Children and Youth — Issue No. 9 — Wednesday, June 4, 2014 (HTML)

Present: Jane Thornthwaite, MLA (Chair); Carole James, MLA (Deputy Chair); Donna Barnett, MLA; Mike Bernier, MLA; Maurine Karagianis, MLA; Dr. Darryl Plecas, MLA; Jennifer Rice, MLA; Dr. Moira Stilwell, MLA

3. The following witnesses appeared before the Committee and answered questions:

5. The following witnesses appeared before the Committee and answered questions:

7. The following witnesses appeared before the Committee and answered questions:

9. The following witnesses appeared before the Committee and answered questions:

11. The following witnesses appeared before the Committee and answered questions:

The following electronic version is for informational purposes only.
The printed version remains the official version.

REPORT OF PROCEEDINGS
(Hansard)

SELECT STANDING COMMITTEE ON
CHILDREN AND YOUTH


CONTENTS
Page
Presentations	234
P. Lacerte
V. Tregillus
G. Hoag
J. Wright
A. Smith
B. Gutray
K. McEwan
E. Adams
A. Paquette

J. Thornthwaite (Chair): Good morning, everyone. Welcome to the Select Standing Committee on Children and Youth. My name is Jane Thornthwaite. I'm the member for North Vancouver–Seymour, and I'm the Chair of this all-party committee of the Legislative Assembly of British Columbia, the Select Standing Committee on Children and Youth.

Part of the mandate of this committee is to foster greater awareness and understanding of the B.C. child- and youth-serving system. Towards that end, the committee agreed last November to undertake a special project examining youth mental health.

Youth mental health has been a recurrent and high-profile issue in the province, sometimes with very tragic results. Youth mental health has also been raised in recent reports by the Representative for Children and Youth. With this in mind, the committee embarked last fall to work to raise awareness of this important and topical issue.

Some of the key questions we are seeking to explore are: what are the main challenges around youth mental health in British Columbia? Are there any gaps in service delivery? What are the best practices for treating and preventing youth mental health issues, and how should resources be targeted in the future?

This meeting today is the first of two public meetings being held this month. Today and on June 11 in Vancouver we will be hearing from expert witnesses and key stakeholders who have been invited to participate in this special project.

These witnesses were selected for their expertise and experience in the field of youth mental health. They were selected through close collaboration between myself and the Deputy Chair, the member for Victoria–Beacon Hill. We worked hard to include voices from across all sectors and all regions of the province. They include health professionals, service providers, academics, aboriginal peoples and other key players. In addition, the committee will also be hearing from youth and families directly impacted by youth mental health.

While I have this opportunity, I would like to thank everyone who agreed to take time from their busy schedules to come and speak with us. We look forward to hearing what I am sure will be some unique and insightful perspectives into complex and multifaceted issues.

I'd like to also mention that the committee has launched a public call for written submissions in conjunction with these meetings. We are inviting written submissions through our website from now until Friday, July 25, 2014. We encourage anyone who is interested to submit their ideas to us in writing. To make a submission or to learn more about the work of the committee, please visit our website.

I'd like to now ask all the committee members to introduce themselves, starting with the Deputy Chair to my left.

C. James (Deputy Chair): Thank you, Chair. Carole James, MLA for Victoria–Beacon Hill and Deputy Chair of the committee. Thank you to everyone who'll be presenting over the next while.

M. Karagianis: I'm Maurine Karagianis, the MLA for Esquimalt–Royal Roads. I also serve as the opposition critic for women's issues, child care and early learning. And shipbuilding, actually, but women's issues is the big one, I think, for us.

J. Rice: I'm Jennifer Rice. I'm the MLA for North Coast, the critic for northern and rural health and deputy critic for Children and Family Development.

M. Bernier: Good morning. I'm Mike Bernier. I'm the MLA for Peace River South. Thank you for coming.

D. Plecas: Good morning, Paul. I'm Darryl Plecas. I'm the MLA for Abbotsford South.

D. Barnett: I'm Donna Barnett. I'm the MLA for the Cariboo-Chilcotin and the Parliamentary Secretary for Rural Development.

J. Thornthwaite (Chair): Kate, would you maybe want to introduce yourselves and your folks from your office?

K. Ryan-Lloyd (Deputy Clerk and Clerk of Committees): Good morning, everyone. My name is Kate Ryan-Lloyd. I'm the Clerk to the committee. Also from our office today is Byron Plant, the committee's research analyst, and Aaron Ellingsen, at the back table, who's also with our committee research office.

J. Thornthwaite (Chair): I'd like to put a special thank-you to the staff from Kate's office because they've been working really, really hard with us, providing us with all the information that we need, organizing the entire committee meetings and keeping us all on track.

Today's proceedings will consist of 20-minute presentations from each of our invited witnesses. Each presentation will be followed by 20 minutes for questions by committee members. The proceedings are being recorded by Hansard Services, and a transcript of the entire meeting will be made available on our website.

With that, I will now turn the floor over to our first invited guest. This is a member from the B.C. Association
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of Aboriginal Friendship Centres, Paul Lacerte.

P. Lacerte: Thank you, Jane. Thank you to the committee for the invitation. I'd like to introduce myself in my language and to say that it's an honour to have my own indigenous language read into Hansard. For the gentleman in the back, I will send you a transcript of this portion of my testimony. [A Carrier First Nations language was spoken.]

I wanted to first and foremost acknowledge the territory, the Lekwungen territory, that we are meeting on here today; to acknowledge each of you, our high-ranking brothers and sisters, to have an important conversation about the well-being of young people in British Columbia; and to let you know where I come from.

I'm from the Carrier territory in north-central British Columbia. I'm a caribou clan member. I was born in Burns Lake, and in the last couple of days before I was born, my mom ate some of the soil. So when we say we're connected to our territories, one of our traditional practices is to actually put the soil right into the baby. So I am of the land. When I say that I'm of that land, that's what I mean. I'm literally, in part, a manifestation of that territory.

Thank you very much for the opportunity to present. I'd like to answer all four questions, and I look forward to a discussion with you around youth mental health in British Columbia. Particularly, I'm going to focus on the issues facing aboriginal youth in B.C. and one which I think you'll hear a fair amount about today. That's a shared challenge around technology, the impact of technology for young British Columbians.

Some of the specific challenges that we are experiencing in aboriginal communities for youth. I'd like to start with sexual abuse and unhealed early childhood trauma. Part of the challenge is that it's not really a DSM-IV kind of a diagnosis, and the mental health system is not so much geared to respond to sexual abuse in an indigenous context. It's very distinct to our communities.

There is not great data about percentages. McGill recently released a report with a range of 25 to 50 percent sexual abuse rates for aboriginal communities across Canada. Some estimates in northern British Columbia are as high as 80 percent sexual abuse rate for aboriginal children and youth in this province.

The second that we're really dealing with is a lack of belonging, a really distinct issue in indigenous communities given our communal nature. Dr. Martin Brokenleg identifies belonging as one of the most important mental health indicators.

There are a couple of leading factors around this issue of a lack of a sense of belonging. One of them is urbanization. There's a real demographic shift that's happened in this province for indigenous peoples over the last 30 years, to a point now where we have 64 percent of the status population living off of the reserves and 91 percent of the non-status population living off of the reserves.

When community and a sense of belonging is such a fundamentally important part of stability and resilience for young aboriginal people, that presents some unique challenges as we seek to decolonize and reculturalize ourselves in our recovery from the residential school system.

The third, of course, is the massive overrepresentation of aboriginal children in foster care in the child protection system and the many ways in which that undermines the sense of belonging that our young people have. This, of course, leads, in large part — these as a collective of factors — to suicide rates in aboriginal communities, which Health Canada and this provincial Ministry of Health estimate to be five times the national average.

I'll be speaking later to the need for very targeted efforts in terms of investing systemically in improving the mental health and well-being of aboriginal youth in British Columbia.

The third challenge is around lack of food security and malnutrition. Folks tend to talk in the broader context of poverty, but there are some very specific factors in that context that affect the mental well-being of our young people. A part of that, again, as it relates to the residential school system, is the life skills, the issue of the lack of life skills.

I am a first-generation residential school survivor. My dad attended the Lejac Residential School. His sister did not survive that experience. It's very difficult for British Columbians to understand a school system where it was common for children not to survive attending these schools.

It's often forgotten in our mental health system that this is a fundamentally recent reality for indigenous communities. So the reinstitution of parenting skills, of life skills around proper nutrition as children are growing and learning and their brains are developing is an area of recovery for our people. Obesity and hormone imbalance due to high levels of malnutrition affect the mental health of our young people in a significant way.

As I mentioned more broadly, the issue of technology, including aboriginal youth, is leading to epidemic levels of social isolation, a lack of connection to nature. A lot of our young people now are growing up on their phones. Even in my era I grew up playing outside. We've seen a pretty fundamental shift in that context. Sleep deprivation is a huge issue for kids and our youth, with technology at night. Oversexualization of our young people, access to each other and to sexual images at a young age, is feeding some of the complex mental health challenges.

And finally, racism. There is a lack of reconciliation in this province between indigenous and non-indigenous peoples. Attitudes towards indigenous peoples are still
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improving, and in some cases there are still very negative assumptions about our people that play out in a fashion that depresses the mental well-being of aboriginal youth in this province.

Gaps in services — absolutely. I'll start, again, around sexual abuse. There is a quantum gap and lack of support services that are culturally-sensitive support services around healing in terms of sexual abuse in our communities. Given the prevalence of that issue and the lack of support, I would suggest that that is the biggest gap in this province between available services and challenges and issues for aboriginal youth.

The gap in service, as it relates to the mental health system, is really around the difference between trauma, which is the prevailing mental health issue in indigenous communities — trauma — and diagnosable mental illness. I'll speak to some strategies that we're undertaking to address some of those gaps.

Something that the representative has been talking about at length over the past six months: a lack of support for aboriginal kids aging out of foster care. We're still in the 50 percent range. We're 4.8 percent of the population and still 50 percent of the kids in care. So we have a massive issue in this province around the number of kids that are in foster care and those kids that are aging out of care and lacking the supports that they need to transition into independence. That, I think, is really the focus that we have collectively to effect part of the change of that system — better efforts around permanency planning and building connections for those aboriginal youth through a variety of strategies.

We need a focused effort on reconciliation. The Truth and Reconciliation Commission has now, for all intents and purposes, wrapped up their mandate. There were truth-telling hearings all over this province. A lot of truth has been told. The reconciliation effort is just beginning, and to be honest, I think that it is really one of those most important resources for a healthier relationship between indigenous and non-indigenous British Columbians at every level of the system.

Best practices in treating and preventing mental health issues for aboriginal youth. First and foremost, I'd like to talk about culture and ceremony. I give you a few examples. We in the 25 friendship centres in British Columbia are facilitating rites of passage for aboriginal youth each year. Rites of passage…. We are hard-wired for ceremony when we're 12, 13, 14 years old. It's one of the oldest practices in all of our cultures over all of the world, that transition from being a young person to a young adult, and it's an opportunity to introduce a code of conduct and to have an intergenerational knowledge transfer in whatever culture you have.

We've been operating those with the support of the Ministry for Children and Families for the last three years provincewide, with a mind to shifting our community-based reality around sexual abuse, violence in relationships — relationship-based violence — and some of the intergenerational cycles from the residential schools that we've inherited, addressing those, treating and preventing them through culture and ceremony rites of passage: potlatch, powwows, simple technologies like circles with eagle feathers.

Tribal journeys are a great example in this province that I'd like to cite. My daughters go on tribal journeys in the summer. They paddle 100 miles on the ocean in a traditional dugout First Nations canoe with about 140 other canoes. There are about 25 aboriginal youth per canoe, so over 2,500 aboriginal youth on the ocean, paddling more than 100 miles.

She comes home after 3½ weeks, and her propensity to harm herself has plummeted. Her propensity to complete an educational assignment and/or an educational goal has skyrocketed. Her resilience as a result, not only of the physical challenge of being in a cultural event like tribal journeys but the cultural teachings that they receive in that context — the connectivity to water, all of those things that are fundamental to the resilience of indigenous youth — are incredibly evident in the way that she conducts herself, and it addresses the issue of belonging.

The second, treating and preventing, is aboriginal cultural competency training in the mental health system. The Provincial Health Services Authority has developed an incredible indigenous cultural competency training program. It's on line, eight hours, and one of our very specific goals is to scale that training up all the way through the mental health and substance use system, particularly targeting service providers.

It offers the basics about residential school, indigenous culture and indigenous language. It helps folks to shift out of some of the lack-of-information-based assumptions that they have about indigenous people and improves impacts and outcomes for the delivery of mental health services by mainstream mental health service providers.

Best practice in addressing sexual abuse issues. The B.C. Association of Friendship Centres three years ago saw this gap and developed an indigenous sexual abuse training program accredited through VIU. We built a curriculum of 18 post-secondary courses, including evidence-based culture and ceremony approaches in responding to indigenous sexual abuse. We brought together 20 students from around the province and graduated 13 of them this past December.

We now have the beginning of a new system, an emergent system, of indigenous sexual abuse counsellors, with mainstream therapies and indigenous cultural responses to sexual abuse.

Gathering Our Voices youth conference we've been offering for 12 years in a row. This year we had it in Vancouver; 2,000 aboriginal youth attended this event.
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Mental health is one of the most central focuses of this event. It's peer support. This coming year we'll be in Prince George in March. It'll be out 13th consecutive year of having over 1,000 aboriginal youth get together and support each other, over four days, to have a better future than the past that they've had in their families.

Facilitating opportunities for aboriginal youth to come together and share a space where they can talk in a safe way about the challenges that they're dealing with at home and at school and their aspirations for a better life is, in my mind, prevention, treatment and strength-building.

We've developed an aboriginal youth sports and recreation strategy. We now have a funding base of $2 million a year, with 13 staff. We're training aboriginal coaches, referees and supporting tournaments of aboriginal athletes.

Sport, recreation and physical activity is a fundamentally important systemic response to mental health challenges in a prevention and treatment context. Next month, in July, we're sending 500 aboriginal youth athletes to the North American Indigenous Games in Regina, Saskatchewan. There'll be 7,000 aboriginal youth athletes there. That system is a very important part of our desired future.

The last, in terms of best practice, is that I am currently sitting as the co-chair of the Community Action Initiative, which is a mental health collaborative. The government of British Columbia provided an initial grant of $10 million and then subsequently, this past year, a secondary grant of $15 million. We have been investing in upstream innovation of mental health and substance use, including now there is currently a call for proposals around culture and ceremony as a treatment option for mental health and substance use.

In that partnership with this government, we have been building an alliance between the psychiatrists, the sociologists, the clinical counsellors, the social workers, the Association of Friendship Centres, the RCMP — a number of primary mental health service providers. Aboriginal youth has been a very central theme, given very high utilization levels by aboriginal clients of mainstream mental health services.

Resources in the future in terms of alignment. As I said, there are almost no resources targeted towards the treatment of sexual abuse. Our recommendation is that we need a long-term sexual abuse strategy in this province. It's a very difficult issue to talk about. Many folks are uncomfortable. It's outside of the medical model, and it gets diagnosed as depression, very often, and ADHD.

What's really happening is kids are suffering from a very particular type of abuse. We would invite the government of British Columbia to think about a future British Columbia where incidences of sexual abuse are radically reduced.

More resources for aboriginal culture and ceremony for aboriginal youth and a research strategy to support the growth of evidence so that, over time, indigenous cultural and ceremonial approaches to building the mental well-being and the mental health of aboriginal youth can be seen to be evidence-based.

We're very early in the process of building evidence in a culturally safe manner around indigenous cultural approaches. We recognize the need for evidence, in the western context, if it is going to become supported at a systemic level.

Scale up aboriginal cultural competency training, particularly for mental health service providers and in the education system, in the K-to-12 system.

Four, support directly the efforts of Chief Robert Joseph and Reconciliation Canada. It's an emergent organization in British Columbia. Their goal is simply to hold reconciliation dialogue sessions in communities across the province. It's not a blame-based environment. It's an opportunity-laden environment for British Columbians to come together and imagine a future where racism is eliminated and folks live together in a fashion of mutual understanding and mutual respect.

The fifth is to strengthen our system of support for aboriginal youth as they're aging out of care, focusing on issues like permanency planning, family reunification, the Roots program and that set of strategies and supports.

As I'm sure you know, the 25 friendship centres, the 1,000 employees that we have, the 1,300 clients that we help a day and the 25,000 hours of volunteer service that we bring to the table each year make us a great partner for this government in the delivery of some of these strategies and in exploring this space together.

It's a pleasure to be here and to make this presentation. Thank you for listening.

J. Thornthwaite (Chair): Thank you, Paul. I have a question or a comment if I don't see anybody's hands up.

I think what you're doing is great. Where are the gaps, as far as your friendship centres not getting to, in the province? I'm thinking that I came personally to visit one of the friendship centres in Vancouver, downtown Hastings. I don't think there are any on the North Shore. Correct me if I'm wrong. But then, obviously, in northern British Columbia….

I'm just wondering if you could give us a feeling of it. I like what you said as far as being partners in dealing with a lot of these issues that you've identified, but where are the gaps with the friendship centres in not being able to access communities all around British Columbia?

P. Lacerte: A great question. Thanks, Jane. Two thoughts. We do not have an agency in every place in the province where there is a significant aboriginal population, but almost. Metro Vancouver is a unique example because we have a 20-kilometre service radius between
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friendship centres, and it's part of the national structure of the friendship centre movement. We have 118 friendship centres across the country.

In the large metropolitan communities the reality is that we're more a part of a network of service agencies. There are 26 aboriginally mandated service organizations in Metro Vancouver, and they have a collective called the Metro Vancouver Aboriginal Executive Council. In the large metropolitan communities there is a different service approach. The gap is addressed by building relationships with other aboriginal service providers for the friendship centres.

In small and medium-sized communities we tend to be larger. We have 200 FTEs in our friendship centre in Prince George. Williams Lake has 100. Nanaimo has 90. Victoria here has 75. So we have some fairly large agencies in some of those medium-sized communities.

You're right. It's the very large communities where friendship centres are not as central in the context of service provision. That could be thought of as a gap. Specifically, the Ministry of Children and Families is woefully lacking in their direct support for mental health services for aboriginal youth. The child and youth mental health system is very child-centred.

Where we have been supported — we, collectively as aboriginal service organizations — has been from the government of Canada through the federal Department of Aboriginal Affairs. For the last 12 years we've been delivering targeted supports, $3 million a year — which is, in the big picture, a small amount but for our people very significant. It's been my office that's been delivering those resources on behalf on the government of Canada. Those resources were eliminated by the federal cabinet in February.

I really appreciate the question because it gives me an opportunity to express the extreme urgency for the government of British Columbia to consider what the implications, the cost implications, might be of withdrawing $3 million per year of targeted support services to vulnerable and at-risk aboriginal youth in British Columbia and what the value proposition is of making an investment now or making an investment in the corrections system and some of the other challenges that present themselves when you withdraw an entire network of support. That's a huge gap, and it's a pressing one, so I appreciate the question.

C. James (Deputy Chair): Paul, I wonder if you could talk a little bit…. You mentioned the back-and-forth and the fact that a lot of First Nations people spend some time on reserve, spend some time in urban settings. There's now that kind of movement.

