Children and Youth — Issue No. 18 — Monday, April 13, 2015 (HTML)

Present: Jane Thornthwaite, MLA (Chair); Doug Donaldson, MLA (Deputy Chair); Donna Barnett, MLA; Carole James, MLA; Maurine Karagianis, MLA; John Martin, MLA; Dr. Darryl Plecas, MLA; Jennifer Rice, MLA

2. The following witnesses appeared before the Committee and answered questions on youth mental health:

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
Youth Mental Health Project: Briefing on New Brunswick Service Delivery	421
P. Peterson
B. Morrison

J. Thornthwaite (Chair): Good morning, everyone. I’d like to welcome you to the first morning of the second phase of the Select Standing Committee for Children and Youth special project on child and youth mental health.

I thought because we have our special guests, Dr. Peterson and Dr. Morrison, what we would do is go around the table first and introduce the members so that you know who you’re looking at. We’ve got a couple that aren’t here and one that’s coming later, but I just thought maybe it might be good to start with introductions.

I’m Jane Thornthwaite, and I’m the Chair of the select standing committee. And our Deputy Chair….

D. Donaldson (Deputy Chair): Doug Donaldson, Deputy Chair of the committee, and I represent Stikine, which is the largest geographic constituency in the province, in the northwest part of B.C.

C. James: Carole James, MLA for Victoria–Beacon Hill — right here, the closest.

M. Karagianis: Second closest, Maurine Karagianis, MLA for Esquimalt–Royal Roads. I serve in opposition as the spokesperson for seniors, for child care and for women. I also serve as the caucus Whip, so I beg your pardon if I have to occasionally glance at my phone. Things happen on Monday mornings that require some Whip’s attention. I’ll try not to let it distract me too much.

D. Plecas: My name’s Darryl. We had a chance to talk first thing this morning. I’m the parliamentary secretary to the Minster of Health, responsible for seniors, and I represent Abbotsford South, which is the most beautiful constituency in the country.

D. Barnett: Good morning. I’m Donna Barnett. I’m the MLA for the Cariboo-Chilcotin, and I’m the Parliamentary Secretary for Rural Development.

My riding consists of over 44,000 kilometres, with a population of under 33,000 people. I have 15 First Nations bands in my community, in my riding. We are very diverse, spread out, with some major centres. But it is immensely rural with many issues because of the rural area that we live in. I’m quite excited to hear what you have to say, because I know where you come from, you have a lot of rural and huge landscapes also with very small populations.

J. Martin: Good morning. John Martin. I’m the MLA in Chilliwack, which is about an hour east of Vancouver.

J. Thornthwaite (Chair): My official territory is North Vancouver–Seymour, which is basically an urban riding, but I do have a lot of geography and a lot of animals and bears in my riding — who also vote.

I’d like to introduce our special guests, and I’d like to let Kate introduce herself as well.

K. Ryan-Lloyd (Deputy Clerk and Clerk of Committees): Good morning. My name is Kate Ryan-Lloyd. I’m the Deputy Clerk and Clerk to this committee.

A. van Leeuwen: Good morning, everybody. I’m Alayna van Leeuwen. I’m the new committee research analyst serving this committee.

J. Thornthwaite (Chair): Thank you, Alayna, for coming and filling Byron’s shoes.

J. Thornthwaite (Chair): We have our special guests, Dr. Bill Morrison and Dr. Patricia Peterson. I’ve got a brief bio that I’ll just read out.

Dr. Peterson has served as a program consultant for the integrated service delivery framework since its inception in New Brunswick. Her background as an academic researcher and educator has contributed to her expertise as a consultant, program developer and writer in areas relating to learning exceptionalities, positive mental health environments and integrated service delivery models.

Dr. Morrison has served as a key program consultant for ISD since its initial inception. His background as an academic, researcher and psychologist has contributed to his expertise as a consultant, program developer and writer in areas related to emotional behavioural disorders, community-based mental health treatments and collaborative service delivery models.

