than the needs of the young people, their families and communities. For example, in many cases child protection services facilitated the pathway to children’s mental health services or counselling, because they were the most adequately equipped service provider in a geographic area. In other cases, there was an absence of structures in place that limited service availability so severely that young people, their families and communities did not receive, and often were not offered, the services that were necessary. This experience was most pronounced in Indigenous communities in the Far North, but was not exclusive to those populations. The Panel observed similar limitations and barriers in Southern Ontario and non-Indigenous contexts as well.

There appeared to be minimal capacity across Ontario to respond to these 12 young people’s multiple complex needs including, but not limited to their mental health needs. It is clear that some young people in Ontario require specialized mental health treatment placements. The availability of mental health treatment beds is declining in Ontario and is inconsistent across the province. Ontario should plan for and meet anticipated needs for these types of services to ensure that young people do not fall through the cracks and are not placed in inappropriate environments as a result of the lack of specialized treatment placement options.

Many of the young people reviewed did not have access to important services within a reasonable geographic distance, which resulted in frequent moves, or lack of access. While the Panel recognizes that not all core services can be provided in each community in Ontario, standards should be in place regarding maximum distances for core services. For example, schools should be available in each community in Ontario, including each First Nation.

3. Develop a wholistic approach to the identification of, service planning for and service provision to high-risk young people (with or without child welfare involvement) that supports continuity of care to age 21.

• Develop and implement wholistic, standardized screening of all young people that come into contact with child protection societies at the point of first and each subsequent involvement, to identify those who are high risk.
• Undertake a comprehensive assessment of the needs of the identified high-risk young person at the earliest opportunity.
• Provide a Navigator for each young person identified as high risk, to act as a stable relationship in the young person’s life, a natural advocate, the lead amongst service providers and the person responsible for planning to enable continuity of care.
• Establish local transdisciplinary teams responsible for service planning for young people identified as high-risk youth, regardless of ongoing child protection involvement. Include the Navigator and Indigenous Elder(s) as part of the team.
• Enable information sharing amongst service providers based on mutual service provision, regardless of the presence or absence of client consent.

Comments from the Panel

Many of the young people reviewed were undoubtedly at high risk, but did not appear to have been assessed as such. While risks to safety and harm were assessed frequently during child protection intervention using the child protection required tools, the tools were not intended to, and therefore did not, identify the constellation of factors involved in their personal circumstances as high risk; child protection interventions did not appear to consistently do so either. Many of these young people were at high risk for reasons that were not directly associated with the reasons for child protection intervention (e.g. their cognitive ability, presence of multiple complex needs, minimal supports) and may not have been best serviced by child protection intervention – though in some cases, no other providers were actively engaged. The long-term risks to the young people’s wellbeing, and the predictable outcomes if services to address them were not provided, do not appear to have been considered in many cases.

The Panel is recommending the development and implementation of a standardized and consistent screening tool to better identify young people at high risk who may be vulnerable and/or require more intensive service provision. Many screening tools exist that could be adopted or modified for this purpose within a short time frame. In addition, options for the administration of the tools should be explored; many tools could be administered by trained people in the community, and would not have to be administered by Society employees or others with professional skill sets – an option that could reduce the overall cost and administrative burden of implementation.

Once identified, understanding the needs of young people is vital to providing services that are responsive to their needs. In the majority of the histories reviewed, there were significant and serious gaps in knowledge and understanding of their needs. In some cases, assessments were never completed or completed but not followed through.

Comprehensive assessment of young people will help ensure an ability to identify what their needs are and which service providers should be involved. The Panel felt strongly that being high risk does not automatically infer that placement is required, though this was seen to be the case in many of the histories reviewed. This model is intended to support early identification and intervention, thereby preventing risk of harm and avoiding placement outside of homes of origin whenever possible. This could take the form of ongoing, in-home family support intervention.

The establishment of a transdisciplinary team in a circle of care model will support a collective understanding of what is available, possible and feasible for the young person. It will also provide clear delineation of responsibilities based on a philosophy of shared responsibility and knowledge. Teams should support planning for young people and their families as well as service provision, and should hold each other accountable. They should be customized based on what is available in each community, but should include all core service providers (see Recommendation #2) and all other relevant service providers (e.g. educators, Elders, teachers, mental health and addictions service providers, youth justice, social work, psychology, psychiatry, etc.). Elders should be included in each community to inform service planning and provision to Indigenous young people. Participation should be mandatory and information sharing amongst team members should be enabled. Input from the young person and their caregivers should be incorporated into service planning.