I wonder if you could talk a little bit about the challenges between on- and off-reserve when it comes to youth mental health and youth mental health services and, as well, whether you can talk about any kinds of initiatives that are being looked at with the First Nations Health Authority when it comes to youth mental health and, again, the on-reserve, off-reserve challenge that's there in providing services.

P. Lacerte: Thanks, Carole. In some ways it's an old issue. The Indian Act was changed in 1960. It removed the travel restriction, where you couldn't travel without a letter from the Indian agent. So 1960 is not that long ago.

It really led to a fairly significant demographic shift, where indigenous people started migrating en masse into urban communities. There was really an out-migration at that time. It led to some of the challenges that I was citing around the process of reculturalization.

For many of our youth, that's their number one challenge. That's the back-and-forth challenge with their home communities — that sense of belonging, being welcomed and the barrier that poverty represents for folks to be able to go home when it's time for them to get a name or for folks to go home when one of their relatives passes away and there is a potlatch.

The child protection system — there are inadequate resources to support youth in care to attend those kinds of cultural ceremonies. Some — a few — of us, myself included, are very privileged to be able to afford to bring our families home and our youth home to avail our kids of those kinds of cultural opportunities. There is a reality of dysfunction and alienation between First Nations and off-reserve communities.

The in-migration of First Nations from out of province represents a very unique tribal challenge, where protocols…. We have protocols that start to affect relationships. The mobility of indigenous peoples is a relatively new phenomenon. The systems are just emerging to address some of those relationship challenges.

One specific example that I think is relevant for this government is the number of agreements-in-principle that are being voted down by off-reserve band members. I've been meeting with the B.C. Treaty Commission to start to, I think, wrap our heads around a better communication system between First Nations governments and their off-reserve systems. The majority of chiefs in this province have more than 50 percent of their citizens living away from their home community and very limited communication mechanisms to engage their citizens on a number of decisions, including the big ones of treaty-making, and so we've had a number of AIPs that we've lost as a result of that lack of communication.

In discussions with the president, the board chair and the CEO of the First Nations Health Authority…. To be honest, their system is still very much emergent, Carole. As recently as last week we were meeting with them and talking systemically in this same kind of space. How do we address and change what has been a mental illness system to a mental wellness system? How do we recul-
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turalize that system, in part in an environment where we've inherited 250 Health Canada staff and the issue of evidence? That's why I raised the need to generate research, but indigenous-led research, around evidence-based practice, where cultural approaches can be proven to improve mental health outcomes.

We can communicate that to treasury analysts, and they can see the business angle of making those kinds of investments. That system is emergent.

D. Barnett: In Williams Lake, in my riding, we have a very active friendship centre, as you know. They do wonderful work, and they certainly service a lot of people that need care and help. They are to be commended for the great work that they do.

Just so that you are aware, you know, we talk about the residential school issue, and we did have in Williams Lake last year a very large ceremony over the reconciliation and the residential school issue. There were some wonderful monuments put up within the city limits and on the Esk'etemc band. We now have, yearly, an Orange Shirt Day where all our students and youth and community come together. We wear our orange shirts and show the reconciliation and the respect for each other.

We are hoping that this will become more than just a Cariboo-Chilcotin initiative — that it will become an initiative in many other communities. It is part of the process of understanding what did happen in the residential schools. You know, there are still some good stories that are coming out now from some people that had a good education at residential schools. Those people who feel that this story hasn't been told would like their story to be told, because they feel that could be part of the healing process also.

We have a long way to go, but there are many initiatives out there. I think we just have to continue on to do what we can do and help each other and respect each other.

D. Plecas: Thank you very much for a very well-articulated presentation. It was great. It seems pretty clear from your presentation that there really is an impressive effort to do things directly for youth, although there are obvious gaps.

When listening to you, I couldn't help but think there was an absence of effort with respect to being helpful to the adults. Of course, we can trace that back in many ways to the residential school experience, but when I think of the issues that you raised — like the sexual abuse, the lack of proper food — and when we look back to where that would be rooted in, it would be rooted in the adults in the community. I didn't hear you say very much about that.

Can you say something about that? Like why isn't that the case, and is there anything that's being done at all?

P. Lacerte: Yeah, I appreciate the question, and thanks for the positive feedback. I guess I was targeting my comments just in the youth context, given the nature of the invitation, but there is an incredible body of work that is happening to support our older people.

I think that the focus of your committee in engaging issues of mental health and mental wellness for youth in British Columbia is appropriate, given the fact that we thought it was 50 percent, but it's actually 46 percent that is our best finding of aboriginal people in British Columbia who are under the age of 25, which is significantly higher than the mainstream system. Again, that reinforces the importance of a targeted response by the government of British Columbia to issues affecting aboriginal youth and the mental health of aboriginal youth.

In the adult context, many of the barriers that I've cited, Darryl, are equally relevant. Many of our young aboriginal people are also parents. We have lots and lots of young moms out there. The issues that are plaguing them around various forms of unhealed early childhood trauma — early childhood violence and children who witness abuse, sexual abuse, neglect — tend to follow folks into their adulthood.

Just to give you one example of an innovation that we're addressing now — financial literacy and changing the nature of our relationship with money and poverty. I'll give you one other example as well.

In the adult context, we are now deploying a financial literacy strategy. To give you a sense, even in the friendship centres, where we have 1,000 employees, about 15 percent of our employees still bank at Money Mart. It's a very striking example of the lack of financial literacy of adults, adult aboriginal people in British Columbia, for a whole variety of reasons. Mostly, that was not a skill set that folks learned while they were at the residential school. That was not part of the curriculum while they were at the residential school. Allowance on Friday — save part of it, and buy some candy with part of it.

Some of those things that folks take for granted — home ownership…. The capacity that many aboriginal people do not have to own their home on the reserve, the in-migration into urban communities and the very early emergence of home ownership are huge barriers around intergenerational financial literacy skill building.

There are some things that we're deploying in the poverty relief kind of context. Something that you may have heard is that our organization has built an aboriginal jobs strategy, which is very adult-focused — 5,000 aboriginal jobs within five years; we call it 5 by 5 — with some very targeted supports for aboriginal adults in this province to transition into the labour market, with some new inputs over the next five years and a very strong costing model for both federal and provincial governments to
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invest in the kinds of supports targeted at the barriers preventing aboriginal adults from transitioning into the labour market.

Those are just two thoughts. There is a lot going on that I could speak to, Darryl, other than just those two.

D. Plecas: Another related question. I have some sense of the canoe journey and like activities in First Nations communities and am also being reminded of the number of times I've visited First Nations communities and talked to elders. Almost always I'm leaving very, very inspired by the teaching of elders who are involved in those kinds of things.

It surprises me that, given how powerful it is, it somehow doesn't transcend to the population overall of First Nations people. There's an oddity there. How is it that you can have this messaging and teaching, which is so powerful and so inspiring, and it's limited to almost like a celebrated event once in a while? What am I missing there? What's really going on there? Given how powerful it is, one thinks: "Wow, never mind doing this for First Nations people. The rest of us would be so helped by being attentive to those teachings."

P. Lacerte: I think you've tapped into the opportunity between the Crown and indigenous communities. We've been incubating meaning. In indigenous culture we've been incubating all sorts of old knowledge but important values that have deep meaning.

For example, in this province we have a phenomenon where a lot of people are going to start passing away in a short period of time. We have deep protocols to help and support those people as they're on their crossing-over journey, which British Columbians are hungry for, and processes to help people make sense of death and dying. It's one of those many very meaningful things that people get access to when they come into contact with our communities. We absolutely have very much to bring into the relationship.

Where there are challenges — I'm getting a sense of your question — and why those deep, powerful protocols and indigenous world view notions do not translate into a general sense of wellness and prosperity is really time. It's time. The general population, the middle-class percentage…. About 60 percent of the general population in British Columbia rates in the middle-class context. It's 7 percent in aboriginal communities — only 7 percent of the entire aboriginal population has achieved a middle-class status.

In 1969 in this country there were 350 First Nations people in colleges and universities. In the whole country: 350. In 1999 there were 38,700 First Nations people in colleges and universities across this country. So when I say "time," it's an evolutionary journey for folks that's really intergenerational, where you're breaking those cycles.

It takes that time, and the accelerator is our culture — the reason that we didn't disappear, based on five generations of a residential school system where kids were not raised by their parents. Our culture, our language, our indigenous ways of knowing and being, for all intents and purposes, should have disappeared. That's a pretty oppressive system. It didn't. And it didn't because of the deep roots and the deep anchor of those meaningful things that folks find when they spend time in indigenous communities.

It is the incubator for our recovery. It's the reset button when we have trauma piled on top of trauma. We go back into those places, and that's what helps us to build that resiliency.

I believe, honestly, Darryl, that the trajectory is one of recovery and strength-building, but it's incremental. I would say that it takes time, and there's no magic bullet. But that's our big strength that helps us to stay on the road to recovery.

J. Thornthwaite (Chair): Well, that's a very positive ending. Thank you very much, Paul. We very, very much appreciate you coming and bringing your insight.

I think what we'll have to do now is just take a brief break. The next people actually have a PowerPoint. So we'll take a two-minute recess, and then we'll do the switcheroo.

P. Lacerte: Thank you so much to the committee for your time. I very much appreciate it.

J. Thornthwaite (Chair): Now we are listening to the presentation from the Child and Youth Mental Health and Substance Use Collaborative, with Valerie Tregillus and Dr. Gordon Hoag.

V. Tregillus: Good morning. Thank you very much for this opportunity. I'm Val Tregillus. I'm actually the lead of the Inter-divisional Strategic Council, which doesn't really mean anything, but it's a collection of family doctors who are working together with their health authority and with the General Practice Services Committee. They raise the topic of gaps in care for children and youth. This is why I'm here today.

G. Hoag: Dr. Gordon Hoag. I'm with the Doctors of B.C. and am the co-chair of the Shared Care Committee. The Shared Care Committee is one of the joint collaborative committees that are defined by the physician master agreement between the Ministry of Health and the
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Doctors of B.C. My co-chair is Marilyn Copes, from the Ministry of Health.

We have membership which includes the ministry, Doctors of B.C. and a tripartite non-defined member, which is the health authorities, including the aboriginal health authority. It has membership on our Shared Care Committee. This is one of our initiatives.

V. Tregillus: We chose a structured collaborative as a methodology for change, given the intractable nature of the difficulties of the gaps in care with children and youth. When it was raised to us by the family doctors in Interior Health, our region, we chose this methodology because it measures progress, it's very structured, and it has the accelerator to the floor at all times. It's very persistent, and it is a very powerful change engine. You either love the collaborative or you hate it. You can't feel ambivalent toward it.

This is where we started. This is the journey that doctors brought to us, having run through a youth's journey with providers in Kamloops. The sad story has been repeated many times around this province, where really it took 12 years for a child to get the appropriate services and had to run into the corrections system prior to getting the help. This is the journey we want to eradicate.

The purpose of the collaborative is to increase the number of children, youth and their families receiving timely access to integrated mental health and substance use services and supports. We started off with just mental health. We didn't add substance use until later, and we were absolutely required to do so.

This wraparound team care does not exist currently. I noticed from your questions that you were talking about the separation between children and youth services and adult services. In mental health, often it's the family that needs the wraparound services, and we're not seeing that model. There are structural barriers why that will not occur.

These are the principles that we adhere to. I would change that first one. We have got children, youth and families as the centre of all improvements. We have learned from the collaborative that they are leaders, that unless they're in a leadership role, we will fail.

Another lesson for us when we started the collaborative is what has gone on and what is going on in the province. There's a massive amount of work. We collected 30 substantial reports, including those from the Representative for Children and Youth — very powerful reports. The awakening for us was: why are we putting up with this situation in this province?

I have worked in the health care system for 15 years in primary health care, previously with the Ministry of Health. I have to say that if this problem was diabetes or congestive heart failure, we would be screaming from the rooftops. And yet all of these documents and we still haven't seen the change.

That was something for the collaborative. If these documents and this awareness do not make change, how can we, the collaborative, make change? I think we will just join shoulder to shoulder with all these other elements and make the change.

It's important to note that we would not be here, would not have a collaborative, without this fundamental collaboration between the Ministry of Health and Doctors of B.C., who have set up three collaborative clinical committees — the General Practice Services Committee, the Shared Care Committee and the Specialist Services Committee.

They give the opportunity for provincial leaders in the health system to step back from normal business and find ways to facilitate innovation and system improvements. It allows physician leadership. If you think about family doctors, who see 80 percent of the population of B.C. in any given year, they are very close to the public and the concerns. So we need the voice and influence of those doctors for the public.

G. Hoag: Yes. The initiatives, which all come through GPSC, the Shared Care Committee and the Specialist Services Committee, all focus on the Institute for Healthcare Improvement's Triple Aim, which looks at the health of the population, it looks at per capita cost, and it looks at the patient experience.

The model for Shared Care is slightly somewhat different. It's not only patient-centred, but it's family-focused and community-empowered. I think you're very familiar with all those tremendous drivers that we must take as critical elements when we drive forward with any collaborative.

We see ourselves as being able to support the practice change so that the health outcomes can change for these people. I think that this is only one of our initiatives that has got a great deal of context from years of sitting by the wayside. We're trying to make it to the forefront.

V. Tregillus: We knew, going into this collaborative, that we had to have a couple of things. One, we needed the funding. We have that through Shared Care. But we also need top decision-makers. We have three deputy ministers — of Health, Ministry of Children and Family Development and Education — as our sponsors, along with the senior management of Interior Health. That's critical because they have to be willing to make the substantive changes that the collaborative brings forward.

We also knew that the local action teams at the local level, making the practice changes — you have to have that simultaneously. The collaborative supports those action teams by pulling from them the gems and the elephants. What is it that really works for them, and what
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are the elephants that are the barriers?

We have identified eight barriers so far, and we have established working groups on those barriers. I think I've distributed the elephant document to you, because it's very critical. Some of these elephants, these barriers, that have been identified have been in place, some people say, for over two decades.

We have the importance of the shared wisdom. We are working, as Gordon said, with the First Nations Health Authority. The collaborative has representation on all of the elements of the collaborative.

Another way that we can partner is with the B.C. section of emergency medicine. When we started the collaborative, we realized that when children and families are in crisis and turn up at the emergency room — which often, as default, is the place where people try to get care — there is no protocol or guideline for care.

It's ad hoc, and there is no crisis response that's set in this province. That's the work that we want to undertake and make sure that there's a standardized approach. The section of emergency medicine of Doctors of B.C. is championing and helping. We cannot do it without them.

We were asked to bring to you what the local action teams had achieved to improve policy and practice. These are linked very closely to the system barriers. Just to go over them fairly quickly, the first thing that they did…. We started last June, so it's one year. The teams have built intersectoral teams for the community. It seems people roll their eyes at this. It's like: "Oh, yeah. Well, of course." Well, of course, but it did not exist. People did not know each other.

There was a workshop, a who's who in the Cariboo, and like-minded people got together. It was stunning how they were able to get to know each other, talk about: "How do you take care of this population? How can I refer to you? How can we work together as a team?" This has to be replicated right across the province so that each community knows and families know the team that will wrap around them.

I forgot RCMP on that list, and I apologize for that. Chief Superintendent Derren Lench has been incredibly supportive, as well as the local detachments, in supporting the collaborative. They backed away from working on child and youth mental health, although it takes up much of their time, because of the privacy barriers. We're tackling that, too, through this collaborative.

I mentioned before the role of youth and parents. We have parent and youth leadership throughout all elements of the collaborative. As an example, in one of the action teams the youth was talking about an experience he had when he turned up at the hospital in crisis and was admitted to the adult section of the hospital. Hospitals do not know what to do with this population. He had a very traumatic experience.

The doctors in the action team left that action team, went to the hospital and changed practice and policy that day. That is the power of having that voice and influence right at the action team or the steering committee or the faculty, having that lived experience to drive the changes.

They have created inventories — they're e-inventories — so that youth and families in their local communities now know the services, know what the services offer and how to access, and providers know how to access for their patients. So a GP now will know how to access local services. They have relationships with each other, and there's a trust between the team members to care for the families.

I wanted to talk about building. The collaborative is building upon the practice support program, which has its own child and youth mental health module. First of all, the module is brilliant and has done so much work in creating increased confidence and practice skills for family doctors and the teams. For example, in the collaborative many school counsellors are using that module, too, to build their practice expertise.

Over 200 doctors in Interior Health have now taken that module. If you compare that to the other regions, which is 99, 18, 185 and 97 family doctors, you'll see the collaborative adds some oomph to it. The clinical outcomes have been evaluated through Island Health, and when doctors take this module, we have seen an increase of 60 percent clinical improvement for children with ADHD, 90 percent improvement for anxiety and 71 percent for depression. So you can see this module has very real change in clinical outcomes.

The complexity of child and youth mental health is the stewardship of care. When you look at the health care system, there are approximately five bodies that make decisions that impact care for adults. Yet for children and youth, there are eight bodies that make decisions. So coordinating, understanding how things can go awry and be in conflict, it's not surprising…. You have three ministries involved, for instance — very, very complex.

The action teams are very connected to their schools, and in some cases have started professional development days in schools to spread awareness and to reduce stigma. I'm sure you've heard that many times during the hearings.

Family doctors. Many youth and families who are in crisis do not have a family doctor, do not have that continuity of care for physical support either. So the family doctors are attaching the youth that come to the ER in crisis to their practice so that they have the benefits of primary health care.

Increased community awareness. Parents involved in the action teams have been holding events. Clara Hughes — I think you may have seen her journey. In Cranbrook recently one of the parents had whole media and community events around Clara Hughes. Very powerful — all the different partners and leaders.

We now have those action teams that, where they had
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started to make system change, have moved on to integrated case management, taking their most difficult cases and working together as a team. This is a very important piece.

Improved transitions from youth to adult systems of care. Because the systems of care are different, different people…. There are different teams, different psychiatrists, different services in the community for adults than for youth. We do not have family-centred care. So there have to be protocols to transition youth to adult systems of care.

We have seen improved access to the Canadian Mental Health Association telephone coaching — that's both Bounce Back and Strongest Families — where coaches are able to connect with families right into their own homes by telephone. It is the most brilliant service, especially for rural-remote areas that have such problems accessing service.

We are seeing, anecdotally, tremendous changes in access to services because of the collaborative. Trying to find data to back up what we're hearing anecdotally is significantly difficult. Charlotte Waddell at SFU I know has been struggling with this for ten years, trying to get baseline data from the ministries, from the health authorities, on: what does access look like now, and what are the baselines? We are determined, with the collaborative, to get that baseline data by September.

In the meantime, anecdotally, what the service providers are reporting is 50 to 67 percent increases in access. This will be profound if we can make the shift and stop the ER, the emergency room, being the default place for service.

You also asked us to bring: what could be done? Our asks are to address the underfunding for this population. Currently we spend approximately $1,400 per year per capita for health care services in this province; $88 per capita on adult mental health and $77 per capita on child and youth mental health — very low investment for the most vulnerable population.

This can be addressed, I think, immediately, and I cannot see an excuse for not addressing it. I think as a very wealthy province that this is a fairly big disgrace for us.