P. Peterson: I had the privilege of meeting Jane last fall. This has been a sabbatical year for me from the University of New Brunswick, and so I had an opportunity to make some visits that I’d been wanting to make for a long time.

We’ve been involved with B.C., in fact, for several years now. B.C. has been particularly open to and ready for positive change when it comes to child and youth mental health and, like many provinces, is still looking to find the path to get to better services and supports for our kids. Bill and I have been working together for a long, long time and have found that, really, bracketing the country we have B.C. and we have the east coast, who really have looked at innovative ways and looked a little bit outside
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the box at what might be done.

We’ve been involved with schools in B.C. and have worked in, spent some time in the Chilliwack district a little while ago, a couple of years ago, piloting some new instruments and information. We’ve been around the block in B.C. for awhile, so we were thrilled to be able to come back.

Last fall I spoke to a conference of principals and vice-principals that Jane attended. The focus of the presentation was, in fact, positive mental health in schools and information for administrators and teachers in schools. Jane caught my little blurb about integrated service delivery models that we’ve been practising in New Brunswick for some time, and thus the interest, I think, percolated a little bit. We’ve had a chance to have several discussions since, and I brought in my colleague Bill to share with us. This is what has led to us coming back today to share with you.

We did read the report that Jane shared with us. It’s wonderful to see the cohesiveness and the commonality of purpose among all of the stakeholders who have contributed to your report and to the work of this committee.

What we’re hoping to do today is to share a little bit about a model, a framework that Bill was first involved in, in New Brunswick. I joined the team around 2008, and we’ve worked together to create a framework for the province of New Brunswick for child and youth mental health services that are brought to the kids. We know the problems. We know what has existed that led to this moment.

It’s been your experience as well as ours and common across the country that kids have too many systems, families have too many systems that they need to access. They are outsourced. Mental health is outsourced from schools in most cases, where a child will be referred out no matter what the intensity of need may be. Whether it’s early intervention or tertiary service support, they’ve tended to be outsourced, and schools too frequently lose that wraparound ability with our kids when we send them off for services, when they are going into….

Whether it is hospital care or tertiary supports, there’s a break in continuity of the services and the supports that they receive in the school setting. Bill and I were asked a few years ago to do some consultation to create a framework, which we’ll be sharing with you today, that is meant to wrap around and hold onto our kids to the age of 21.

In 2009 there were some reports released in New Brunswick that came from our youth ombudsman, the Child and Youth Advocate in New Brunswick, who was a particularly passionate individual at that time. What he managed to do was to put faces to the issue so that it was no longer theoretical. It was no longer: “Oh, isn’t a shame that we have lost kids in care? Isn’t it a shame that we haven’t done the best we could do?”

He was able, through The Ashley Smith Report and the Connecting the Dots report, to really humanize this issue of losing our kids within systems. The government of the day agreed to the need for doing something drastically different — for stepping outside of our comfort zones, our silos and our traditional ways of doing things and to do something different.

We were brought on at that point to come in and create a framework that was child-focused. We get so mired in our systems that too often our ministries, our systems, our comfort zones and our turf are protected over and above the needs of the child or the youth. What we were asked to do is to put all assumptions aside and design something that was child- and youth-focused, with a view towards fostering the positive growth and development of all of our children in the province.

Sometimes we need to go back, take a step back and think universally. It’s not just about kids at risk. It’s about determining…. It’s about avoiding the intensity of risk that can exist, by starting earlier with our kids. Those are environmental, universal supports. How do we change environments across ministries so that our kids do not intensify levels of need and get no notice of where they are and what they need until things have progressed so far that we have tertiary systems involved and kids not having environments that can support them?

The goal, as well, was to reduce the prevalence of those kids with complex needs, to keep them from working their way up through the pyramid of interventions so that they don’t get noticed until they’re in that top 5 percent. What do we do with the whole pyramid? How do we integrate that wellness platform for our kids in the school setting?