The Panel found that young people did not have advocates as a result of multiple placements and their distance from their home communities and natural support systems. Consequently, the Panel recommends that where a young person identified as high risk, requires multiple services and supports and/or is experiencing frequent placements a “Navigator” should be assigned to support them until age 21. The Navigator becomes the person responsible for leading and facilitating a wholistic approach to planning and service provision. The Navigator would provide a stable relationship and would act as the point of contact as well as an advocate for the young person. They should be responsible for guiding care planning, delivery and enabling continuity of care. In order to adequately fulfil this role, Navigators should have facilitation and case coordination skills as well as experience working with young people and families.

4. Strengthen accountability and opportunities for continuous improvement of the systems of care through measurement, evaluation and public reporting.

• Collect, link and integrate data across all children’s services (whole of government approach) to facilitate accountability and enable evidence-informed treatment models to be put in place.
• Identify indicators and outcome measures to enable assessment of youth experience, measure and publicly report on them.
• Institute mandatory public reporting on placement availability and placement achievement of quality standards.
• Streamline documentation completed by children’s aid societies and Indigenous Child Wellbeing Societies so that necessary information is recorded accurately and in a timely fashion.
• Fund evaluation of service delivery explicitly.

To improve the system, we must first be able to understand its’ complexities.

Over the course of the Panel’s work, several different pieces of data were requested from the former Ministry of Children and Youth Services (now MCCSS). Detailed review revealed that there were several challenges pertaining to data collection. Data is not collected in several areas that the Panel considers key – for example, no data is collected in a standardized way on number of placement moves or the cost of a day of care in a particular type of placement setting. It did not appear that the data collected would enable the ministry to have a sound understanding of service availability, provision or total cost in order to exercise good governance and fiscal oversight.

Furthermore, the data that is available is not linked to data from other ministries; so, for example, it is not possible to electronically determine the placement dates of stay for a child that moves between a residential placement and hospital (either inpatient, or more frequently, emergency department visits) or to align it with a child in care’s educational history based on Ministry of Education’s electronic records. The absence of this information, both at the individual and aggregate levels, results in serious gaps in the ability to assess outcomes, service experience, service availability, provision and total cost.

While service availability and provision are important from an accountability perspective, so too is performance. The Panel found no evidence in the material reviewed that service availability, provision or performance are well understood from a systemic perspective. Consequently, the Panel is recommending that data be collected, linked and integrated across all services to facilitate accountability and enable evidence-informed treatment models to be put in place. Furthermore, the Panel is recommending that service agencies be funded to conduct program evaluations, separate from their core funding, to help assess efficacy and inform continuous improvement.

At the core of service provision to young people is a desire to improve their wellbeing. The current system does not provide a great deal of information on how young people in the province’s care are doing. Children’s Aid Societies and Indigenous Child Wellbeing Societies are required to publicly report fiveperformance indicatorsreflecting the safety, permanency and well-being of children and youth. Only one indicator pertains to wellbeing; the quality of the caregiver-youth relationship for children in care (the others pertain to safety and permanence). There are several limitations on the use of this indicator and the population that is measured is quite small relative to the number of children and youth that have child welfare involvement. The Panel suggests that additional indicators and outcome measures to assess youth experience are required.

In addition to how young people experience their care, it is also important to measure the quality of the care. The Panel recommends that the ministry institute mandatory public reporting on placement achievement against defined quality standards (see recommendation #5).

Independent of quantitative data that is collected, qualitative data is also routinely collected through mandatory documentation completed by Children’s Aid Societies and Indigenous Child Wellbeing Societies. This documentation is meant to inform service planning and provision, as well as reporting to the ministry when serious incidents occur. In the comprehensive review of the files associated with the 12 young people, it became clear that in many instances, the documentation was completed for the sake of completion, rather than for its intended purpose. This conclusion was based on the sheer volume of repetitive entries that were seemingly cut and pasted and the presence of information that did not relate to the subject youth in a number of instances. Another issue was that the reports were often filed later than the required timeframes. The Panel recommends that the Ministry conduct a review of the documentation that is completed, and streamline it where possible so that necessary information relevant to the subject young person may be recorded in a timely fashion.