We also know, given the power of having people with lived experience shifting practice, shifting the system…. That is a continuous thing. It just is not a one-off. To have parents and youth in residence through organizations like the FORCE is pivotal. We need to pay attention to placing those people with lived experience in our system of care so that they can have that influence, and it's not just through the collaborative.

We notice that municipalities — we work with regional hospital districts on things like recruitment of family doctors — also have a tremendous interest in youth, and we would like to work with them on FamilySmart. We do believe that a co-funding model with municipalities to build the infrastructure for caring adults, caring communities, which we know is a very strong protective factor for youth and stops the exacerbation of mental health…. The McCreary Centre has just published their results, and we know these protective factors.

The ask is for an assistant deputy minister position in the Ministry of Children and Family Development, responsible for child and youth mental health and children with special needs. There's a lot behind this ask. If this ministry does not get support or show its support for child and youth mental health, I think all of the action at the local level is lost.

The practice leads and the executive directors and all the clinicians working in that ministry at the local levels in the regions need to know that their ministry is supportive, and we can show that by having an assistant deputy minister with those responsibilities.

We also are very aware of the agony going on in our schools right now. We feel there's a healer here. As we've experienced in the doctor health care system healing that we did with a similar system collaborative years ago on diabetes, we believe there's an opportunity here for the Ministry of Education and schools to work with the B.C. Teachers Federation to implement evidence-based programs to build resiliency, emotional intelligence and early intervention, building on the ERASE strategy.

We know that members of the B.C. Teachers Federation, the ministries and the schools desperately want to help this population, but it's not a declared priority, and I think we can make it so.

The collaborative is spreading as we speak. We have Island Health that has already wanted to join — that's both the administrator-leaders and local divisions of family practice — and MCFD workers and communities want to join the collaborative. It's a voluntary but irresistible change engine.

We thank you very, very much for this opportunity, and we will be glad to receive your wisdom and answer your questions.

M. Karagianis: Great presentation. Thank you very much. It's the first time I'd actually heard about the collaborative. I think that the more we all understand the potential here, the better. I was interested to hear that other health authorities and health regions are starting to pay attention and think about utilizing this kind of model.

I did note in your comments here that you didn't specifically say whether or not you have done any work in identifying gaps in the system. We heard from our previous speaker…. You know, the gaps in the system are serious barriers, and I didn't actually hear you address that. I heard you talk positively about the success of connecting youth and families with existing services. Is part of the collaborative, part of your job, to identify where there are gaps and where there need to be further service provisions put in place?
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V. Tregillus: I think we are not even at that stage. We need to build these action teams, and what we're finding is that they're finding that when they come together with their resources, there are probably sufficient services there, just not working together. There are probably additional gaps, but currently we're focused on improving access by those services that do exist by working together. We're addressing that gap first.

And I think the underfunding…. For example, a local community agency I was talking to the other day…. She has a wait-list for 18 months for parenting courses. There's a gap in service. The agency exists, but…. She gets $10,000 a year to run parenting classes, so there's a profound gap.

I think those action teams are now starting to be able to identify those gaps because there's the growing awareness. They feel that they now have a voice, through the collaborative, to make those gaps heard.

C. James (Deputy Chair): Thank you, as well, for the presentation. I think it’s great work that needs to be talked a little more about so that people are aware of what's going on in communities, particularly for parents.

I've got a couple of questions. Maybe I'll just ask them all and then get a response. One is: where is the opportunity for parents to connect through the collaborative? I understand that the collaborative, as you said, is trying to include people with lived experience, but it is focused on the system and how the system can better coordinate. Where are the opportunities for families or for parents to give feedback?

You mentioned that you've expanded to other regions, or you're starting to expand to other regions and looking at opportunities. I wondered a little bit about that work.

You mentioned the protocols for emergencies, for emergency rooms. Will those protocols, then, be shared across the province or simply with the regions that are there?

Then just my last question. I think it sounds like wonderful work is being done between the systems to make sure that they're doing better coordination. But the continued concern that we hear — and, I'm sure, you hear as well, through the collaborative — is that families get a list of all the services there, and it's still up to them to try and navigate a system at a very stressful, very difficult time in their family's life. I wondered if there's been discussion about how the system can respond to families, rather than the family having to navigate the system.

V. Tregillus: One of the things that we've talked about — and I think there's an urgency to it — is holding forums in communities. We do know that where they've been held it makes a huge difference in a couple of ways.

One is that youth tell us after these forums that they can talk to their parents, and parents are able to talk to them. That’s a very important issue. People do not feel as isolated, and they know how to talk with each other and access help. I think the forums will probably be the very best way of going about this, and we have that on our objectives.

Spread. We're talking to all of the regions, and all of the regions have joined our system working groups in some way or another. We have ongoing local meetings on spread and regional meetings on spread.

The ER protocol. We took the draft guideline to the annual general meeting of emergency medicine, where emergency doctors met from across the province. They all agreed to champion this and make sure it was embedded through all emergency rooms in the province. It will first be prototyped to make sure that that guideline is the best we can do for a guideline, and then we'll embed.

The other part of that guideline. You cannot have a successful guideline in the emergency room unless you know what the community care looks like. If you don't know what happens for a family in crisis, you can't have exemplary emergency rooms. It's two very large pieces of work under one umbrella.

We think that the best way for the system to respond to the family is to have the parents and the youth on the local action teams, the local care teams, part of the care team. When that occurs, youth can reach out to youth and help navigate and connect people to families. I think we're seeing a shift where we see families as an asset and not as a deficit. We think there's an endless need there that we have to serve. Instead, we're seeing youth and parents take on a tremendous asset role and being guides to doctors, guides to service agencies.

It's been a complete consciousness shift for everyone who experiences that. That is the shift we have to continue, I think, with all of our services. We have to turn our services completely around to respond to what you've just raised: children and youth being served by the system.

The concern I have is…. Your improvements, which I know you're working on, for populations living in rural and remote areas of B.C. have become a focus for the collaborative. So how are these areas being engaged to be part of the process?

V. Tregillus: Cranbrook, Creston, 100 Mile, and Williams Lake all have action teams, and they're all part of the process. Island Health has already got telehealth operational in some of their remote areas. It's also a priority for Northern Health.

It's the communities that drove that, parents who said…. One parent who lost her daughter to suicide has been a pivotal leader of the collaborative and said: "We do
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not have anyone when we're in crisis in small rural areas."

They talked about having group visits so that you have a psychiatrist on telehealth, but the group sitting in the community with family, where parents can support each other, youth and children can support each other, and the school counsellors and perhaps a family doctor — whoever is part of the team — in the room together so people feel like they have a wrap-around team and not feel so isolated.

We have some terrible things going on in rural-remote communities right now, and those parents and family members and the providers live in fear of what's going to come next. So we have to tend to this. Knowing that through telehealth and shifting our comfort level from a one-on-one situation to a group situation, we can provide safe and good care — preventive, crisis and management care — right across the spectrum for rural-remote communities.

D. Barnett: If people need this kind of assistance…? How can they become involved and engaged if they don't know this is available in these small, remote and rural communities, where access to information isn't that great?

V. Tregillus: I think it is the media. We have engaged local media with our action teams. I think that's a requirement. We have spent a considerable amount of time. Doctors of B.C., the three ministries and the health authorities…. All their communication folk — it's the first time I've ever seen it — are all working together. Usually there's a sort of competitive situation — there isn't — to provide that media at that level.

Then, more importantly, there's local media and local awareness. I think that's where municipalities, schools and parents can feel connected. We're seeing, in those examples that I gave, that parents led the local media, got hold of the local media. Local media turned out in a dramatic way in response to parents. Parents had other parents come together to raise awareness.

G. Hoag: This is an initiative with an expanding agenda. What you're seeing is the earliest phase of the initiative. I think that where the initiative has had great productivity and great influence has been with the families. They, actually, are the greatest spread you can ever have. It's their voice.

V. Tregillus: Not to excuse the collaborative, but for the first five months there was such a hostility toward the collaborative and people trying to stop it. That is the price you pay when you want to work together on something. It's very, very challenging for folk to work together when they've worked in isolation and are in fear.

We've spent probably eight to nine months just creating collaboration. We are really now a cohesive collaborative. I do apologize that our results aren't as strong, but I think that's what you're seeing. This system is so broken that it took that length of time just to build a foundation to go forward.

J. Thornthwaite (Chair): Dr. Hoag, did you have some slides or something that you wanted to add to this?

G. Hoag: I think that the subject is around shared care. Maybe I would just show one slide because I think it is informative to all of our projects, not only the child and youth mental health. Because there seems to be some understanding that we have not got a grasp of what the initiatives are, I would just share one slide here.

Maybe it's not going to come up. Anyway, what I would share with you is that the focus is that we really do have….

G. Hoag: No, I did not. I just had three slides, and I'll just go through the first one very quickly. There it is. It sort of explores what the shared care committee's focus is.

Our intent is that we will improve the health outcomes. Key is the patient journey and wondering how that patient journey could become transformative to our practices and building upon that transformative capacity that exists when we really understand the patient journey.

We also understand that with the patient journey, there is another key factor — that is, the family journey. When we talk about patient mapping, we understand now that we have to do family mapping. We have to understand this completely.

Through the health care system, we are primarily in shared care to strengthen the relationship between the family physicians and the specialists. But we also see ourselves as enabling all of the elements that are part of the system for health care and for the patients' benefit to work together.

So we see it used from diagnosis through treatment and recuperation, and we want to be seen as the people that can bring that focus to it, that we can coordinate it. We can have a continuous process that will lead to the patient having a better outcome than in the past and transform our system. Our initiatives, we consider, are transformative change, and transformative change has a cost. You've just heard about the difficulty, even in terms of the collaboration. You have to take the time and the energy to make these things work if you're going to transform the system. That's what shared care is about.

J. Thornthwaite (Chair): Thank you very much. I just have one question. Can we get a list of where the collaborative is branching out into?

G. Hoag: The collaborative will go to all health au-
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thorities, so the timing is more or less on the state of readiness of each health authority to accept it. But we needed to have behind ourselves the initiative and the understanding of how we can build these collaboratives in a most effective and efficient way to drive the system to its new change.

V. Tregillus: We would have a list in probably about six weeks, and I don't know if that's too late for your purpose.

J. Thornthwaite (Chair): That would be very helpful, whenever you have it available.

D. Plecas: I just want to first say to Valerie and Dr. Hoag: fantastic presentation. You mentioned, Valerie, that there were some early indications of improved outcomes. When you refer to outcomes, are you referring to improvements in terms of the process by which people are getting help? Or are you referring to the outcome of treatment?

V. Tregillus: Outcome of treatment, because that is a clinical practice support module for treatment.

D. Plecas: The second question is: if you had to put a dollar figure on the kind of money that is needed, what would that be, ballpark — I know it's difficult to do that — in two ways? In terms of providing ongoing support and development for the collaborative is one. Then beyond that, in terms of we have this gap that you've referred to…. What are we talking?

V. Tregillus: Thank you for that question. To close the gap would cost $10 million. That's to bring it up to line with the adult investment per capita, from $77 to $88 per capita, so that's $10 million. I believe if that was matched by another $10 million, you would see substantive changes. There are many, many people who want to work on this, because a lot of these things are the protective factors.

I was listening to Paul, who spoke before us, and there's much that communities want to get involved in here. Society wants to get involved here.

We can do that. It doesn't cost money, but what costs money is holding something like a community forum. If you have a small amount of money to do that, an additional $10 million would give that infrastructure to communities to get hold for this population to happen.

G. Hoag: But there is ongoing funding allocated from the Shared Care Committee for the expansion of that collaborative.

V. Tregillus: If you take the business case of investment in children…. I'm sure other people more capable than I have made this argument. But for investment for children in kindergarten, people know that they can identify children who have problems in kindergarten and their families. We can put the supports in place there. It's a miniscule investment. Then we get into the forensics system and so forth. Then we put…. We're happy to spend $100,000 a year.

It's a societal myth, a mystery to me, why we wouldn't want to do those investments, and I think we can make that societal shift. But you're quite right. It's a tiny, tiny investment to make massive change.

J. Thornthwaite (Chair): Thank you very much. Excellent presentation, very much appreciated.

I'm not too sure about the group next, if they've got any slides, but if not, we can just maybe take a minute or two just to do the transition.

J. Thornthwaite (Chair): Okay, we'll carry on. Thank you, everybody, for keeping us on track and on time as much as we can.

Now we're on to the next presentation: Child Abuse Prevention and Counselling Society of Greater Victoria, the Mary Manning Centre. I welcome Judith Wright.

J. Wright: Thank you. I really appreciate the opportunity to come here and speak to you. There are a number of you that I've spoken to already and who know about our agency, but I'm sure there are many of you who have heard nothing about this association.

The reason I'm really primarily here is we're really interested in the effects of trauma on children. I have
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provided you with a little booklet, and part of what I am trying to do is bring the voice of children into these hearings.

We're the adults. We're often talking about what children's needs are. I think we need to be really focused on what children and youth also say about the experiences they have.

Our agency has been around. We're in our 30th year now, and I've actually been part of the organization now for 24 years. It's been really phenomenal to see some of the shifts and changes and what we have seen happen with children and youth in our society.

It was wonderful to hear Paul here, as well, who I've heard speak before. Really looking at what he's saying, it confirms that underlying many of the issues that we are looking at and the problems we're looking at for children and youth is trauma. Paul mentioned this, around sexual abuse. You're going to see, as we go through the presentation, that there are some very confounding and interesting things that are occurring right now but some developments that I think keep us back and focused on trauma.

A second speaker, as well, in working with substance abuse and the collaborative, I found very interesting as well, because there has been a momentum in the province. About three years ago, for adult services around substance abuse, they began an initiative doing trauma-informed practice, beginning to look at the effect of trauma in substance abuse.

I attended a meeting of that collaborative about, maybe, a year ago. One of the things that came up on a questionnaire that we filled out was asking about the effects and where we thought substance abuse was coming from and the areas that were really important to that. It was really fascinating to me that there was no mention of trauma as an underlying piece of substance abuse. I just wanted to put that out there.

I'm going to try and stay for the whole day to hear everyone else, because I do think we're going to find that there are going to be some central themes that do emerge from this.

Your front page is just a number of things children have said. We're a very child-centred agency. As others have said, we work with the child, the youth and the family. It is a collaborative. It is the way we need to work.

Our centre is accredited, I guess I've outlined, under the SAIP, sexual abuse intervention program. Many of you may know or may not know of that.

The sexual abuse intervention program has been around since 1990. It has members that are practising clinicians in many regions of B.C. That was actually looked into by Kimberley McEwan, I believe — did a review of the SAIP programs a number of years back. And in 2010 we had the representative's office also take a look at the SAIP programs and make some recommendations. We have standards that have been put in place. There have always been standards in place, but they were reviewed.

The program, although it has been going around, has gone through various forms of decentralization at periods of time. Regionalism, which…. There is no network connection other than what we create ourselves, even though it is under the ministry. I'm just putting that out there. Although it's not in my presentation, it's one of the key things that I think is very important — having that collaborative connection with other providers in the region who also do this incredibly difficult work.

We're basically the front end. Part of our service…. We're unique in that we do the sexual abuse intervention program, which is a therapeutic intervention for children and youth. We cover both….

The sexual abuse is under the SAIP program. We can see children under that program who have sexually acted out who are under the age of 12. We did an initiative — we probably worked on it from 2004 on — before, through government levels. We were able to say that children who are non-adjudicated youth who were sexually acting out, who are not going through forensics should have the same right to receive some treatment to change these behaviours, get support, so they don't become the next part in our system, the juvenile system.

We were able to do that, and we've been operating it now for a couple of years only in our little region. One of the recommendations of the representative's office was that the SAIP programs should be seeing those youth. But it's a very difficult thing to do if you're one person in a regional community. You have children and youth coming to you. It's sexual abuse you're dealing with, sexual acting out. It's really hard to think: "I'm going to try and learn the expertise to work with that particular older group that's not mandated." So it has never spread outside the region.

It was with interest that I actually went back and read that report and thought: of the recommendations, how many of them have we done?

The other part of what we have in our program is actually victim services. It's sponsored by Justice. Victim services, again, is throughout the province. We're unique again in that we are specialized. We serve children and youth, and we have developed really different ways of supporting children through the justice system if they have to testify in court about what's happened to them.

I think probably a good ten years ago, we went out and did training with victim services across the region. We've also done training with MCFD, with their social workers around permanent placement planning. It will be something I'm going to allude to at the end — about some more of the recommendations — because I think you'll see, as we're going along and talking about the needs of these children, that we need to do a way better job in terms of planning more appropriately for placement.

I did want to tell you a couple of things that we've done,
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because it leads into what Paul Lacerte was talking about as well. Our name changed quite a long time ago because we recognized that children coming though our door were not just coming in with sexual abuse. As we did our assessments and our treatment plans, we were hearing about lots of other forms of trauma. So it was fine. We were under the SAIP umbrella. We were able to do that.

What's happened over time and what we are seeing…. And we have a great statistical database — ours works — and it's wonderful. We're now collecting on what the reason for referral was. We can have primary, tertiary and secondary, even, so we are getting that complexity of information coming out. We began to open the doors, just a little tentatively, with MCFD and other funders, letting the professionals in the community know that we would see other forms of trauma.

We thought, "Maybe people coming in and it's not sexual abuse — it's going to be small," so we began a process of opening those doors. When we opened those doors, we opened them just a little tiny bit. We got about ten the first year, then 20 the next year. Then we thought: "Ooh, this is substantial. In a little, tiny agency where we only get about 170 to 200 referrals a year, with a very small staff, if this increase goes on, we're going to have difficulty serving them."

But how do you make decisions between a child here who has had extreme trauma from physical abuse or violence in the home, who really cannot function well or someone else who had a single sexual assault outside the family — terrible, really impacted them? Do we say no to one and yes to another?

We actually went and got funding, and our collaborative, to do that funding, was that we have to be able to assist these children. We have talked to government. We've done all of those other things. We've gone up the ladder, just as we did for the youth with sexual behavior problems, trying to say: "Really, can we not change the…? Can we not just open it up? Can we not do something better than this?"

There isn't a desire right now, that we have heard. It's all about funding. Cuts are there. There is no funding. It is not going to happen, we've been told. We did manage to get a Norgaard Foundation — a little bit of money to allow us for two years.

We had a floodgate in the next year when we started to see them. It was almost half of the referrals. So we know the route there. We know there's great demand for it, and it's trauma underlying it.

I just want to point out one of the other projects we have. It's on the third page, if you're trying to follow. I may go back and forth between all of this.

As Paul was saying, having trauma-informed practice within the aboriginal communities, especially those on reserve where there's a huge amount of abuse…. And it's undisclosed, often. It has not come forward. That's not so unusual when you think of probably…. We believe it's at about 90 percent — stats vary on it, but it could be up to 90 percent — of children that don't disclose.

We see the tip of the iceberg, and you'll see later on I have some more stats about that. There's confounding information.

We entered into the WISH project. That is Weaving in Spirit and Health. It was a three-year collaborative. We did not get money from B.C., except through foundations that we got support from. We did get money from the federal government, and it was under our victim services mandate, under Justice.