There’s lots to do in order to look at this issue. We had four ministries involved in New Brunswick — Education and Early Childhood; Social Development, which is your child and family ministry; the Department of Health; and the Department of Public Safety — who came together and said: “We will work together. We don’t know what it’s going to look like yet.” But the will was there, and the will must be there for the ministries to be willing to cross those, to step out of silos and find a way collaboratively to make this work.

The framework that resulted from our consultations — we’ll tell you a bit about the process in a moment — committed to address service delivery gaps in the provision of assessments and interventions.

We had kids on waiting lists, long wait-lists, for mental health services. When a school makes a referral — I’m sure it’s much the same here — to mental health services, that child could wait six months to a year to be seen. By that point, either the problem has intensified or the kid and the family have lost the will and the motivation to say: “Okay, we’re ready now. What can we do?” A year down the road, maybe not. Maybe the child is too far along at that point, or maybe the family has lost that motivation.

Timely interventions, early interventions, and the fact that they needed to be collaborative and team-based,
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were related to this need to avoid a child having to speak to four or five different ministries and tell this story over and over again, to have files that exist, to have assessments that are done among ministries who don’t talk to each other because of privacy issues, because of confidentiality and because of turf.

When you have a child having to retell a story and be, in fact, revictimized by having to retell their story over and over again, it is the system, then, that is victimizing that child because of its inability to work as a whole, inability to cross through our sectors, through our professions, through our departments and ministries in the best interest of the child.

We want to enhance the capacity to respond in a timely, effective and integrated manner — to look not only at the risk-needs profiles of our kids but to flip that paradigm and start looking at the strengths that exist. Strength-based approaches have been at the foundation of the work and the research that Bill and I have done for many years. Understanding that we are not defined by our labels, by our areas of need, by our problems only but that we are holistic beings. We have strengths, and so do the children and youth within our schools.

Identifying those strengths needs to be part of any assessment process in order to work with our kids in a way that gives them the opportunity to feel not only defined by mental illness, by their struggles, by emotional behavioural disorders, or sometimes just by their behaviours they exhibit — because sometimes that’s the first thing we see on the outside — but by their strengths, that they have things to offer, and they have innate strengths that will allow them to prosper and to thrive.

Promoting those universal and collaborative approaches as well that foster positive mental health perspectives and practices. Awareness needs to grow. We need to be speaking the same language. We need to have a common framework to work within so that we’re working towards the same outcomes for children and youth.

In preparation, there were really four key things that we did in the beginning, which Bill and I were asked to do by the Premier. We came in with this focus on research, reviewing, engaging and developing. We did a comprehensive review of literature in the area of evidence-informed practices for supporting collaborative services.

What do we know from the research? Bill and I have always been of the mind that yes, evidence-informed practice is important, but so is practice-based evidence. What’s happening on the ground? What are people actually doing? What are schools telling us? What are mental health service providers telling us?

We looked at the literature. We talked to the professionals. We did a review of internal government documents, because nobody wants to throw the baby out with the bathwater. There are good things happening. Our Department of Social Development was doing wonderful things, our Department of Education and Early Childhood — innovative, wonderful programming, but not integrated, not talking to each other, not informing each other’s practice. So looking at those internal government reports for about a two-year period.

Execution of multiple consultations. We did this sort of thing in New Brunswick, the sort of thing that we’re doing today, over and over again. We did it across departments. We did it within departments. But we didn’t stick with government, and we didn’t just stick with schools.

We talked to NGOs. We talked to service providers in the communities. We talked to families. We talked to youth themselves. We spoke to boys and girls clubs and anybody involved with the well-being of our kids. Their perspectives and their practices were valued in this process and brought into the framework.

Finally, a development of plans for sharing our resources and integrating our services. Probably one of the greatest challenges that we faced throughout this whole process was finding a way to integrate information-sharing, because we have separate protocols across our ministries.