To the Ministry of Children, Community and Social Services:

5. Immediately enhance the quality and availability of placements for young people in care.

And specifically:

• Establish quality of care standards for all placement environments, identify clear mechanisms to achieve the standards, and measure and monitor to ensure implementation and ongoing maintenance. Standards should also apply to any auxiliary programs or services offered by the placement.
• Undertake a government-led planning process to plan for and implement placement availability across Ontario, based on identified need, and establish clear and transparent placement access mechanisms.
• Issue a Directive to Children’s Aid Societies and Indigenous Child Wellbeing Societies that directs societies to place young people:
  • In licensed care environments only;
  • In the highest quality placement available;
  • In environments that are able to meet the identified needs of young people;
  • With a view to stable, nurturing placements for as long as required that ensure as few moves and transitions as possible; and
  • As close to their home communities as possible, where this does not present a safety risk.
• Expedite the development of a human resource strategy for the residential placement sector to address recruitment, retention and skills of caregivers. The strategy should include:
  • Pre-service educational qualifications/standards for staff of placement environments
  • Mandatory pre-placement training to foster and customary caregivers including, information on support to young people with mental health challenges, fetal alcohol spectrum disorder, developmental challenges, substance use, the impact of social media and the internet on young people, and human trafficking.
  • A northern recruitment and retention strategy across all children’s services to support the development of a local, skilled workforce based on a needs assessment.

The majority of the Panel’s recommendations focus on supports that optimize the potential for young people to stay at home with their families. The Panel recognizes that when safe care cannot be provided in the home, out-of-home placements are a necessity. The Panel felt strongly that safe, high quality placements that are as close to home as possible should be available for the young people who need them.

The Panel’s review found that placements appeared to be selected based on availability rather than on suitability. Placement availability and access mechanisms were not well understood, their quality varied considerably, their licensing status was variable, difficult to understand and inconsistent across the Province, and those responsible for caring for children were under-skilled for the task.

The Panel does not believe that the current licensing system provides insight, monitoring, accountability for quality of care in placement environments, and notes that quality of care standards are distinct from licensing standards.

Many placements offer auxiliary programs and services in addition to being a place of residence. These sometimes include section 23 education classrooms, mental health services or other programs. Quality of care standards should also be in place, measured and monitored for these programs and services, where they are provided.

It was also clear that the current system does not direct the availability of and access to placements based on predictable need close to young people’s home communities. The Panel suggests a government-led process to identify need, plan for and implement availability of licensed placements to better facilitate equitable access in a cost-efficient manner.

The Panel noted that a workforce development strategy is going to be under development by the ministry, with implementation planned for 2025. The Panel asserts that having skilled workers taking care of young people in licensed placements should be a key priority, and that work towards achieving these improvements must begin immediately in order to mitigate risk to the young people in Ontario’s care.

“A lot of these recommendations seem like basic human rights.”

Youth responses to recommendations

Three groups of young people with lived experience were brought together in Kenora, Thunder Bay and Toronto to provide insight in support of the Panel’s work. Following the Panel’s meetings, the groups were brought back together. Staff of the OCC shared the Panel’s recommendations with them, and asked how the recommendations could impact youth experience and, if implemented, they would make things better.

Overwhelmingly, the young people were supportive of the recommendations. They felt that if implemented, the actions suggested by the Panel would have a positive impact on the wellbeing of young people in their communities.

Some of the things the young people highlighted in relation to the recommendations were:

Equal opportunities for culturally and spiritually safe, and relevant services to Indigenous young people, their families and communities.

Indigenous young people asserted that it is important that their basic needs are met. They noted that the United Nations Declaration on the Rights of Indigenous Peoples should be honored and implemented in Ontario, and these rights should be taught to Indigenous young people early in life.

They commented on the need for mental health services on-reserve to be available 24/7, and for service providers to be consistent; explaining that calling in help takes days and often times, people cannot wait that long. They also explained that communities need more education on suicide prevention.