What we did is we wanted to find a way to move in collaboratively, learning both culturally but also sharing the cultural experience and our expertise with a team. Our perfect team that we happened to meet was from Tsawout. We have completed that project. That mentorship, in many, many ways…. They now have two victim service workers there, because we lost one, trained another one. Both are now back in that community working. They know about victim services, how to support, and they're taking some lead roles on.

We also, in that process, helped them to learn about clinical practices that they could put in place there, which led, actually, to their accreditation for the mental health team. They actually have a clinical supervisor there now who is delivering service. They also have an aboriginal First Nations woman who does have some of that practice healing, who is a support to them when they can take other avenues. Ours was to mentor, to be able to build the clinical expertise that they will flavour and take away and do what they need to do with.

I think that is a route that is something that needs to happen. Our collaborative ended. It was very, very taxing on our agency to do it because the sustainability in creating that…. We had to carry it as it went through.

It's a wonderful way to go. It lands in with what Paul is saying as well — that we need to be doing more of this. It can both come from aboriginal but can be enhanced from services that have already been in place for a long time providing this service.

I wanted to touch on the research and trends that are going on. The Canadian Incidence Study many of you may be familiar with. They tend to do it about every four years. It comes out with new stats on it. It's on page 4. It talks about the reflected decline in confirmed reports of sexual abuse.

This has been going on…. Finklehor did a study back in 2004. Again, they were looking at the incidence of it, the confirmed incidence. That means it's been substantiated on some level. It doesn't take in the ones who haven't come forward. It doesn't take in the ones where they're not able to get a statement or the child won't disclose or there may be behaviours, but there's really not an indicator there.

What they found is it's gone down. The latest was that
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it was basically in half. It used to be we'd say one in four children will experience sexual abuse by the time they get to adulthood. If we take that half, well, one in eight will experience it, and there may not be a disclosing. They may never seek treatment. It's often done in retrospective studies.

I just want to say a bit about that in terms of service, because I think in child and youth mental health it's a much easier take to be able to have a child stand up and say: "I was depressed. I was anxious." We cannot do that with children who have been sexually abused or abused in other ways. We protect them by law, but they do not have to identify themselves.

I want to point out a little difference with this too. The effect of being traumatized by something you did not do, that happened to you…. You tried to protect your body integrity, but it was overwhelming what happened, and it left you with a normal traumatic reaction to unavoidable events. Many victims of child abuse do not want to be seen as being a diagnosable mental health disorder, which Paul alluded to. You'll find especially in the aboriginal community that is so.

Even our languaging around this…. The reason we developed SAIP networks was really to keep it out of having to be this mental health diagnostic manual disorder and put it more under a societal issue that had traumatic effects that affected mental health. But our hope was that early intervention would get children back on course.

That program was pretty novel and innovative, because children were able to access the program across B.C. through different regions. They were able to be seen and work. There were no restrictions on "you've got ten sessions, and you'd better be done." It was really done in a very child-focused, assessment-based way of working — and with the whole family.

Often the children's difficulty was also in the disturbance within the family, what that meant for the family, where a whole family fell apart or lost their beliefs on what this pure little innocent child now faced. So a lot of our work is really difficult around belief systems, but it's also around the actual trauma effects.

J. Thornthwaite (Chair): Judith, you wanted a five-minute warning, so I'm giving it.

I think what I really want to go to is on the needs for the other forms of service. We are seeing out of developmental trauma…. All the research is here. You can read through it later. You may want to even go further. Bessel van der Kolk and others came up with developmental trauma as a means to cover some of the difficulty we're seeing and that kids have experienced — adverse trauma over periods of prolonged time.

These children need an awful lot of help, and they are not easily mitigated by normal evidence-based CBT, trauma-enforced CBT. They need wraparound services. They are not getting served that I can see. At this point, if our view is that we had all of this influx — we know child and youth mental health here, locally, has waiting lists longer than ours; we have long waiting lists — these children are not usually being seen in child and youth mental health until they've got a diagnosis. So they are out there.

Examples of this might be a five-year-old who's a runaway already from school, who absolutely is triggered because he's so dysregulated that he's flying out of the classroom. Or we've had kids who've taken apart the whole classroom. They are totally out of control of their body because they're triggered by different events that have happened from their past. Would we say we're not going to help them? I don't think so.

We're in a debate in our agency. We have to find a way to see both. My recommendations on some of these, as you will see through…. I've got and collected some of the comments from our SAIP network as well. People — we sent out to them, we consulted, and they also believe we need to shift it.

A sexual abuse intervention program should be a child abuse intervention program. We need to work collaboratively with ministry. We need to find an influx of, somehow, some kind of money for the front line, because all of this planning on the top end is not materializing on the front end. We need to be able to serve right away, and we have a network to do it. Not to use it, I think, is a little unconscionable.

We've got the clinical training. Everyone's seeing the same. Van der Kolk — whether he ever gets this diagnosis put in or not, it doesn't matter. It fits with what's on the ground. There are children, who at single trauma, it's quite easy to work with. Children who have support in their family — quite easy to work with.

These children are often in care. I know there is a practice going on, the trauma-informed practice in ministry. I applaud it. I think it's great. Watch and take a look at what it's going to mean to: who actually gets served and how many more are out there?

I think everyone should be at least cataloging or putting out: where are the requests for these other kids? Where do they go? Trauma is not going to be done by Children Who Witness. That is a great place for kids who are pretty well okay. It's not a place when it's trauma. So we need to do something.

People in the U.S. would say it's an epidemic of what is facing society. The trauma are the effects you're seeing in dysregulation: kids not being able to meet their education, going into substance abuse, suicide or cutting or other forms of self-harming, poor relationship development — and the genetics of it. If you wire and fire together in your neurons and every time you're responding to trauma, you, yourself, may be taking that — and it's an epigenetics — into another generation. I think we've al-
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ready see the effect of that in First Nations as well.

The recommendations we would have are listed on the back there: to partner, to do some of these collaborative partnerships, of course, with others when we can do it; share the knowledge; do the mentorship. Do all of these things, but is has to be something at the front end. We need to tell that children who've been abused by other forms of violence do not have to wait for a diagnosis to get help, that those children are as important to us as the children who have experienced sexual abuse, even if it's treated much differently in our province.

I think I'm probably right there, at the five minutes. I do actually really hope that you read through, because there are some comments by children of what the experience is for them. I would have loved to have given you what I gave a number of MLAs — an experience of what it is to just have a moment of your own dysregulation, by thinking of a very negative thing you may have experienced and what happened to you in that. Just imagine a child, who has no defences. Let's do something to support them.

C. James (Deputy Chair): Thank you for the presentation. One of the things, which I think was reinforced by the presentation before you, was the simple fact that I think all of us recognize: if we don't deal with the trauma, if we don't deal with those children now, we will be dealing with the end result. The end result could be damage for that child and that family, or the end result could be damage for other children and the community.

I think that's why it's so important that this be linked to our discussion around youth mental health. I think, as you point out, it's not necessarily a mental health issue, but it causes difficulties with mental health when someone's gone through trauma. I think that's a very important piece that sometimes doesn't get looked at when we talk about diagnosis. We look for the diagnosis rather than looking at the trauma that has caused the mental health.

I wonder, Judith, if you could just talk a little bit about where you see referrals. Where are you getting these kinds of cases? You mentioned education is often the place where this manifests.

J. Wright: Quite honestly, when we announce to our child and youth mental health…. You know, we have a number of child and youth mental health people around here. It's not really under our SAIP program — although, quite honestly, to some degree, we're doing this little bit of a bend. We can't really hire out and ensure that we're going to have another person there. But the referrals were largely coming from the social workers on the ground.

Once they heard, "Oh, there's a place where we can send them…." Child and youth mental health also put the word out and said: "Oh, they're going to do the trauma work with this group." So instead of some of them coming in the back end….

Although, quite honestly, if they have come in the back end, it's four years after they've experienced domestic violence. They went through Children Who Witness, and they didn't get any support of any other kind of counselling. Then they showed up, finally, at mental health. In one case I can think of, the girl was actually not attending school any longer. She was terrified of being out in the community. So the referral came to us because underlining it was the trauma fact.

We had a lot of referrals, really, from the ministry — child and youth mental health. Then we had to put the word out again that we can't deal — without being able to get another staff person on. We're going to have to juggle between who's the top priority here, and these children are top priority.

The other part of that, Carole…. What really is concerning to me is the group who are coming in with the multiple forms of trauma, such as witnessing, physical abuse. There may be sexual abuse there, but there may not be. They are actually fitting the envelope of the developmental trauma. So they're compromised on many, many levels. The wonderful, valuable thing about that is in our assessment, we can now start to pick it up, and we're going to start tracking it.

I think the cases, like van der Kolk…. We have these kids. They are going to cost us a huge amount of money in the future, because they're not making…. I like the developmental label rather than complex, because it speaks to the problem in the development that has been interrupted. If we don't get that back on track, we're going to be paying for it in the future.

I just have one comment. How do you get your name out? How do people know where you are and how to access what you offer?

J. Wright: Well, that's a difficult one. We are a non-profit agency. So obviously, our executive director or any website things that we have out, any information…. Our child and youth mental health services know all about us, probably the social workers here. But out in the bigger community we have many people, we know, on our lists. We've put that out.

I'm more worried about the SAIP communities in small communities. I really am. I've heard things like: they travel between two communities. They have a half
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person to do this kind of work. We've heard that at times they don't want to open the door to suggesting other forms of trauma because they can't possibly manage, because there's not the assistance.

I think it really brings it back to the front end. If we don't have people there to do it…. We can make all the planning we want in the world, but if you don't have someone to actually assist you on the ground, then we're not going to be doing the work. We can talk about great practice. We can talk about what we need to do, but we need people to be able to actually see the child.

I did quote that little stat: for a five-year-old, if you've got to wait six months, that's a tenth of your lifetime. If we don't shift that when it's really easier to shift, then we're going to be looking at this longer and longer.

I will say that our staff find it quite difficult. This is a different phenomenon. When it's gone beyond the complex. Real development…. It is going to take the wraparounds, which everybody else is talking. It definitely will. We'll need the medical community. We may need child and youth mental health in the end. We may need other assistance from community-based social programs. Collaborative is great, but we need to be doing something right now.

M. Karagianis: Judith, you didn't make any mention of wait-lists, although there's a referral here on page 6.

M. Karagianis: You haven't really touched on that, though. Obviously, you've talked about needing to kind of broaden the support systems to include trauma.

M. Karagianis: I mean, for children, waiting years for treatment is catastrophic. What are your wait-lists like?

J. Wright: Our wait-lists. Right now we've got 35 children waiting for just about four therapists.

Because of development trauma, which takes some time, we're not…. You have a choice of whether…. Do you do ten sessions and say you're done when you know you're not done? Or do you actually do the work and really do the wraparound, transition appropriately? Of course you do. That's what you do in clinical practice.

That list translates into probably a four- to six-month waiting list. The four-month ones would be top priority. That's an urgency one — recent sexual assault, recent physical trauma, suicidal, hospitalized, etc. But if we were talking about someone who had previous support and they were wanting to come back because something else had come up, we'd probably triage them lower because at least they've had a bit.

We also take advantage of doing a very quick brief service, perhaps with the same therapist. I think maybe if you do it like — what do you call it? — a vaccination, an extra shot. By doing three sessions, maybe that'll hold, and they won't have to come right back in. We do know that these are the children who'll probably need multiple levels of service over time, but the biggest one is to identify early. Those waiting lists are difficult.

Here's the worry we have. Because we have the waiting list now and because they know that out in the community, the referral sources and referrals to our agency have dropped. The last time this happened was under sexual abuse intervention, where again we made a very big splash about how we needed extra service for sexual abuse. In the end, we got that, but in the year that we let people know that we had these waits, our service referrals dropped — we're not quite as low as it was then, but it still was very significant — by about a third, the drop.

That makes us wonder: "Well, where are they getting service?" If they're getting service, great. But it is the right service? That's a very good question. Child and youth mental health — we sometimes try and refer to them, but they've got waiting lists as long as ours — or longer, actually.

D. Plecas: Judith, thanks for a great presentation, and thanks for the great work you do.

One of the things on the wait-lists…. If somebody comes and they eventually make it off the wait-list — and they could have been waiting six months — then it may well be that the diagnosis reveals that they need a psychiatrist's help. They'd be waiting again for that, right? Or would they?

J. Wright: We have our victim services, as I told you. It is our intake team as well. They're very well trained — there again, a master's level of training, just because we feel that, although it's not required in the province, we want real expertise in child development, etc.

What we would be doing is…. If they were not attached to a psychiatrist and it appeared that they'd been hospitalized, etc., we would already want that in place. We'd be talking to the parents. We also give support to the parents around other things they can do, other services that may hold.

Right now we're doing two groups for parents right off the wait-list, because we think that at least we can support the parents so they can support the child. At least that's better than having nothing. That is one thing that our waiting list contributed to. When we had no waiting list, parents didn't really care about going into a group because they had access immediately to the therapist. Now that they have to wait, they want to come in for the group. So it's another way.

But yes, we would be looking at all of the supports that are in place, as in Project Alive. Have they worked with
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Project Alive? Is there anything they can do there? What's the school support system? We try and do a fairly extensive what the wraparound could look like, but it's still not the same as delivering the trauma therapy.

D. Plecas: If I may ask one more question. How much money do you need to operate for a year, if we said that we're going to kill off the wait-list?

J. Wright: Well, I could probably guess right now…. We were — I hate to say this; we're small — about a $900,000 budget that was doing it when we were able to keep the FTEs. With the drop of Norgaard, which is providing some funding, to keep on another 1½ FTEs, which could possibly bring it…. I mean, two would be great. But even if we couldn't have two, 1½ would do substantial….

The waiting list would be very minimal. You'd wait maybe six weeks, a month or whatever. The cost of that would probably just be $120,000 to do that every year — built in to ours.

Now, I can't say what's happening around the province anymore. We've lost the ability for that interconnection because they regionalized SAIP, and we were actually spearheading to keep that connection together. But as our little service has been stretched, it's been hard for us to keep the connection. I don't know if they have waiting lists. Some of them may. Some of them may need…. We know that they're into seeing some of this trauma. But if they were to actually open their doors and say, "All forms of trauma," that may need to be looked at.

I would suggest…. We got an influx when they first did the SAIP review. I think it was something…. We were at a $5.5 million budget for all of the province. It hadn't been looked at for 20 years, and they brought in another influx of $1-point-whatever million for agencies that had a waiting list. That's what we've lived on for the last five years.

But this is now opening the doors to the other forms of trauma, which are fundamental. I mean, I'll hazard a guess. It could be, if you were to actually do a review of other agencies providing this kind of work in the SAIP network, that it probably would be a similar influx. It may need $1 million — not $10 million — but on the line maybe $1 million and a bit.

In our particular agency, I actually know that every year we have to raise at least $90,000 to $110,000 — fund-raised dollars — just to manage what we already have. It's not all government-funded. And unlike government, where your buildings are paid for, we have to pay for our own buildings. Administrative costs have gone up, and other things have not.

It does seem like a real drop in the bucket, you know, but it's very, very hard to find the funding. We've used foundation moneys. We have gone after all sorts of ways of stakeholders providing some funds, and they've been very generous to us, but you do not go back the third year and say: "I would like funding again." It's one of a kind, a one-off. Like our WISH project — that was phenomenal, what we did. That group is still operating out at Tsawout. The children's group is still going. It's prevention education. They have therapists there who could identify and get the disclosure and work with those children.

It's phenomenal, at a very low cost, really, to do that, to build that kind of collaboration together. But it cost our agency because we use our professionals, a victim service worker and a therapist, to do the mentorship and be there. If you could look at a way that…. Either two combinations. Mentorship — that's a different thing — and then there is what's on the ground in front of you and the number of kids needing service. Right now 1½ would probably be close to eliminating the waiting list.

J. Thornthwaite (Chair): Thank you very much, Judith. We have to move on, because we're still kind of running behind, but we very much appreciate you coming and taking the time to share with us. We've got your materials.

Thank you for the opportunity to present today. It was really an honour to be invited as a service provider. I'm happy that I got to hear the other presenters first and can echo many of their sentiments in my presentation. I do believe that the issues that you're facing on this committee are really complex. So many of our citizens face these issues in their day-to-day lives, but as citizens we — all of us — have a hard time articulating to our elected officials what some of the solutions might be when it's issues like these because they are really personal, deeply troubling, and often there's blame and anger associated.

I really wanted to focus my presentation on the work that I think is valuable that's being done out there, not only by our agency but in the communities that we work in. I'd really like to focus, as much as possible, on the positives and, although there are many challenges, how these challenges can be turned into opportunities.

We recognize that there's not an unlimited flow of cash that's able to come from government. Our agency is 100 percent funded by the provincial government. We're a private agency. We don't have the capacity to fundraise, and we feel very much in partnership with government. It doesn't mean that we don't have suggestions and comments about how the structure and the system can be improved.

I'm just going to speak a bit about our agency for those of you who aren't familiar with us. I know Donna is from the Cariboo and is familiar with our founder. Axis Family Resources started in 1992, so we're in our 22nd year of operation. Rick and Maureen Gibson founded the agency
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on a two-bed, specialized contract. At the time, I was working as a ministry social worker in Williams Lake. My background is in child welfare.

I've worked, I guess, as a social worker and now an administrator for 28 years, and my passion is in child welfare. It wasn't my intention when I attended social work school back in the '80s. In fact, very few of my fellow students thought they would go into child protection. It was considered the worst job that you could take. However, as a brand-new grad, it was the only job that was available to me.

I was in New Brunswick, so I moved into child protection and was immediately inspired by the possibility of the work that could be done — change from within the system. I always thought that I would be on the outside as a community developer, but I realized the amazing opportunity that we have working in the system. But it's very, very challenging.

All of our systems are really complex when it comes to dealing with families and the kind of traumas that you've heard about — not only today, but I've read the transcripts from your previous meetings. I know that the representative has provided you with example upon example upon example. Those are the people that we work with, so I don't need to repeat that.

Back to our agency. At the time, in the ministry, there was a movement to develop specialized-care homes that were a little bit different than the foster care system.

There was a movement away from group homes to specialized family care, so our founder, Rick, and his wife started a two-bed contract. As a social worker…. I was the first social worker to place a child in their home, and it was a real gift for us in our ministry office there at the time to have an option other than group home care — a really, really important distinction. I could talk a lot about the model of specialized care. I can certainly talk more if you wish, but I don't really want to go into the detail.

The point is that we believe, and I know the ministry folks believe, that there does need to be a spectrum of specialized residential care for children and youth. We are on our way to developing that full spectrum. We have a ways to go.

As an agency, the services that we provide tend to be at the far end of the spectrum: the children and youth who have blown through multiple foster placements, adoption placement breakdowns and some kids that come directly from their biological families. We're working with kids — children and youth — who are at that extreme end of behaviour challenges. Many of them now are coming to us younger and younger who have either diagnosed mental health conditions or simply, but not simply, that trauma that we're talking about. Addiction issues, developmental disabilities, FASD — the whole gamut. They're coming in younger.