We have privacy agreements. We have confidentiality agreements. It took a privacy impact report that’s probably this thick in the province before we were able to overcome those issues, in the interest of the child. What it boiled down to is that if you have family consent, you’re good to go. We can share information. It took a long time to get to that commonsense outcome, but that’s exactly where we arrived after all of that work.

The information-sharing and the privacy issues and going to the one-child, one-file point was absolutely essential to this process but it was very complex to arrive there.

B. Morrison: Through that process, from literature review to travelling to visiting programs internationally to consulting, we came together across ministries in identifying some common targets or desired outcomes — really, the vision. I’m just going to touch on these briefly, because this is what is guiding and continues to guide the evolution of the framework.

The first one is a focus on the child. We talked about moving from a system-centric approach to a child-focused approach. Sometimes when we think of mental health, we tend to think of reducing risk of problems. The flip side is fostering positive child and youth development. As Patti mentioned, the framework has explicitly and implicitly a focus on building strengths in children and youth — not just a few but all children and youth.

When we think about positive child and youth development, we think of family and community attachments as being critical, school engagement and academic success being important, being part of the school, retaining children and youth, not losing children and youth over time.
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In New Brunswick we had a history of having kids on attendance rolls but not being followed. This was meaningful engagement. Also, keeping children and youth out of our prison systems, providing opportunities in the community for fostering positive development and growth.

The second one was accessible, timely services, not having to wait. Instead of talking about referrals and wait times, we talk about access. You’ll see some of the outcomes so far in terms of accessing services at the right time at the right intensity. Sometimes we wait too long, and there are times when we overintensify when we shouldn’t. But actually meeting when the child and youth and family are ready is responding in a timely manner so we can prevent the escalation of concerns.

We found in a lot of cases that the wait times and wait-lists…. Kids went from a secondary level to a tertiary level because of the time that was given. We saw escalation. So decrease wait times for assessment and direct intervention.

We found a lot of it was the way we did our business. It wasn’t always a question. We had an interesting conversation over supper about increasing resources. We hear that oftentimes. It’s not that I’m against increasing resources, but it’s how we do our business. Sometimes to add resources where the system is not efficient, is not working well, is not to use our resources wisely.

You see No. 3, effective case planning services — so increase continuity and increase capacity to adjust service intensity and then to reduce service intensity. Sometimes we end up referring on. A child or youth encounters some difficulty, and we end up referring on to a more intense service, and that child is no longer linked with the environment. In this approach we want continuity of service, but we want to be able to adjust the intensity up and down as needed without losing the child and youth family from our communities.

Hence, we’ve got to work in a different way. It’s more than just multidisciplinary. I think we’ve talked a lot about how we come together, and a lot of multidisciplinary work is going on, but a different approach in how we work together on a single team with a single file with a single approach with engaged families and youth.

Finally, enhance relationships with youth, families, service providers. Information-sharing that is used to support, as Patti mentioned previously. And, you know, increase job satisfaction.

When we work in silos, our clinicians work in silos as well. We burn people out. People work very hard, people that are called within professions — teaching, helping professions. But if we continue to work in silos, we end up becoming overwhelmed with the task before us. And, of course, who helps families navigate the system? Who directs the case plan? How do we work together? The idea of enhanced relationship was to make sure we’re not alone — children and the family nor service providers at the same time.

Finally, system efficiencies, increase coordination of services. Instead of doing…. It’s really interesting. In our system when we did a review, we found out there are children that had four and five assessments done, and that would happen through multiple ministries. That information was never passed on. Then we had children and youth that didn’t receive any kind of assessment, that were trying to engage those services without resources — really a fragmented system. So to shift that so we work efficiently, we coordinate our services, both in terms of information management but continuity of our service delivery practices.