Young people explained that services should be available in the Indigenous languages spoken by the people they serve. Service providers should be committed to long-term service provision in communities and should be culturally informed, qualified, and prepared for what living on-reserve is like. They spoke of the importance of service providers working in their communities for the ‘right reasons,’ not just to make money.

They explained that standards for Indigenous homes should be different. Extended families are important in Indigenous communities, and they could care for young people when their parents are unable to.

They asserted that non-Indigenous and Indigenous people should work together and suggested that non-Indigenous government employees should visit reserves, before making policies and programs that affect people living there.

They emphasized the need to apply Jordan’s Principle, and explained that young people should be given opportunities to understand it.

Core services and an integrated system of care:

Young people highlighted the need to be connected to services before they transition out of care and suggested that an aftercare program would be helpful.

Substance use treatment services, counselling and traditional healings services for Indigenous young people were identified as particularly necessary.

Young people suggested that access to education should include access to opportunities outside of mainstream education as well.

Young people explained that mental health diagnoses should be a priority, however; young people should not be shuffled through multiple doctors because this can result in a ‘sea of diagnoses,’ negative labels attached to them and being heavily medicated.

Identification of, service planning for and service provision to high-risk young people:

Young people indicated that some young people are high risk because of their parents so it is important to heal both the parents and the children.

Many young people were in agreement that service providers should be able to share information about the services being provided to high risk young people. However, some had concerns about sharing confidential information provided in a counselling context amongst service providers, noting that trust is a significant issue and sharing without consent can compromise that. Young people warned that service providers would need to take care not to disclose information that young people share in confidence, unless it is for necessary for safety reasons.

Young people shared their feedback on the role of a Navigator for high risk young people. Most felt that the Navigator would be a useful resource and liked the idea of having someone “in their corner.” Others asserted that if there is a Navigator, they must be ‘fighting for the young person and no one else’ instead of working on behalf of the foster parent, staff, or other service providers. Some young people felt that this is the role of the Society worker and worried that if there was another type of job, there would be even fewer workers available to do Society work. They felt that whether there is a Navigator or not, there needs to be work to improve Society worker turnover so that young people are able to establish relationships and build trust.

There was a suggestion that the Navigator role should also monitor medication changes in young people because they can occur frequently and are often overlooked or are not well monitored.

There was also a suggestion that there could be a partnership with the organization Big Brothers, Big Sisters in order to identify Navigators.

Strengthened accountability and opportunities for continuous improvement:

Young people with lived experience from all over Ontario need more opportunities to provide input and there should be more youth outreach. In particular, young people in foster homes should be asked how they are doing and their voices should be heard.

Some young people felt that evaluations of service delivery would not mean anything because they felt it was unlikely anything would change as a result.

Some young people were very supportive of licensors doing unannounced visits to children’s residences; work to implement this type of oversight is currently underway by the MCCSS.

Enhanced quality and availability of placements:

Young people felt that the child tax benefit should stay with the child, instead of it being provided to Societies. They saw this as a violation of their rights.

Young people asserted that placements outside of home communities don’t allow young people to maintain connections with their families and should be avoided. They suggested that there should be a deeper understanding of a young person’s needs when they come into care so that placements can be matched accordingly and are based on need rather than availability. They highlighted that there should be a focus on the differing needs of young people in placements. For example, if one young person has higher needs than others,’ the staff or caregiver’s attention can be occupied by supporting them at the expense of the needs of others in the residence.

If transferring placements (and it is not an emergency), the transition should be slow and thoughtful with visits to the new placement in advance. They noted that multiple placements can be ‘damaging’ to a young person’s wellbeing, and that anything to make placements stable and long-term will be helpful.

There should be more effort in residential placements to understand the roots of a young person’s behaviours instead of immediately responding with a restraint or a type of punishment. Further, there is a need to monitor the frequency of restraints used in children’s residences and the effectiveness of restraints as an intervention.

Licensing all homes was viewed by all of the young people spoken to as important. In some communities, there are not enough foster homes available. If the solution is to have more group homes, all group homes should provide high quality care.

Training for caregivers was strongly supported. In particular, some young people felt that caregivers should have training to understand what considerations are needed to support LGBTQI2S young people.

“It shouldn’t take 12 deaths for somebody to care. It’s been a broken system for years.”