Today, currently, our agency provides just about 100 specialized placements. We've spread from the Cariboo all through the north, down into the Thompson, in the Okanagan, and we're in the East and West Kootenays. We have, as one agency, over 100 specialized beds right now at that high end, what's considered to be the high end.

Now, they're not all in staffed resources. Many of these children and youth — and some of them are adults, as well, with special needs that have transitioned from youth…. They are not all in staffed resources. Some of them are in specialized care homes, which is that first model that we introduced in the Cariboo in 1992.

We also provide a range of what we call non-residential services or family services. Again, we tend to work with the families that are at the higher end of need — for example, in a program that we call family outreach, which is based on a model out of the States, the Homebuilders program. These are families where their children are just about to be removed from their care. This is the last-ditch effort to try and keep those kids in their placements. Our counsellors go in and work intensively with that family for four to six weeks to try and create enough of a safety plan to get that family on the path so their children do not have to come into care.

This is a tremendously cost-effective program. If we can prevent a child from coming into care, it will save our programming and save the government the cost of that placement. I don't have the current figures for what a foster care placement — a regular foster care placement — costs in the course of a year, but it's not cheap. If you start moving up the chain as to the intensity of that resource, it gets more and more expensive. We believe that a program like that is very cost-effective, so we're working at both ends of the spectrum.

As a private agency, again, we're in a situation where we need to make the most efficient use of our dollars, what we get from our funders. Primarily, we're funded by MCFD. We're also funded by CLBC, Interior Health, Northern Health, Justice, and we work from time to time with aboriginal partners. For example, today, currently, we have two specialized residential contracts with First Nations organizations in the Cariboo: Knucwentwecw Society and Secwepemc Child and Family Services.

These are aboriginal organizations that are seeking specialized residential programming from outside of their own resources. That's a need that we're really excited to respond to, if we can, because that enables us to build those partnerships with those communities and learn as much as we can on an ongoing basis about how to provide that care.

Generally, about 60 percent of the children and youth that we have in our residential placements are aboriginal. That's about the same statistic of our persons served in our non-residential programming as well. We work a lot with First Nations people.

It's really important for us to keep in mind the values that we have as an agency, and one of those is that the family is the centre of the planning. I know you've heard that frequently from other speakers. I think one of the earlier speakers this morning said not only do they have to drive the plan; they have to be the leader. It's really, really tough to do that in our system. It's a very complex system. I know you're aware of that — how Health interacts, the ministry, the mandate that they have, the school system. I wanted to speak a bit about that.

In preparing for my presentation, I spoke to as many colleagues as I could in Williams Lake. It's where I live, and it's the community that I know the best. I was really struck when I met with a couple of our high school counsellors. I have two young adolescents in high school, so I know these women. The day that I was there, there had been a homicide in Williams Lake on the previous weekend. It was a young man. It was a case in the news a couple of weeks ago.

The school was absolutely shaken that day. There was a revolving door in and out of that counselling office. One of the counsellors had to keep leaving. It really struck me — though I didn't know this young man, and he had not been in care — the effect that it was having on the vulnerable students in that high school that day. What the counsellors told me was that they're in their school and feeling this real sense of isolation in what they can do and how they can connect with our system.

In the Cariboo we're really lucky. We have amazing relationships between agencies in the non-profit society and the private organizations and government. You've heard a lot about those initiatives. But when tragedy hits or when there's so much stress in the system, I think the biggest challenge that I've heard about — and that I know we experience — is the time to get together and collaborate and do that collaborative work.

Often we say to our staff…. We have about 400 employees and subcontractors across the many communities that we work. Often they're young people that we're recruiting who may or may not have their own children, and coming to work with very challenging cases. What we try and say to them is that sometimes all we can do is try and support these kids to stay alive until they're old enough to deal with their issues or until they're old enough to develop the support networks they need in the long run. It really is a touch-and-go for so many of the youth that we work with.

Challenges. I'll just speak really briefly. We like to think of challenges as opportunities, but it goes without saying that our system is really stressed right now. There is a growing demand for serving children who are younger and younger. Again, this has an implication for the kind of staff that we hire, the kind of training that we provide. When these children are coming into a staffed resource, we make that resource as much their own home as we can. We don't know how long they're going to be with us.

We hire staff. The model that we use for most of our staffed resources, actually 99.9 percent of them, is a 24-hour-shift model. That's a little bit different than a traditional staffed resource where you have eight-hour shifts that transition throughout the day. Our model of a 24-hour shift, we believe, is very, very powerful, because it reduces the transitions that these youths have with the staff who are caring for them.

It's also, we think, a more cost-effective model for providing this kind of programming. It's a little bit cheaper to…. We pay a flat rate, and we believe our staff are well paid. But it is slightly different than paying an hourly wage. They sleep at night, and so on. We provide 24-7 support to our resources. It's a good model.

That challenge we have now of the growing demand…. As I said, we're providing just about 100 children and youth and adults with specialized placements right now. We're just one agency. We receive calls on a weekly basis to provide emergency placements.

We did an emergency placement last week. It was the child of a young person that I removed from his family care when I moved to Williams Lake. It was my third day of work as a social worker.

A large sibling group, and over the two years that I worked for the ministry, these children came in and out of care numerous times. I was really struck last week when this placement that we made was the child of, I think, one of the youngest in this family. The issues are very, very entrenched with many of the families that we work with. I think you've heard a lot about what those issues are, so I don't need to go into that.

Some of the other challenges that we face — again, we try and see these as opportunities — is how to work in rural communities where there are major transportation issues. Also even cell phone coverage — it's something that I haven't heard mentioned so far.

We have to be mindful of where some of our resources are that have adequate cell phone coverage so that we can respond to our staff if they have an emergency — or how far away the resource is from the nearest hospital or the school. Costs are different in those cases, so that's a challenge that we face.

Another challenge in the system right now is the recruitment of caregivers or regular foster homes that the ministry contracts with and that we contract with as well. It's harder to find people who are willing to take these children and youth into their own homes. We're a lot more risk management savvy than we were 20 years ago, and many of these kids have issues. They're very damaged, and the destruction they can do to property, the risk they can pose to other children in the home….

There are kids and youth that we work with, but it's sometimes hard to find family care homes — families who are willing and able to take those kids in. Often they're not in school during the day. They've exited from
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school programs, so there isn't much of a break there. The recruitment of caregivers is challenging.

However, we believe that if you support caregivers in a way that they feel they're part of a team and they're a part of the solution…. They don't have to be the entire solution, and that's the kind of support we try to provide to our caregivers.

The other challenge that I think we face, which is also our opportunity, is keeping moving forward the initiatives right now to develop that full spectrum of services to bring the collaborative work really on track with all the ministries. You've heard several ideas about how that could happen. I really, really echo that. We know that when we work collaboratively around our kids and build that team, we have success. But it takes a huge commitment of time, and it takes a value to do that.

I've heard from other folks, again, that people are sometimes afraid to come to the table to work with these kids. The fear of someone committing suicide on your watch, the fear of saying, "We don't have enough staff to deal with that problem…." It is really tough right now, but I think if people can overcome that and come to the table, it makes a huge difference.

A couple of the best practices that I'd like to mention, which we're either involved with ourselves or we know happen in our communities…. The complex care intervention initiative, I think you've heard about. Dr. Chuck Geddes has worked in the Interior for the past few years.

We've been really fortunate to have Chuck involved with many of the kids that we serve. Again, what that is…. It brings that collaborative team to the table, and it's a trauma-informed practice model that we see as very, very valuable across the board. I know the ministry is looking at that and expanding that, and I really applaud that idea. If we could have that kind of support for all of our specialized resources, I know that we would have greater success. It really is an amazing program.

J. Thornthwaite (Chair): Ann, could I just interrupt a bit? What did you say the name of that program was?

A. Smith: Complex care intervention. Dr. Chuck Geddes is the lead contractor. I hope I'm correct, but I think he's worked with maybe 43 cases so far. We've had him in a few of our cases.

J. Thornthwaite (Chair): We've got about five minutes, and then we'll open it up to questions.

A. Smith: I'm just about done. I'm sort of speed talking. I hope it's not too incomprehensible.

One of the things that we've built into a lot of our contracts with the ministry is something that we…. We kind of coined the term "a toolbox of resources." It's funny because a few years after we had some of these toolboxes in our contracts, we heard someone talking about this toolbox. We said: "We actually coined that term." "No, no, that's a ministry term." No, actually, we did. It's a really amazing, simple solution. It puts some flexibility into contracts. It's an agreed-upon sum of cash inside your contract to do things that are not easily paid for otherwise.

When I was a social worker in the ministry, you didn't have to go up to the deputy minister to get approval for extra funding for a foster parent. It was a lot simpler back then. Today, understandably, it's harder to ask for something that doesn't fit into a contract. So we've built these toolboxes into a number of our contracts. What it does is allow the social worker and our staff to make decisions on the ground to say: "Yeah, I say putting $500…." Sometimes very small amounts per thing make a huge difference.

For example, we can give money to parents to travel to an assessment in the Lower Mainland. We can pay for play therapy. We can buy rodeo gear. That's an example that someone reminded me of this morning — rodeo gear for a young man in foster care who was just acting out all over the place. People were coming together, trying to figure out what to do. This was a few years ago. We determined that he had a love of rodeo. They didn't have the money for this. It was hard to get it through his child-in-care file. We paid for this, and things settled down. It's kind of a fun example, but it really shows that if you have some flexibility in your funding and can build in these toolboxes, it's great.

We have it connected to another program, where we work with youth aging out of care. One of the ways this toolbox works in that program is that before the youth ages out, we get them into their own apartment, and they start to experience what it's like to live on their own in an apartment. Gee, maybe they get evicted, but we've got the money through the toolbox to start again — get the damage deposit for the next place and get going again. It gives them that life experience with a little bit of that financial backing while they're still under the age of 19.

There are a million ways that these toolboxes can be used. I've got other examples, but I think I'll end it there, in case there's anything specific I've raised that you want to hear a little bit more about.

D. Plecas: Ann, thank you for your presentation. I think I heard you say that you have 400 employees.

A. Smith: Yes, we've become quite large, starting from our little two-bed contract in Williams Lake in 1992.

A. Smith: Well, in some communities we have one or
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two staff, and in some we have more than 100. We have staff in Prince Rupert, Terrace, Nechako, Dawson Creek, Prince George, Quesnel, Williams Lake, Kamloops, Vernon and then South Okanagan and East and West Kootenays. We're very spread out.

A. Smith: We expand every year. We're always expanding because the demand for the service continues to grow all the time. We also respond to RFPs and so on. I mean, we seek out our own expansion. But what I call the unsolicited new business is great. It's generally from the ministry, and it's often crisis-driven placement needs. Placements break down.

We also provide a foster parent support program, which is a provincial program through the ministry. Again, the more support we can provide, as communities, to regular foster parents — the ministry foster parents or levelled foster parents — the more we can prevent that placement breakdown. That's our goal.

We're in the business of providing specialized care, but the more we can prevent placement breakdowns, as communities and as the province in general, that's where we're going to find significant savings. It really, really is.

C. James (Deputy Chair): That was a nice segue to the question I was going to ask. Thank goodness you're there to provide that kind of crisis need, because we know and as you've said, there have been many reports come forward from the representative and others that have pointed out the need for that specialized care.

It may be an unfair question to ask you now. Maybe a follow-up is needed. Are there some consistencies that you see in the young people you serve, which you would point to around prevention? Are there some things you see that bring young people to that crisis point, bring them to needing a specialized care home, which you or your agency can point to and say: "If the system dealt with these pieces first, we wouldn't be seeing the kind of pressure for the increase of beds in the province"?

A. Smith: Yeah. I mean, that is a good fundamental question. Personally, I think what I see is the stress on families that increases…. It's kind of ironic. I think the more we know about trauma and the sort of trauma-informed practice that you've heard people mention…. I don't want to say that it creates a greater demand, but I think there is a heightened awareness in school personnel or in medical personnel that things are going off the rails for a child.

I don't know, Carole. I think one thing we see that's maybe related in the resource communities that we work in is the draw of the oil sands for our young men who we used to be able to recruit a little bit easier into working with our population. I think sometimes families are getting fragmented a little bit just from the stress in our system in general. But I don't know. I mean, I see the demand growing all the time. I don't know why.

C. James (Deputy Chair): I think demand and acuity — I hear that from everyone. The cases are getting more complex. The youth who are coming in have more demands than people were seeing previously. It's kind of at the root, I hope, of some of the things that we're going to be able to look at around this committee as well.

J. Thornthwaite (Chair): Thank you very much, and thank you for all your work and what you do for children in British Columbia.

A. Smith: Can I just make one more comment? I can't remember who talked about it. It might have been the representative — some discussion about the age 19. We provide a youth addiction mobile treatment program funded by Interior Health. Their youth goes up to, I think, age 24 or 25. That's really, really useful in working with that population. I just wanted to put that plug in for thought on that.

Post-majority services are challenging. Our agency set up a bursary fund a couple of years ago. We've provided bursaries to former youth in care — $1,000 each. We don't put a stipulation that they have to go to university. We've provided funding for people getting their welding ticket, their professional driving ticket, FoodSafe — all kinds of stuff like that. I think the more we can invest in post-19-year-old services, again, that's a preventive measure.

J. Thornthwaite (Chair): Thank you very much. My only request would be: would you be able to provide later to the committee more information on your request and excellent comments on the Dr. Geddes initiative that you referred to?

J. Thornthwaite (Chair): Can you just get it to us later so we can take a look at it?

The next presentation on the calendar is at one, so we'll take a break for 15 minutes and come back to get ourselves organized for the rest of the people. We'll recess.

J. Thornthwaite (Chair): Good afternoon, everybody. We are back. The committee is back in order. We have Dr. Moira Stilwell on the line now, joining us.

Our next presentation is the Canadian Mental Health Association, B.C. division. We've got Bev Gutray and Kimberley McEwan.

B. Gutray: Good afternoon, Members. Thank you very much for this opportunity to present. I'm just going to do a very brief history on the Canadian Mental Health Association.

We are Canada's oldest mental health charity — 97 years old. In B.C. we operated for over 60 years. We have 18 branch offices across the province, which provide services to over 100 B.C. communities. In any given year, through our collective impact, we reach 80,000 British Columbians. Just a little bit of history.

I just want to say, before we start, that as I was listening…. That's more likely a disadvantage coming early to listen. I thought: "Oh my goodness, what a tremendous responsibility you have as a committee." It's very clear from listening that there's a tremendous amount of evidence today that we more likely didn't have 20 years ago to make good decisions on.

There are big challenges, right? We all know those big challenges. We know that the child and youth mental health system doesn't nearly address the need that needs to be addressed. We know we want to do better overall in the long term. We don't want to be graduating young people who have been served by the child and youth mental health system into the adult system. Right now we graduate about 75 percent. When you look back, these are the kids that had mental health problems. So we want to do better there.

We're going to talk as an organization about two kinds of initiatives or strategies, one more upstream. So what can we do on an upstream basis? Then on the other side, really looking at the recommendations from the last representative's report about what we can do with the current youth that are graduating from the child mental health system. Graduating is more likely not the best description. I don't think they would describe themselves as graduating. We know that each year some 700 kids graduate from that system.

I also want to start by saying that at times we've done things pretty well. I think that will be news to you, because often we're talking from the other side. I'm going to hold it up here. This is the 2003 Child and Youth Mental Health Plan.

We actually, for a number of years, got it right. It talked about strong central authority. It talked about core services. It talked about ensuring that there was consistent practice across child and youth mental health. Then it talked about strategic investments. So we actually got it right.

We had great leadership. I want to pay absolute tribute to people like Dr. Jayne Barker and Dr. Charlotte Waddell. Those were our key leaders in this area: a great assistant deputy minister and a great deputy.

But you know what happens? We sometimes do really good things, and we don't stay the course. So whatever your recommendations are and whatever structures you come to, I would say, "What can we do?" — that if we're going to invest, we don't just invest, make progress and then go back, because we all want to do better for young British Columbians and their families. So I just want to recognize that good work that has been done. We had made progress, but we did not stay the course.

At this point I'm going to turn to Kimberley McEwan. Kimberley has worked with the Canadian Mental Health Association off and on for five years. I give her absolute credit for being one of the major architects on our Bounce Back program and also on a telephone-based program now that is supporting parents across B.C. We've had a very good working relationship over time. Sometimes Kimberley's a consultant, and today she's a volunteer consultant.

K. McEwan: I want to just leave you with a couple of messages. I think the main one is that we need to be smarter around children's mental health. We need to modernize. I don't think that we are as innovative and as modern as we should be in terms of mental health delivery systems.

As you would have heard today, it's estimated that one in five children and youth are struggling with mental health problems. We've looked at the epidemiologic literature six ways to Sunday, and it always is there. It's always around 20 percent, and I think that those figures are quite credible. We know that the rates are higher in aboriginal children and youth, and as you've also heard throughout the day, it seems that the service needs for children and youth are more acute, that we're seeing more and more complex cases.

Our system is focused primarily on downstream answers to these problems and downstream strategies, and that's not sufficient because we will continue to see cases that are increasingly complex and simply drain our resources. So we need to move upstream in a big way.

We know that most mental illnesses begin in childhood or adolescence. Most adults that have mental disorders say: "Well, you know, the onset was when I was just at puberty" or "I had an anxiety disorder when I was a child." These things begin early in life, and if they're not treated, they persist. And when they persist, they interfere with educational outcomes, they interfere with social functioning, and they interfere with self-esteem. But we can mitigate these things in children and youth. We can improve their functioning in the short term and social inclusion, productivity, employability and all of those
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things in the long term.

We know that access to services is the number one challenge. That's what you're going to hear about, probably, all day. People don't have access. There are not enough services. That's certainly the case, and certainly the biggest problem, for children and youth with severe and complex conditions. However, a very large proportion, the majority, actually have mild to moderate conditions, because these are early onsets, recent onsets, and those are the children, very large in numbers, that we can do a lot for.

The children and youth with mild to moderate conditions do not necessarily need to see a mental health specialist. They don't necessarily need a psychiatrist. They don't necessarily need a psychologist. There's a number of innovative programs now around the world where non–mental health specialists deliver evidence-based treatments under the supervision of higher-trained mental health professionals, where fidelity is monitored throughout the program very effectively. These are very cost-effective programs, and they're done very effectively elsewhere.

To make these programs even more cost-effective, they can be delivered via telephone. CMHA has had a great deal of experience with telephone-delivered programs. They have an adult program for depression called Bounce Back, which Bev referred to, and a telephone-delivered program to parents of children with disruptive disorders.

Our current reliance on traditional models of service delivery — which are office-based practices, the use of specialists more or less exclusively and complex and lengthy referral processes — prohibits us giving timely services to children. There will never be enough services to meet the demand. We know, the evidence shows, that services have the greatest benefit if they're provided early in the clinical course of a disorder, not later — not five years later, not ten years later.

With funding from government, CMHA has developed two innovative telephone-based therapies that have benefited thousands of British Columbians. These services could be provided via government, but government is, to use an overused word, not sufficiently nimble and has not had the capacity to introduce some of these more modern and innovative delivery models.