Finally, effective use of resources. When children go into tertiary-level placements, crisis units, places of safety, treatment centres, psychiatric units, it’s an amazing amount of money that we spend at that point. If we were more efficient, we would use a lot more up front in a different way. I think part of the push, too, that came was the amount of money that we spent on children that are not just out of our region but out of province. We needed to look at it very specifically to reduce the escalation of need and to use resources wisely.

P. Peterson: There were four basic key components to the ISD framework. The first we’ve spoken about a bit, that unifying and youth-focused service delivery philosophy. It was necessary for everybody involved to accept this.

When we talk about having different ways of doing things and departments having their own processes and procedures, all of that doesn’t disappear when you integrate your services for kids, but there needs to be a unifying philosophy, and it has to have the child or the youth at the centre. Some of the things that are assumptions we can make about this philosophy are that youth, as we’ve said, have inner strengths and gifts already that support their capacity to initiate, direct and sustain positive work and life directions.

I have a 32-year-old son. He’s a big, gentle giant. He’s 6 foot 4 and 300 pounds. He is my hero. He also has autism. I have lived a life of trying to find ways to convince those around him, as he went through school in the ’80s and the early ’90s, that he had gifts and strengths. He was not defined by his autism. He was defined by the whole person that he was.

When we look at all of our children in this way and we focus on their strengths and on what we know we can draw from them with a little bit of mentorship, help, support and wrapping around, we see outcomes for our kids that are amazing. And it doesn’t take a lot of money. It takes a paradigm shift in the way we think about our kids with special needs, whether they’re mental health or developmental.

Youth engagement and empowerment. They’ve got to be part of it. The youth need to feel that they have voice.
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They need to feel related to what’s happening around them. Don’t throw a program at a kid that doesn’t involve the kid’s engagement. They need voice. They need empowerment. They need autonomy within this.

Their social contexts and networks, whether we’re talking about the community or the school or family or peers, are important resources. So part of the philosophy of this program is that that needs to be built in. We need to be looking at where they’re spending their time and what sorts of resources they have.

Finally, the relationships that best contribute to psychological well-being with youth are characterized by those interactions that are genuine, that have empathy, that show unconditional caring and affirmation. Oh, how rarely our kids with mental health problems or emotional and behavioural problems get unconditional caring and affirmation.

Training. Upfront awareness is so important with our educators and our service providers to ensure not that anything goes and we accept and love all that you do but unconditional caring and affirmation. “I believe in you. I believe in the best for you.” That informs everything that we do with our kids, and it’s foundational to this model and framework.

We need a way to measure. When we’re looking at doing a program like this, how do we know it’s working? What can we look at? What are the practices that are actually measurable? One of the things that we did in preparation for this rollout in New Brunswick was…. Bill and I created an indicator of change framework that looked at the integration of services in five different areas.

We looked at leadership and governance. What was happening with ministries? Were we actually moving closer together? What were the indicators of change that showed us that we were moving together?

How about our intake processes? We knew that was a huge problem to begin with. They were completely separate from each other — what Social Development did, what Health did, what Education did. It was all separate. So did we move closer together?

What about our service orientation? What are the foundational beliefs around integrated services and collaboration that we bring to this?

Our service provision activities. Did they actually remain child-centred? Did we keep that at the forefront as we moved forward?

What about engagement and participation? Who is involved? Who has voice? Are our families empowered by this?

We did create this framework for measuring. I’m just going to pop up…. This is a sample report. This is something that a school or a district, depending on what level of evaluation you wanted to do, could actually get back that looks through stages of change.

Are we at pre-awareness? We don’t even know these things are important yet. Are we at awareness and contemplation? Are we thinking about it and planning to do some things, but we’re not there, not quite moving forward yet? Then we have initial plans and actions, expanded plans and actions. Finally, has integration and working collaboratively across ministries become a sustained and embedded practice of “this is how we do business”?

Those stages of change can be assessed, and a report like this could come back to an individual school, to a district, to a region and even provincially. What we’ve done in New Brunswick is individual schools are able to compare their results around integration with the province to see: are we keeping up? Are we moving forward? Are we continually working towards sustained and embedded practice?