Once again, I'm talking about kids that would be defined as in the mild-to-moderate range of difficulties, whether those are anxiety disorders or disruptive behaviour. Disruptive behaviour is a very big focus for CMHA right now. Disruptive behaviour is known to be a precursor of conduct disorder, and conduct disorder is one of the most difficult and intractable conditions of adolescence, carrying risks of harm and serious lifelong consequences for those youth and for their families.

There's quite a bit of scientific evidence, quite a bit of research evidence, on parent management training, particularly coming out of places like Oregon — a very longstanding, well-developed, well-researched program. Parent management training in Oregon has shown that interventions for parents, for kids with disruptive behaviours at early ages, can affect not just clinical outcomes, not just symptom reduction and behaviour change but academic outcomes, school outcomes and social outcomes, and can also affect maternal depression and employment. In that regard, parent training can mitigate the effects of poverty.

The other thing about telephone-delivered programs is that they can reach anyone in the province. We need to get over the idea, for some interventions, that two people — the therapist or the provider and the client — need to be in the same space. It's not the case. The advantage of a telephone program is that you can have immediate access. Families can have access to a therapist after hours, in the evening, Saturdays. The program that CMHA now delivers for parents, for kids with behaviour problems, is delivered outside of that traditional nine-to-five workweek.

It is available in areas of the province, very remote areas of the province where there are actually no services at all. There may be a GP; there may not be a GP. There may only be a nurse practitioner. Even the most remote communities can benefit from these programs.

B. Gutray: And Kimberley, if I was going to add something, it's the fact that both of these programs are linked. In the adult program it's linked to physicians. In the parent program for children and youth it's linked to pediatricians and GPs. There is a complete referral and referral-back circle that we do.

K. McEwan: The programs also have the potential to be adapted for aboriginal individuals and families in communities. That's something that is being examined by CMHA. Supporting families with children is a strategic priority of the provincial government through its early-years strategy and family-first agenda.

I think one of the requests that we would have is that those provincial initiatives give greater emphasis to mental health issues in children and to think differently than we've been thinking before about service delivery. There are lots of opportunities to be much smarter about how we go about this, be much more efficient and more modern, in ways that improve access in ways that we have not seen before.

B. Gutray: Now, if I could just start to talk about: what about the youth that are leaving care, the 700 youth that the Children and Youth Representative so eloquently talked about, and what the barriers are. I believe that we have done, at our branch network, some really innovative practices.

For example, in Kelowna there's a community naviga-
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tor that actually works with youth and works in partnership with the family services organization to help youth navigate to get the kind of help they need, whether that's in the health system, whether that's income. There is a fairly substantive income barrier within the Ministry of Social Development and Social Innovation, so it's hard to get, actually, funds so that you can have a safe place to live. Then it helps them to get back on their feet and to not navigate through.

That program covers the ages sort of up to 24. It is that bridging program. It bridges between the Ministry of Children and Family Development and the adult system. It absolutely is consistent with some of the findings of the representative's office.

We believe that that whole piece around the Ministry of Social Development and Social Innovation that talks about a two-year waiting period separated from parents — all that's doing to youth that are leaving care is forcing them into dangerous circumstances. Those dangerous circumstances will either result in victimization or are dangerous as far as being in conflict with the law so that they can have some funds to meet their basic needs. We would really urge you to think through that.

The unfortunate thing with the project that happens in Kelowna…. It's like so many projects in B.C. We are definitely the land of pilot projects. As a lot of the previous presenters have said, some of these need to be looked at and need to be absolutely built in as core to how we do our services — you know, looking at the whole system and what the strategic investments are.

The project has done well. It's actually meeting a very unique need. It's helping youth to build connections, so that has worked well.

At the other side of it is: can we not do better with the 700 youth that are graduating, as I said earlier, from the child and youth mental health system or from the youth-in-care system? I believe that we — the private sector, the public sector and the non-profit sector — could line up together with a collective impact project that would look at a portion. We've got at least a baseline of data.

We could look at, let's say, 50 percent of those youth, and let's try and invest in a different outcome. If they have connections to their foster parents, like the representative's report said, let's maintain those until they complete their training or their trade or their education. As far as a protective factor, if we can invest in education so that these youth now have funds in their pocket, they'll have a safe place to live and they'll have the floor of support that allows them to have friends and contribute to a community.

I think we can do a lot better. I think there are many people who would come to that table. There is a way to measure that impact. Many of the things we wonder about — can we measure them on a big basis? Well, it would be a substantive basis if we can make the difference between youth graduating to poverty and youth graduating to a career or a trade. That will make a difference for all of British Columbians.

I just want to go back to something you said, Bev, right at the beginning. I wonder if you just could shed some light for me. I always find it interesting when someone says that things were working well, but it changed. You referenced that report. What changed? For a committee like ours…. Was it funding? Was it maybe science in itself, more recognition around things?

B. Gutray: No, I would say it was a shift in priority in the ministry. There was a focus on child and youth mental health in 2003, and there was a plan, and there was proper leadership. Then the focus changed to a different priority. The ground that we had gained we actually lost over the next several years.

K. McEwan: Yeah, there has been changing executive within government, shifting priorities…. It was actively implemented for about four or five years — would you say, Bev? — before it split.

And it had strong central authority. I think that's one of the things we risk. You know, we have decentralized service delivery, and we have a centralized policy function. But really, it's helping the services to be consistent across the province, not different across the province.

D. Plecas: Kimberley, I was really excited to hear about your phone initiative. That would seem to be something that holds incredible promise. So how far along are we on that? I mean, looking relative to what you're doing right now, how much more could we do? Are we talking about ever getting to the point where you could see this as something which happens as a matter of course, particularly in remote communities?

K. McEwan: There's lots of room for expansion. Right now there's a focus on two particular conditions: adult depression and disruptive behaviour in kids. There are a lot of other conditions.

There is a shift. It's in the ten-year mental health plan. We've seen it in every mental health plan, and that is greater reliance on evidence-based practice. That means that the therapies we deliver are delivered within a fairly tight protocol. We know what we need to do. We know what's effective for different conditions. Given that, non-specialist staff can be trained to deliver that over the phone — if they have tight clinical supervision from
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registered psychologists. That's the model we use.

There's great room for expansion to other conditions. There's also room for expansion within those programs to broaden the base and have more service volume. Right now I think…. How many?

B. Gutray: Right now we can serve 700 parents in a given year through the telephone coaching. It's a very intensive program. They actually get more support than they would in any other way. It's actually 12 sessions of 45 minutes each. That's quite a substantial amount of service.

K. McEwan: And scheduled at their convenience. They don't have to travel. They don't have to get babysitting. They don't have to park.

D. Plecas: What could government do? What do you think government needs to do to help make that better, to help that expansion?

B. Gutray: Remember that earlier I said we're in the wonderful land of pilot projects? This, too, is a pilot project. I think there's lots of desire on the part of the ministry to see this incorporated. I'm sure everything will happen to make that come true. But this is only the telephone coaching part.

One of the other pieces Kimberley referred to was the wonderful parent-training program in Oregon, which is not just focused on a program. It's focused on a whole systems change where while you're doing the telephone coaching, you're actually training your mental health clinicians in the mental health centres to provide the same type of treatment.

Am I right, Kimberley? Kimberley is the psychologist. I'm just the CEO, right? What do I know? So she can correct me on this stuff.

That's the point. It's: can we get major, major impact? Major impact requires big-systems approaches.

K. McEwan: Yeah, I suppose. Related to that is that this particular kind of intervention plays a role in the response continuum. It has a place. It's place is with the mild to moderate, and it's a broad reach. That's got to be connected to the next tier in the response continuum. It's building it into a systems framework, rather than a bunch of piecemeal things happening in different places and they don't really fit as part of a systemic approach to children and youth mental health.

D. Barnett: Thank you for your presentation. I do have in one of my communities a Canadian Mental Health office, and they do some good work.

One of the questions that I have, that I'm confused about, I'm sure a lot of the public is confused about. This is funded by the federal government, right?

B. Gutray: No. We're not any different than the Heart and Stroke Foundation, etc. We're funded as a provincial organization and at the branch level. We're often funded on a contract basis either through the Ministry of Health or the Ministry of Children and Family Development. A lot of branch offices provide housing. That's through B.C. Housing, United Way, individual donors. We have a donor base. We have a United Way base. And we have a corporate sponsorship base.

D. Barnett: See that? I never understood, and I could never get a straight answer from anybody. Thank you very much.

This pilot project that you're talking about for the phones — which parts of the ministries are funding that pilot project?

B. Gutray: We've had wonderful support, actually, from both the Ministry of Health and the Ministry of Children and Family Development. We do, actually, no promotion of this program, when I talk about the 700, because we have to keep it within the limits of that budget.

Right now, parents maybe wait a month for our service at the most. Once they get the service, it often lasts six to eight months.

K. McEwan: Compared to a wait-list of six months at a child and youth mental health team.

The adult depression program, Bounce Back, delivered by telephone, has had over 25,000 referrals from GPs in this province. The uptake among the medical community — the general family doctor — has been huge.

D. Barnett: Has this basically been for rural and remote, or is this for the whole province?

K. McEwan: The idea initially was that it would most benefit — and it does most benefit — rural and remote, but it's available provincewide. We do ask for a GP referral, because most parents with problems with their kid will present to the GP first. The GP then has an opportunity to rule out whether there are some medical causes for the child's disruptive behaviour.

D. Barnett: If I could just ask one more question. Do you know what the breakdown is percentage-wise of where this service is being delivered, whether it's urban or rural and remote — what the percentages are?

B. Gutray: We'll break it out by region with no problem. We have all of that data.

C. James (Deputy Chair): I just want to follow up on your comment about integration. I think the telephone service is wonderful, but as you point out, it's one tool. It's simply one piece that works well for certain youth, certain families and certain kinds of challenges.

I would agree, around the child and youth mental health plan, that the plan on paper looks terrific. It's the follow-up and the resources behind it, the determination, the priority and the focus that have to be there.

You mentioned that access to services is the number one problem and that the telephone service was one way to deal with some of those pressures. Are there any particular areas in accessing service that you are seeing as the biggest pressure right now or the greatest pressure? Is there any one particular area, or a few particular areas, that you get calls about most often or hear about most often?

B. Gutray: As an organization, across the province we most often get calls from, I would say, youth, parents or care providers around the fear that the youth who have received care will not get the same care when they move to the adult. I would say that whole piece. "How do I get help?" is the big question.

B. Gutray: Yeah. The navigation is tremendously challenging. I'm sure you know that because you get those calls in your constituency offices as well.

D. Plecas: Two questions. One wonders why, then, we don't have something like a 1-800 number, like one-stop shopping, as a first stop. That would be one question.

The other question, Bev, I had for you was…. You mentioned that it's eight to nine months that someone stays on the program. Does that mean that after eight or nine months, there's been a successful intervention and there's no further need for services for the moment?

K. McEwan: Yes. In fact, eight to nine months is the average. But in looking at some refinements to the program, we're hoping to have more of a sort of dose-response relationship, where for kids that have more minor problems, it could be a shorter intervention — the family — and for more complex problems, a longer intervention.

Generally, because it's an evidence-based program and because we have very great attention to fidelity in terms of how it's being delivered, the outcomes are good. That doesn't mean that families don't need some ongoing support, and booster sessions are available. But again, it's part of the overall response continuum — where is the continued support? — and having that built in as well.

That could also be in places like schools. We've talked a lot about how this could be supported in schools, because teachers are often the ones that struggle, very much, with kids who have behaviour problems. They can disrupt the classroom.

B. Gutray: And they are the first line — the school and their doctor's office.

If I could just take a few more minutes of the committee's time, I'd like to just end our part of the presentation with a story. Most often it's parents with young boys that are being referred to the program. This is a story about a family out of Vancouver, actually. The mom has a little girl, age eight, and was referred to this telephone-based parent support program.

What had started to happen was this little girl was starting to get alienated in school because of her behavioural issues. There were issues around friends. There were issues around her being sick, not wanting to go to school, and she was actually starting to be bullied.

This parent actually came and spoke with the ministers. At the end of the parent-training program this little girl was able to go to school, and she wasn't bullied. She was able to return to education and find friends in her classroom. That's the impact of the intervention of the parent.

J. Thornthwaite (Chair): I'd like to request, then: could you provide us with more information on that program — where it is and stories like what you've provided? Because that's very helpful. Success stories are really important for us to know, because that's where the resources should be going. We need to know the positives as well.

The next speaker we have is from the office of the provincial health officer, Dr. Evan Adams.

E. Adams: Good afternoon, everyone. I'm just going to load my PowerPoint. It'll be a minute or two.

J. Thornthwaite (Chair): Thank you, everyone. We have Dr. Evan Adams, who is our next presenter.

Dr. Adams, you've got a presentation. Are you going to give us a copy later, then?

E. Adams: I will leave you a copy, and my apologies for not having it to you beforehand.

E. Adams: Well, good afternoon, everyone. I have about 20 minutes to present some ideas to you. It would be great if I could finish early, because I would really much rather dialogue with you today.

I was joking with my assistant that I hoped you wouldn't ask me any tough questions, but on reflecting on that, I thought, well, actually, it's probably better if you ask me some really tough questions and we be very, very direct in this subject area.

We're often a little shy, I think, when it comes to issues of ethnicity and race. I think that doesn't help us get to the point. Certainly, when it comes to First Nations children and youth — and fully half of our population is under the age of 25, so a lot of First Nations are very young — I think we can be direct and forthright about some of those specific challenges.

As far as your work as a committee, I do think this presentation can also be generalized to other targeted groups in children and youth — that is, other ethnicities. It's okay to target subpopulations of children and youth and not just have general measures.

My name is Dr. Evan Adams. I'm from Sliammon First Nation. I'm the deputy provincial health officer for aboriginal health. I've held this position for a couple of years. British Columbia has been, I think, very sophisticated about its approach to First Nations and their attendant issues, particularly in health. I will describe some of those.

My job as the deputy provincial health officer really is to watch over the population of B.C., along with my office and the provincial health officer, Perry Kendall. We report on the populations in the province, and we make recommendations. So we stand a bit apart from the minister in that regard.

We reported on the health of aboriginal people, including First Nations people, in 2009, though the report has a title of 2007. We saw a number of good outcomes for First Nations.

We are distinct and different from other First Nations in the country in that B.C.'s First Nations do quite well relatively, compared to other indigenous populations across the country. We did see that we are getting better in many, many places, including motor vehicle accidents, accidental deaths, poisonings and drug-induced and alcohol-related deaths.

Generally, in our health outcomes we are still higher than the average British Columbian. That's a generalization. That's not true for all First Nations or all aboriginal people or all aboriginal children and youth, just in general, statistically speaking.

We have lower cancer mortality. That is changing and getting worse. We're starting to meet the general population in that regard. We do have a higher prevalence of chronic disease, including issues like HIV. These are very much related to social issues, not to our genetics.

I hope that we've all thrown out the idea of the genetic inferiority of indigenous peoples. It's really their social conditions, most often, that begets these higher incidences and prevalence of disease and poor outcomes. For instance, an aboriginal woman having a higher risk for HIV — it's not about her biology but about her social conditions that put her at risk.

The issues around poor mental health, including substance use and misuse, are true for First Nations and are difficult for us to talk about.

I won't be showing you a slide about our alcohol-related mortality, which is still five times the alcohol-related mortality for other British Columbians. We don't generally talk about it. I get shouted down when I'm with the chiefs. I get the aboriginal press saying: "How can you talk about this publicly? It really does contribute to stereotypes and doesn't help us better the people's health."

I certainly understand the arguments, but if we have an alcohol-related mortality five times the provincial average, including for youth, how can we not talk about it because we're being polite?

One of the worst outcomes of poor mental health, of course, is suicide. The top line is the suicide-related mortality for status Indians, 1993 to 2006. The bottom pale blue line is for other British Columbians. You can see that there is a downward trend for both, which is good news. First Nations suicide-related mortality is higher, but the gap is closing over time.

We've just revised this timeline, and this downward trend for First Nations is actually steepening. It's getting better. We're meeting — we like to think, because of our efforts — the provincial average around suicidality faster than we had anticipated.

Of course, we would love to see a suicide rate of zero — all of us. I'm not sure, honestly, if that's attainable. But certainly, we can set firm goals around reducing suicide rates and other health outcomes in mental health for young people.

If you took suicides by band or by village or by First Nation and you ranked them left to right, putting on the
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left those bands that have zero or little suicidality and on the right bands that had higher rates of suicidality, you would see this. It shows that fully half of the bands or half of the bottom line have not had a youth suicide in about 15 years. About half of the bands have solved — looking at this crude representation — youth suicide.

You'll see that 10 percent of the bands accounted for 90 percent of the suicides. So 10 percent of the villages had nine out of ten status Indian youth suicides. This tells us — it's wonderful that we can actually track this, because lots of provinces can't track this, but we do here in B.C. — that there are youth at risk who are aboriginal. Not necessarily all aboriginal youth are at risk, so we should target youth at risk and not just all youth.

That means that a school-based program might be — might be — misguided compared to a more directed approach at youth like youth in care, youth in custody or youth who've been identified, through a school system or a justice system or even at a community level, as being at risk. A community-level layperson could identify which children or families might be at risk. It's called surveillance on the ground. I'm a big fan of it.

Getting to the structure of the day, there is a First Nations Health Authority in British Columbia. It really should be called the B.C. First Nations Health Authority, not just the First Nations Health Authority. It came about from a series of agreements between the government of B.C. and First Nations between 2005 and 2007.

The chiefs of B.C. are generally quite unified. At the time, they all signed on with the provincial government and the federal government in a tripartite agreement to look at the disparities, particularly the disparities in outcomes for First Nations. These were economically, socially, educationally and in health. This series of agreements means that we are officially partnered to look at these issues. And that's very important — that it's a partnership.

What we want to avoid…. There is a misconception that, for instance, First Nations want to take over cancer care and have their own cancer care centre — which would be, well, ridiculous. The B.C. Cancer Agency does a fine job. The reverse would be ridiculous, where the government of British Columbia looks after all British Columbians except the Indians.

It really is truly a partnership. We've just formalized it. From there we've built a number of health plans.

The First Nations Health Authority, then, is basically the health arm or the health staff of the chiefs. It means that we have about 300 staff who look at First Nations health, which is about 300 more than most of the other provinces dedicate to this area. Remember, these are staff under a First Nations health organization. We're dedicated solely to First Nations health.

Governance is a key element. Much of the decision-making is around who's in charge. If we said, "Who's in charge of youth mental health?" or "Who's in charge when a child attempts suicide?" that should already be decided.

That shouldn't be a situation like we had in Vancouver where a bunch of aboriginal youth made a suicide pact within a school and we didn't know who would be in charge. Should the police do it? Should the psychiatry unit at Children's Hospital do it? Should it be a Downtown Eastside child society? Should it be the school? Is it the principal? Is it me, as the deputy in charge? Is it the Ministry of Children and Families? Who was it?

The idea of governance — who's in charge — is part of our policy-making. You can see in the example I gave you. In a case like cancer it's clear the lead is the B.C. Cancer Agency, and the First Nations partners, stakeholders, would follow. But in other areas — like: what do we do when a child commits suicide? — it might be a more on-the-ground entity, one that's close to the child, who might be empowered, resourced to react.

Let's face it. A youth in crisis is a common enough incident, like a broken arm in a child. It's highly predictable. It's going to happen, unfortunately. We should be really good at reacting to it. That's the message we give to First Nations communities: you should know just what to do when the threat of suicide or poor mental health outcomes is upon your families and communities, and of course, we'll help.

Just a reminder to you around the UN declaration on the rights of indigenous peoples: "States shall consult and cooperate in good faith with indigenous peoples." We have a good reputation for doing exactly that here in this province. James Anaya, the special rapporteur for the United Nations, wrote a scathing report about indigenous peoples in Canada except for British Columbia, where here we cooperate and consult.

We have community-based planning. We have a central health plan for First Nations, but we have devolved these two more community-based plans, so mental health planning for First Nations happens at the front line. We try and hear from them their own ideas about how they think help should come down. The old way of doing business, where a directive might come from, say, Ottawa, about how to deal with children in crisis for that time — that time is over.

Our mental wellness and substance-use plan is quite well developed. We've been developing it alongside the provincial mental health and substance-use planning. We have an approach. First Nations are very sensible about being holistic, and they want to include their own traditional knowledge that they've had, basically, since they were kids. They're not going to put aside their own ideas about how to be well and accept a governmental mental health plan. They want to include their own indigenous knowledge.

So a holistic approach with indigenous knowledge, one that focuses on positives, not just negatives — and here
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are some of its goals: to improve services, supports and health outcomes; to keep aboriginal and First Nations peoples' well-being at the centre of our initiatives; to use strategies and actions that reflect individual and family needs that are community-driven and nation-based; to encourage First Nations aboriginal people in the journey towards improving health outcomes.

We understand quite intuitively, and they tell us this all time, that the idea of mental health is related to a number of other social issues. Communities, we find, are picking and choosing which of these areas they wish to target for their specific area.

You can imagine a reserve within the city limits would have a certain interest in, say, substance misuse, which might be different than a community in the north in a rural area that might identify another issue like, say, resilience in their young people. So we allow them, of course, to make those priorities and decisions.

Holistic approach. I think I really don't need to explain that to this group. Here I just want you to pay attention to the red letters. We have community care–based planning, integrated care–based planning and specialized care. So we have objectives in all of these areas to try and basically grow the teams that respond to the mental health needs of First Nations people.

That's really important. I do spend a bit of time asking caregivers to include First Nations in their catchment — that they're worthy and deserving — and really give them permission to give care where it's needed.

Again, the First Nations wellness model is well developed. We actually consulted with literally thousands of First Nations health workers to ask them around a set of principles. We thought that this set of principles…. Rather than thinking of health as a set of programs, it's really a set of principles. If I took, say, a young aboriginal woman from the Downtown Eastside and cured her cancer — if I could cure cancer — and I put her back on the street, have I done what I can for the wholeness of her health? Of course I haven't. Thus, the idea of this circle is our best representation of the thoughts of the people around saying: "We really need to think about our minds and bodies and spirits all at once, as we were taught."

Surveillance is very important. We need to be reported to about poor outcomes in mental health. One way we can do that is to discuss with people on the ground, the stakeholders on the ground — the families, the health centres, the hospitals, ambulance…. We can look at provincial data in a better way. One way we do that is that we have a First Nations client file that we can match to provincial data. That's why we have such good reporting on incidence and prevalence in a number of areas.

A number of provinces don't track ethnicity — a bit nervous about it. They don't track aboriginal and First Nations populations, so they can't give you the basic incidence or prevalence.

We're just starting to look at chief coroner data. I'm not sure if you're familiar with chief coroner data, but the local coroners gather a lot of information about the deceased. We look at death-related data so that we can prevent deaths. We can hear about cases of youth suicide and learn from them. So there's a child death review panel. I sit on it. Whenever there are deaths in young people that are not expected, we review those cases, and we try and learn from them. We make recommendations from that data.

There's also the regional health survey, which is a sampling of First Nations communities where basically First Nations clients are asked to self-report on their health and health outcomes. It's a very small cohort, and it is self-reporting. So the data is not amazing, but it does give us a little bit of a clearer picture.

A lot of our efforts currently, at the moment, are to respond to basic mental health emergencies. There's a long history of this from Health Canada's First Nations and Inuit health. At its worst we would helicopter in a health professional after a dramatic mental health event, like a suicide, and for a very short period of time ask them to try and help. That's at its worst, because it's of course acute and time-limited. You know, the horse has already left the barn. I can't remember the expression in English.

At its best we anticipate that there are going to be crises — for instance, the end of a relationship, drug and alcohol misuse, gay/lesbian/bi/trans youth coming out, family issues, violence directed towards young people, rape. Those are very predictable events in young people's lives that we should have a plan for and that health workers on the ground should have heard of, instead of running around and saying: "We don't know what to do. Someone do something." They should know themselves, somewhat, how to respond.

Here are some examples from Vancouver Island. We have three mental health programs: national aboriginal drug and alcohol programs; Indian residential school programs, which deal with issues around trauma; and the national aboriginal youth suicide prevention strategy.

The Indian residential school support programs look at issues post–residential school, issues around colonialism and around trauma.

The drug and alcohol programs look at, of course, drug and alcohol issues and look at the issues of survivors of drug and alcohol abuse. It also deals with issues like residential care and withdrawal.

The youth suicide prevention strategy puts teams on the ground who can track youth at risk. Their main issues are making sure that their personnel are trained well enough that they can react to most, if not all, mental health crises but also that they can effectively identify which youth are at risk. One of the big complaints that we hear from them is they don't know which youth to track, so they're tracking all of them, which is pretty hard.
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Here's where some of those teams exist. We would like for these teams to be a little more widespread, a little better prepared.

In summary, the First Nations Health Authority has mental wellness programs and plans. It has a large provincial plan and many regional and local plans. It has many programs that we've inherited from Health Canada but others that are now in development. These can be holistic in approach, so someone like a traditionally based worker — someone who prays or sings or speaks the language — can also help around mental health.

There's an evaluation component. We've been given, actually, quite a lot of money in our transfer agreement between Health Canada. Health Canada transferred their First Nations and Inuit health program endowments — their responsibilities but also their resources — directly to the First Nations Health Authority, to the tune of about $500 million a year. These include a number of programs that are already up and running.

With that transfer of resources there is an evaluation component. And of course, we're holding to the science as well. That's part of my job. Someone might say: "Oh, what young people need is cold water baths every morning." As much as I would love to throw my teenager in a cold water bath in the morning, we have to look at the evidence and say: "Well, what is…? Let's do an environmental scan of our programs that are working, and mix it all up and put our best thoughts forward."

Moving forward — again, a holistic approach. A focus on social risks. A focus on community-level and local planning and approaches. Building on existing strengths and not being solely deficit-focused. Multiple, complementary strategies, so having a youth centre where young people can hang out might be just as effective as having a psychiatrist ready to react when someone has attempted suicide.

We'd like to encourage the role of the medical health officer, or doctors on the ground who have public health functions, to prioritize wellness programs and services, to support community capacity. That means investing on the ground, and not necessarily centrally, to help provide leadership. Leadership also means encouragement and also reminding them to be confident in their responses.

Intersectoral coordination. Surveillance, or watching over the population. And, again, planning and evaluation.

What do you do when you have identified specific bands? I was struck by what you said. And I totally appreciate that you've got the data, which is great. What do you do, when you've identified a band that has the most challenges, to intervene?

We've heard of this from the rep's last report, actually. There are these so-called no-go zones where social workers are trying to intervene but aren't actually allowed on site, and they're threatened with physical violence. What does the system do, or what can we do, or what can you do to intervene?

E. Adams: If I could be a bit poetic in my response, mistrust is sometimes an issue with First Nations communities. For instance, with the education bill you saw federally, there's definitely a mistrust from certain communities or chiefs who thought that their educational autonomy was being threatened. If that was being threatened, they would turn down a huge whack of resources. So mistrust doesn't help.

If I have a magic pill, say a pill that…. If you have HIV and I have this magic pill that means you can live indefinitely instead of dying from HIV in 18 months, but you don't trust me and you think I'm trying to poison you or you think I'm a jerk, then you won't take that pill. So the issue of trust is actually quite important. That relationship-building should be happening before a crisis.

We saw during H1N1…. Sorry to pick on Manitoba, but in Manitoba, where there was a very poor relationship between public health officials and First Nations, the First Nations would, in the press, be very quick to say that Manitoba's public health was not doing enough.

Here in B.C. we had built relationships, and I think they felt like we were very reactive to all of their concerns. Even when they had cases or when they had lots of cases and they felt like it was spreading quickly amongst them, when we reassured them that we were doing everything we could and that we cared, "Let's work on this together," they completely accepted that.

The idea of relationships needs to happen. I think if a social worker can't get into a community, then there needs to be some ceremony, there need to be some high-level meetings, and there needs to be some goodwill.

D. Plecas: Dr. Adams, one of the things you brought to our attention was the analysis which showed that, really, the largest percentage of the problem is concentrated in 10 percent of First Nations communities.

D. Plecas: And you did that with respect to suicide. Presumably you've done that with respect to other issues as well. To what extent have you done that? And to what extent is there an overlap between suicide and substance use, as you describe it? I would describe it as abuse. Can you speak more about that? What's going on there?

E. Adams: Sure. First of all, it's because we have such good data collection and good relationships that we can actually share and use the data amongst ourselves, as government and as First Nations, and that we get such a clearer picture than other jurisdictions get to have.
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For instance, because we collect ethnicity data and we have physicians who are reporting diagnoses via diagnostic codes during office visits, because we have a relationship with First Nations and they report to us when they use alcohol or how often they use alcohol…. And we trust that data. They trust us to hold that data and not use it against them, and they can respond honestly.

We know, for instance, that amongst young First Nations people in B.C., their use of alcohol is actually less than that of other British Columbia youth. But when they drink, they drink more. Those fewer numbers in First Nations who drink, drink more than their counterparts.

Because we have that data, we can then target those at-risk youth, and we can say things like: "Bingeing is a social norm that needs to be discussed and turned aside." Or if we can't break the culture of bingeing, then we should institute chaperones. They can be peer chaperones — someone who's sober and in their midst. Or it can be an older chaperone who's acceptable to them, who watches over so that nothing bad happens when they're drinking.

We know from our look at mortality data, specifically First Nations youth mortality data, that alcohol can often play a role in suicide. It's a disinhibitor. You do things when you're drinking that you would never do when you're not drinking, like commit suicide or attempt suicide. You might go for a swim when you're drunk, and drown.

We've just finished looking at First Nations drownings, youth drownings for the last six years. We saw that the vast majority of them were alcohol-related. Because of these data, we can then make solid recommendations about what might be helpful.

Before, we might have guessed that First Nations drowning rates were worse than the general population's, and we might have instituted a school-based life jacket program — which might have been misguided, because we see that most of those deaths are not in children but actually in teenagers who are drinking. The focus should be: where are they drinking? Why are they drinking? How are they drinking? Who's there to help on the ground?

D. Plecas: If I may. I'm not sure. Maybe I didn't state my question clearly enough, but I’m not quite getting it from your answer. For example, one of your stats was that the rate of psychoactive drug use was five times what it was in the general population.

D. Plecas: No, you also had a stat there on psychoactive drug use. If I recall, it was five times what it was for the general population.

In any case, I guess what I'm getting at is…. We would all say that whatever problems youth have are in part a function of that environment within which they have to live — which is an environment filled with adults. If there's a great amount of substance abuse amongst those adults, then that is going to impact in terms of violence against youth, youth suicide, a lack of helpfulness.

What I'm ultimately trying to get at is this. Is it the case that those problems that we have, like in that 10 percent of First Nations communities…? If we went into those 10 percent, would we find a disproportionate amount of problems with respect to other issues like alcohol abuse, alcohol use, drug use in general?

E. Adams: We might. Well, we probably would, but I would also say that there's probably a whole constellation of issues that would also need consideration. High drug and alcohol use in youth is not just related to their family environment. Some would say it's also related to issues around parenting, around boundaries, around school-based programs….

I'm not talking about drug use or alcohol use amongst youth. I'm talking about drug and alcohol use in general within a community. If somebody were to say to me, "Where am I going to find the most domestic violence?" I'm going to find it where I have the most alcohol use. That's pretty much a truth in the whole business of domestic violence and other kinds of issues.

D. Plecas: Since you have that analysis, I guess what would be helpful is for us to know: are we really talking about 10 percent of First Nations communities in general? When you talk about being targeted, as you suggested — which I thought was one of the reasons you said that — maybe we can be more targeted in a more general way to those 10 percent.

E. Adams: Okay. I think I'm getting where you're going, and I wish I had now included…. I've put up this slide around promotive factors around youth development and youth mental health, but I also have a slide, which I don't have, around risk. Certainly, there are risk factors within families and, of course, risk factors within communities. You would expect that youth at risk or youth who are drinking or youth who have poor mental health would have particular situations in their families and communities that would need addressing.

D. Plecas: I think this is a particularly significant issue, given your one comment, your nicely blunt comment about the reluctance to discuss the issue of alcohol amongst, presumably, leaders in First Nations commun-
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ities — I mean, the very people who would have the ability, the wherewithal, to help make changes in a community. I think it would be good for us to have a really good picture of that.

E. Adams: I agree. I think we haven't had very good uptake around our alcohol misuse strategy in First Nations because it's such a difficult conversation to have. For instance, when our stats came out and I saw that alcohol-related mortality, or deaths caused by alcohol, was five times the provincial average…. For First Nations, it was five times the provincial average or five times that of other British Columbians. APTN started their interview with me by saying: "We're not sure why we're even talking to you about this, but we've been asked to." They were pretty mad at me.

It doesn't mean that I shouldn't talk about it. I could do it badly. I could be accusatory. I could get the chiefs' backs up. Or I could try and bring it up in a really good way, like: "How do we meaningfully do something about binge drinking or alcohol-related deaths? What do we do about risk-taking when you drink?"

D. Plecas: I promise, Madam Chair, this will be my last question on this. I really think it's significant. As you know, it's significant in or outside of First Nations communities.

People will talk about the overrepresentation of First Nations people, not in First Nations communities but with respect to domestic violence. The other question people need to be asking: is it really a function of that, a function of the amount of alcohol, or the manner in which people are drinking within those households? Really, all roads point back to the alcohol issue, and we never really tap into the alcohol issue. We stop and, say: "Oh, it's all about being First Nations." Well, no, it's not.

I'm just saying that I think that whole thing needs to be investigated, and it would seem to me from my work that it hasn't. One reason, again, is…. My experience has been the same as yours in terms of it's hard to raise this issue, and people understanding that it's not about trying to be insulting to anyone. It's about trying to get at: what are the root issues here?

E. Adams: If I might turn it…. Public health messaging that's negative, we find, is ineffective. If we say to people, "You drink too much," that often isn't quite heard. If we could find a positive way to put it…. One way we might do that is to look at resilience. Young people encounter drugs and alcohol. They do. So they should be armed, and they should be forewarned about it.

We know in Europe, where drinking ages and their drinking culture are different than here, that binging and alcohol-related deaths are different. If we can change the culture around teen drinking or challenge it or nurture it, we can make young people more sophisticated about alcohol.

That's maybe a more positive way to frame it — maybe. It's just a suggestion. But I completely agree with you that the dialogue around alcohol in our families and our communities is terrible.

C. James (Deputy Chair): Thank you for this conversation. I think it fits with the discussion that we had as a committee around the issue of mental health. I think mental health and addictions — a lot of the conversation has to deal with stigma. I think sometimes it's race-related, sometimes it's community-related, but I think the issue of stigma has to be part of our conversation of how we deal with those issues overall.

Two quick questions. The first one is related to the youth suicide numbers and the statistics. Those statistics are on reserve. Correct?

E. Adams: No. Those are all status Indians, so anyone who qualifies by a federal definition.

C. James (Deputy Chair): Okay. Because it was drawn out with bands, that would include, then, if a child was in care and the child was from a band and they committed suicide. That would be included as part of those stats.

C. James (Deputy Chair): Thanks. I think that's important to take a look at, because many of those youth will have been removed from the community and may not be on reserve and may not be linked back to a band.

Then my other question was just related to the challenge — we talked about it earlier in our committee — of on reserve, off reserve and the fact that First Nations people, aboriginal people, are mobile and often, for work or for health or for family, go back and forth between on reserve and off reserve. I wonder if you could talk a little bit about what you see from your role on the challenges in accessing services.

Just an example. We hear around the committee that for someone who is turning 19 and wants to get community living services, they have to go off reserve. They don't get any services on reserve. They have to move off reserve. I'm guessing we see some similar challenges around mental health supports as well.

E. Adams: Yes and no, in that not all reserves are rural or remote. In fact, when we asked community how they defined themselves — as being urban, semi-urban or rural and remote — only 20 percent of First Nations in B.C. define themselves as remote. In places like Chilliwack or greater Vancouver lots of communities said it felt like they had good access to tertiary care centres.
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Honestly, the jury is still out about whether reserves are a risk or protective. I know that generally the thought is reserves are place of risk, but they may also be places of protection because that's where families exist, language and culture. There's some investment in programs. Actually, there are some good investments in programs on many reserves. The statistics are still coming in. For instance, our cancer data shows that living on reserve is protective. Living off reserve, living in the Downtown Eastside is actually a risk.

As our data gets better… We're adding a field around not just band number, because your band number just tells you if you're a member of a band. It doesn't say that you actually live on the reserve. We have place-of-residence data, and hopefully, we can try and tease out some truths around that.

But definitely for First Nations, a lot of the disparities are related to geography, the rural and remote sector, but also the poor — those amongst the First Nations who are poor.

D. Barnett: Thank you very much for coming and making this presentation. What period of time were these statistics taken from? Was it a ten-year period, a five-year period?

E. Adams: The data I've been presenting come from about six different data sets. We at the office of the provincial health officer report on aboriginal health every five years, so 2001 to 2006, 2006 to 2011. We're very busy getting together our current data.

We track about 65 health indicators for First Nations here in B.C., and we're going to be expanding that as the First Nations Health Authority expands its capacity to track its own citizens. Part of that will be that communities will report on their own people's health and well-being.

Now that the First Nations Health Authority is in place and the transfer of funds has…. I don't know if it's been done or it's in the process. When we have issues like we have on some of our reserves where there are suicides and the social workers could not gain access…. You said it was a lack of trust. Will there then be First Nations workers sent to these places where there's a lack of trust when there are the issues that there were surrounding this one particular suicide?

E. Adams: Essentially, no. Really, the approach is that the stakeholders on the ground should partner to remedy the situation.

Where a social worker needs to gain access, one of the partners shouldn't be saying to the other: "Just leave it to us. We'll deal with it. You're not welcome here. Get out." That should never happen. We wouldn't expect a social worker to say that to the family or to the community, and we would never expect a community to say that to the government or to a government-based health authority worker. That does not fly.

They need to get their business in order. We could help facilitate that, absolutely, but we wouldn't helicopter in workers to remedy the situation. That's like in a marriage, for the two partners to sort out.

Yeah, I think if social workers are saying, "We're not welcome there," then some very-high-level meetings need to occur so that those workers get in there by the afternoon.

J. Thornthwaite (Chair): Dr. Adams, this has been very helpful for us. Personally, I really appreciate your honesty and your frankness. I personally believe that if we're not honest and frank and get the facts out and are afraid to say the uncomfortable things, then nothing's going to change.

We appreciate that you've been here. I actually would like to continue the dialogue with you. I'm sure that I speak for the rest of the committee in how much we appreciate your presentation.

E. Adams: Great, and thanks for being so forthright. I do appreciate it. I'm glad that we're not just kind of glossing over it and saying: "Oh well, it's too complicated."

J. Thornthwaite (Chair): Well, we've heard all of the representative's reports, so we know what the reality is out there. We really appreciate it.

We've got another presenter that's going to come, and we've got to be out of here by three. If Andrea wants to come up and get set up, that would be helpful.

We've got one more presenter, and we'd like to welcome Andrea Paquette from the Bipolar Disorder Society of B.C. We just need you to make sure that you speak into the microphone, but we don't mind if you're standing.

A. Paquette: My name is Andrea Paquette. I'm executive director for the Bipolar Disorder Society. What we do at our organization is…. We're under the umbrella of the Bipolar Disorder Society of B.C., but what we do is educate youth about mental health.

We go into classrooms, and we talk to them about things like a personal story — because I have bipolar disorder, a mental illness. What we go in and do is talk about stigma, and we also talk about mental wellness.

I want to start just a little bit back, because I think it's really relevant. When I was four years old and my mother had bipolar disorder, one of the things that was quite a shame was that she was quite sick. There was a time when I heard the ambulance come into the driveway, yeah….
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My father never talked to me about it. I didn't know what had happened, but she was taken away in an ambulance.

One of the things that I think we don't talk about enough is stigma in families. This is really important, that the child knows that their mother is going to be okay and that they're looked after and maybe even have a hospital visit, and that isn't such a bad and scary thing.

I went to live with my mother when I was 16 years old, and she started suffering with delusions. She got really sick, and that led to me being kicked out of my house at the age of 17. Instead of getting back at my mother, I got $10,000 in scholarships and bursaries and made it to the University of Victoria, and I graduated.

Considering that when I was 16, I was kicked out of school…. When I lived in Ontario before my move to B.C., I was kicked out of school. I did drugs every day. I drank every day. Maybe I was self-medicating and I didn't know it. I wasn't in a good spot, but I made it out.

I ran for nomination for Member of Parliament. It was really interesting, because I wanted to go to one place, and that was Ottawa. I drove across the country by myself, and it was spectacular. With Saskatchewan skies and the trip across the country independently, it was amazing.

I headed to Ottawa, but I didn't find a political career in Ottawa. I found bipolar disorder. I found bipolar disorder because I tried so hard and got so stressed out — what's called a trigger. I tried to get a job, but I just couldn't get into the House of Commons.

As time went by — one, two, three months — nothing worked out. So I thought to myself: "Well, if I can't get a job in the House of Commons, I'll make my own job. I will make the next federal election strategy to win so that I could be Prime Minister." That was my goal.

When I say that was my goal, I don't mean like it was a willy-nilly goal. I was in what's called a mania. A mania is an elevated state that you have with bipolar disorder. I believed as strong as I am standing here giving you a presentation today. That was how strong I was going to be Prime Minister. It was 33 pages, three hours and single spaced, and I was assured that it was going to happen.

One of the things that I experienced and that a lot of people don't talk about when they have a mental illness was psychosis. I experienced psychosis during this time. I was in my mid-20s by this time. I was at my friend's house, house-sitting. I saw the devil's head dance in front of my face. I saw this glow in my view. Many people ask: "How did you know it wasn't real? How could you possibly think it was real?" Well, I had a break with reality, and I didn't know what was happening. And it happens — quite often actually.

What ended up happening from there was I ended up in the hospital for a month. I got better over three weeks of medication, but I realized something. A lot of what happens to people with mental illness is this. You become jobless. You become penniless. You become friendless. You become family-less, because they weren't there, and not even having a home. The hospital was my home, because my roommates had kicked me out. They were afraid. The stigma is so great that people don't even want to talk about it.

I had one thing in mind. I got a place to live, because it was rent-negotiable, and I got that place with $400 from social assistance. That was all I had, and I made it happen.

A lot of people don't make it happen, and they can't, because they're just in a situation where they're not well enough. I was lucky that I was able to make it through.

I drove across the country, once again, to go home. There were no Saskatchewan skies. It was bleak. As I headed back home, it was quite horrible, because I experienced depression for the first time. When I experienced this, I would walk into a grocery store and it would be so overwhelming even to see the food on the walls and to have to try and pick something. I couldn't even taste my food.

If I was to cook something or take a shower or do a simple task, it was like building a house. It became really overwhelming. The only thing that I thought I could do — and the only way out — was to commit suicide. I attempted with a large bottle of pills.

It happens all the time. People with mental illness attempt suicide. I survived, and I was in this place which many of you may know: the Eric Martin Pavilion. It's not taking patients anymore, thank goodness, because it wasn't a great place to be. There were no services, and I was left to stare at a wall and just do nothing.

I met a great psychiatrist. I think this was the tipping point, where I actually met someone who cared. That's what people need when they have a mental illness: somebody who really cares about them. He would remind me of things: "You've done great things in your life. And you will do better things."

I got out of the hospital on a new medication regime, therapy in place, a case manager, a team and a will to survive. I ended up going to South Korea. That's where my next step took me. It was really random, but I went because I needed to get away. I needed to get away, out of Canada, for good.

I was there for two years, and I taught children, which was amazing. They made me feel so much better. Children are very healing. Having a job that you can be confident at…. I became a university professor for a year. Having a job where you can exercise your skills and your abilities — that was one of the things that helped me get better.

I ended up coming back for a vacation to Canada. As I walked along the harbour, I realized that things weren't so bad anymore, so I decided to come home. Just to sum up a little bit of what happened next, which I think is important to know, is that during this time I ended up getting a job in the B.C. government with the Ministry of Social Development and Social Innovation. I made some really wise decisions. I was really well. I still suffered once
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in a while, but I was still doing very well for myself, and my health was pretty good.

I ended up taking self-development courses, and they asked me at the end, "What did you get out of this seminar?" and I said: "My name is Andrea, and I have bipolar disorder. I have an illness; I am not my illness. I have bipolar. So what?"

Then, at another seminar…. It was a freeing moment. It was like the self-stigma…. It's not just stigma out here that you experience with people and the stereotypes and the movies and everything. It's the stereotyping in here that's really happening, as well, that I was able to shed with some help from my circumstances and the people that I met.

It was really neat, because I was in another project seminar and there were funny T-shirts around mental health saying things like "The problem with being bipolar is that everybody else isn't." Or things like "What is normal but a setting on a washing machine?" They just questioned: what is normal anyway?

So I have my T-shirt. It's cute. It's pink. It's amazing, and it's going to be called Bipolar Babe. That's how it was born. It was a T-shirt idea. As time went on, we became bipolarbabe.com. We were not just a logo. I was giving out postcards to people. I was doing all of these things, trying to get my personal story out there.

As time went on, we became the Bipolar Disorder Society of British Columbia, with five programs now, of which I'm executive director. With these five programs, what's really important is that we provide peer support for youth, which is something that is so vital and so important.

As well, we do the classroom presentations, like I said, and we've spoken to 1,800 youth since September of 2013. They're changing their perceptions. When they can get this education, they say things like…. One boy said: "Because of your presentation, I no longer feel scared to meet my biological father, who has bipolar disorder." It's changing lives, and it's bringing the education into the classrooms. That's what's really important.

With our youth, we can teach them to stay mentally well. We can provide them with the information they need, and that is what we do. We provide them with the little cards that I handed out to you, in the classroom. If you turn it over, it says: "Do you feel alone? Do you feel scared?" Or whatever it says, it's just asking: "Are you okay?"

We need to let these kids know that they need to talk to their family doctors, most especially, and the people on the front line, like the counsellors, the teachers and the parents, not just to each other because that isn't enough. But that's where they go.

We did a survey of 90 grade 8 students at a particular school. We asked them: "Will you ask for help before your problems get out of control?" Out of 90 kids, 48 percent of them said no. It's really sad. So we go to the schools, and we tell the kids: "Ask for help before your problems get out of control."

If there's going to be support, why don't we have things like the crisis line highlighted and really well advertised, for instance, so kids know where to call? It just seems like nobody knows what to do, and there's not a clear path or a road map when it comes to mental health services for youth. The youth themselves have issues with transition into adulthood — have a great fear of this. Really, all they need is the support.

I just want to thank you here today. We can discuss recommendations and topics and what the Bipolar Disorder Society of B.C. has experienced and heard from youth, because we've heard a lot.

J. Thornthwaite (Chair): Thank you, Andrea. That was really good. I don't think I've ever had anybody stand up doing a presentation.

D. Plecas: Andrea, thank you for that presentation. I wanted to stand up and cheer.

D. Plecas: Yeah, it was great. How does somebody know the point at which they have bipolar? I mean, say for example, for you. Is it some event that happens where somebody else is saying: "Hey, something's wrong"? You described a situation where you were in a psychotic state. Well, in theory, you wouldn't know you were in a psychotic state.

D. Plecas: So can you tell us a bit about that? I mean, I guess you could say something about not just bipolar but mental illness in general.

A. Paquette: One of the things that's very important to know is that it doesn't happen the same for everybody. When people are diagnosed with a mental illness, the occurrence can have similarities to other people's experiences. But bipolar in particular…. It hit me like a wave. It was like this huge psychosis, this horrid experience, where other people experience more mild ups and downs and would never have a psychotic experience.

There was nothing in my past or in my youth even, really, that pointed to the fact that I may have had a mental illness and I didn't know.

When it comes to approaching that, one of the toughest things to do is to know if you have a mental illness or to
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know if your friend does. Like I said in the presentation, the youth are reaching out to each other, but they need to reach out further than that so they can be assessed by a professional and so that they don't feel scared to do that.

M. Karagianis: Yeah. Thanks very much, Andrea. I'm particularly interested in your outreach to young people. You've talked a little bit here. First of all, do you get some funding to help you provide this outreach to schools and to youth?

A. Paquette: We do. We get funding from Telus, Bell Canada, the Edith Lando Foundation, the Children's Health Foundation of Vancouver Island Foundation — just various funders. If you go to bipolarbabe.com, you can see all the funding there. Yeah, we're a humble little non-profit, but we do pretty well. We do get the funding. A lot of people and a lot of funders actually really, really care that these kids are getting this education.

One of the things that I wanted to share today in talking about the work that we do: why isn't there curriculum in schools? That would be an amazing addition, so that when I come in — or Natasha, who is the other presenter for the Bipolar Babe project — it's not just one day. It's not just one day where they feel inspired, they write a feedback form, they feel amazing, and they say that it made such a difference in their perception and that they would recommend it to a friend.

Really, when it comes down to it, why don't we have this? They're developing this in the States — curriculum — and I'm in contact with somebody who's actually doing this. It would be amazing to have once a week even, where we have a class on anxiety, a class on schizophrenia, one on suicide, another on therapies. You know, it would be fantastic.

M. Karagianis: A further question, if I may, to that. One of the discussions, the themes, that has come out of our presentations today is the issue around services and accessing services — a different experience if you live here in the capital region than if you live in more remote communities.

I'm just wondering if you want to make any comments about access to services. You talked earlier…. You sort of alluded to your experience at Eric Martin. If young people come to you and say, "I'm having these issues. Where do I go? How do I get help…?" Right? What is your observation on what supports are out there?

A. Paquette: What's going on — yeah. Well, basically, I met two young girls who contacted me out of Ledger House. They were staying there, and they were admitted. I would go and visit them and just spend time with them and play the mentor role a little bit. I asked them directly about the service that they're receiving, and they said: "Yeah, it's a little boring in here, but it actually is really safe." They feel really safe.

But one of the girls couldn't get in for a month, and that's one of the things that concerns me. What was she doing for that month? Just sitting on her hands, not going to school, feeling completely helpless? Obviously, I know that there aren't beds all the time, but there need to be more.

Another thing is I really like the idea of a phone call system as well, which the Canadian Mental Health Association was recommending, especially for the remote areas. I think that would be very beneficial.

As well, I just feel that the transition from youth to adulthood and going into that system is very complicated, convoluted, and it needs to be assessed. We need to create a roadmap for these families. I hardly understand it. It is so confusing.

One of our young girls who was in our Teens2Twenties group said she went to the hospital, and they refused to serve her or, you know, talk to her about her mental illness because she wasn't 19. But when she went to Victoria General, she wasn't young enough. So she's being left in the mix. This is a real problem that's happening all the time.

One of the things that's developing here in Victoria is the Moms Like Us initiative with the clubhouse. That's really something I would like to see developed because that way our youth can transition into a place where they're supported. That would be amazing. It's basically a clubhouse that gives educational services, a structured workday, housing — all of these things that are just basic needs for people. They need all the help that they can get.

C. James (Deputy Chair): Thanks, Andrea, for your continuing good work and the presentation.

Just a couple of quick questions. One is just based on your own experience. From the time period that you were diagnosed until now, have you seen…? I'd just be curious, from your own opinion, whether you feel that there's been a shift around stigma, whether you feel that some of that has been addressed.

Then the second question is: what's been the response as you look to expand your mentoring program? As you look at other schools, what has the response of the education system been around the kind of support that you provide? I know that a lot of your contacts are made through the education system. What's been the response of the education system around your work?

A. Paquette: In regard to stigma, I feel that we’re in a movement, and things are changing. I'm very hopeful. I don't want to be negative about it, because I do feel very hopeful.

I believe that over the last 11 years that I've had a mental
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illness, it's become a lot easier to talk about it. I could actually now host events called the Bipolar Babe Benefit, and people are like, "Oh, what's that?" where maybe 15, 20 years ago it wouldn't have been so out there and accepted.

With stigma, as well, it's a great thing when somebody can start feeling better about themselves with that, in shedding that internal stigma and becoming the person they want to be.

How's the educational response been? Well, if you think about the classroom size, it's about, I would say, 20 to 30 kids in a classroom, and we've presented to 1,800 since September. It goes to show that the teachers are very responsive.

Many of them have mental health conditions themselves. One of them actually wants me to come to speak to the PAC committee, the parents advisory committee, because the parents are the ones who also need to be educated. A lot of the times the parents are the ones preventing their kids from getting the help that they need. People would be like: "What? Is that possible?" Well, when the parents aren't educated and they don't believe in mental illness, then the kids don't get the help that they need.

It's not only about educating the students and the kids. It's also about educating the teachers and, most especially, if there is the opportunity, the parents.

J. Thornthwaite (Chair): Andrea, thank you very much. Excellent presentation, and your message is bang on. That's what we're trying to do here in this committee: blast out the stigma and get people talking about it. Because of presenters like you, you're helping us to do that.

A. Paquette: I have been to Burnaby. That was a couple of years ago now. I did get in touch with one woman I met at a conference, from school district 41. I'm not too sure, exactly, what that encompasses.

But we want to expand our programs. We've been to Comox, Cumberland and Courtenay, which has been great, and they keep calling us back. They want more presentations. I was just there. Right now we're very Victoria-based, but eventually…. We are the Bipolar Disorder Society of B.C., and we would like to spread our message further.

J. Thornthwaite (Chair): Well, I’m sure that you’ll get a little boost from our committee today.

Darryl's got a brief one, then Jennifer, and then we're going to have to wrap up.

D. Plecas: Well, you asked if I had any other questions. I have a zillion of them, but we don't have time for that. Just to comment, I think the criminal justice community — police, corrections people, courts — would benefit greatly by hearing from you. There's another group that you should think about connecting with in a big way.

J. Rice: You mentioned that you'd been to Courtenay and Comox and over to Burnaby. I’m just curious if the Bipolar Society has a strategy for reaching out to rural environments?

A. Paquette: The problem is with travel. But I can see…. I really think that a good strategy…. You can give a presentation over Skype. Wouldn't that be amazing, to give a video presentation to students — streaming, maybe, live from another classroom or something such, being really innovative and modern about it?

We haven't thought of that yet, but it is on my mind and is something I'm definitely going to bring forward in the next year. It is: how do we reach the ones in the remote communities? I think it's just going to be through technology.

J. Thornthwaite (Chair): Thank you very much. We so much appreciate your insight and your inspiration and wish you well in all of your future work, particularly with the kids that you go and visit in the schools. But we'll get you into the PACs as well.

At that, unless there's something that any of the committee members want to bring up….

C. James (Deputy Chair): I was just going to say that we should just reinforce, again, that people can send in written submissions. Although we've only got a couple of committee opportunities for presentations, people can send in written submissions. They just need to go to the website. I think we want to hear from as many people as we can.

J. Thornthwaite (Chair): And pass it around to our networks as well — the press release.

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3) Child Abuse Prevention and Counselling Society of Greater Victoria (Mary Manning Centre)	Judith Wright
4) Axis Family Resources Ltd.	Ann M. Smith, MSW

Chair:	* Jane Thornthwaite (North Vancouver–Seymour BC Liberal)
Deputy Chair:	* Carole James (Victoria–Beacon Hill NDP)
Members:	* Donna Barnett (Cariboo-Chilcotin BC Liberal)
	* Mike Bernier (Peace River South BC Liberal)
	Doug Donaldson (Stikine NDP)
	* Maurine Karagianis (Esquimalt–Royal Roads NDP)
	John Martin (Chilliwack BC Liberal)
	* Dr. Darryl Plecas (Abbotsford South BC Liberal)
	* Jennifer Rice (North Coast NDP)
	* Dr. Moira Stilwell (Vancouver-Langara BC Liberal)
	* denotes member present
Clerk:	Kate Ryan-Lloyd
Committee Staff:	Aaron Ellingsen (Committee Researcher)
	Byron Plant (Committee Research Analyst)

Witnesses:	Dr. Evan Adams (Office of the Provincial Health Officer, Ministry of Health)
	Bev Gutray (CEO, Canadian Mental Health Association, B.C. Division)
	Dr. Gordon Hoag (Child and Youth Mental Health and Substance Use Collaborative)
	Paul Lacerte (Executive Director, B.C. Association of Aboriginal Friendship Centres)
	Kimberley McEwan (Canadian Mental Health Association, B.C. Division)
	Andrea Paquette (Executive Director, Bipolar Disorder Society of British Columbia)
	Ann Smith (CEO, Axis Family Resources Ltd.)
	Valerie Tregillus (Child and Youth Mental Health and Substance Use Collaborative)
	Judith Wright (Mary Manning Centre, Child Abuse Prevention and Counselling Society of Greater Victoria)

2) Child and Youth Mental Health and Substance Use Collaborative	Valerie Tregillus
	Dr. Gordon Hoag

5) Canadian Mental Health Association, BC Division	Bev Gutray
	Kimberley McEwan

6) Office of the Provincial Health Officer	Dr. Evan Adams
7) Bipolar Disorder Society of BC	Andrea Paquette

REPORT OF PROCEEDINGS (Hansard)

SELECT STANDING COMMITTEE ON CHILDREN AND YOUTH

REPORT OF PROCEEDINGS
(Hansard)

SELECT STANDING COMMITTEE ON
CHILDREN AND YOUTH