Looking again at those five key features — leadership and governance, intake, service orientation, service provision, and engagement and participation — these things are assessed by the workers themselves. The people actually providing services will take a snapshot of where they are.

In fact, the very process of going through the indicators of change instrument generates discussion about where the areas of needs are, so it ends up impacting strategic planning for going forward. Wow, we’re really not quite getting there at pulling families in, in that engagement piece. Then that needs to part of our strategic plan for this year. It’s ended up being a tool not only that gives the snapshot assessment, but it’s a tool for planning and for discussion and opening dialogue in some of these areas.

B. Morrison: If you think about the vision statements that we went through on what we wanted to change, the indicator framework for service integration came out of the discussion of that vision. What are the steps to move towards integration? It’s not something you do in six months but something that will take a year or two to be able to move through, beginning with our strengths and building on those.

One of the areas of service integration was looking at all of the service providers from the four ministries who were involved with children and youth — in fact, the same children and youth — from a universal perspective or from a targeted or from a tertiary level. It was really interesting.

When we started looking in a little rural region that had a couple of islands as part of that region, where you’d have to take a ferry over and work from a fairly long distance, we started looking at the numbers of people that were involved with children and youth who had complex needs — my land. They all worked in silos — even within, for example, Social Development, where you have multiple people working with families. Even within departments we saw silos. Within the regional health authority,
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addictions and mental health working separately with the same children, youth and families, with multiple plans.

At some point you had to say: “Boy, we not only have points of duplication; we have gaps.” Yet we have a lot of people running, and a family that has to navigate a system with four different interveners — it’s not doable. It’s overwhelming for families, and there’s a sense of having so many people, so much risk, that we just can’t move, so we don’t even feel that we have the capacity.

One of the things we looked at through the service integration, in order to do that — and this is so short — was to look at bringing together on the same team…. This isn’t just a case conference, sitting around the table, but doing the work that it took across the ministries to put the same people who worked with the same youth from the universal side to the targeted side on the same team, with the same information system, working in the same context. That was the very first thing.

We ended up, in one of the demonstration sites, having eight different people on one team that served groups of schools from K to 12. When I say serving schools, they served not just the school but also the regional catchment area because there were lots of children who were not in school. So when I say schools here, it’s school catchment areas — working from within in a preventative way, but also reaching out within communities.

Teams typically would involve a number of professionals — a mental health psychologist, addictions social workers, school psychologist, resource personnel, school counsellors, youth care workers, interventionists, school social workers — but on the same team. We called them initially child and youth teams — in fact, we had child and youth development teams, and they shortened it to be child and youth teams — that would work within every school community and outbound.

It’s really interesting. At the close of today we’re going to play a little video, which is about two minutes long, which is people from the teams actually talking. What’s really interesting is that instead of being at mental health….

Now my background. I was a school teacher, but I went from school teaching into psychology and worked as a provincial director of mental health services in my former life before coming to academia at the university. If you looked at our regional mental health services, community-based services with youth, you would have attrition rates of 30 to 50 percent. In other words, if I had five children scheduled today, I would see two that would not show — couldn’t get there, didn’t show up. Then, of course, that was missed time. You think about that. Boy, that’s not a good use of resources.

Now think about moving a team into schools — out of your office — in the hallway, building community, part of the community. Suddenly the attrition rates go down. Suddenly I see more children and youth than I’ve ever seen. Sometimes it’s a matter of seeing a child or youth and saying: “How’s it going?” That’s all I need for that day. I didn’t need to say: “Skip a day of school. Come to employment. Spend an hour with me to say, ‘Okay.’” It became more normalized. It became more of what we do naturally in communities. So the idea of being on a single team in the schools was an important part.

The other thing was how we work together on an interprofessional team. Sometimes the multidisciplinary teams come together. Everyone shares their idea. Then we go away, and we’re not sure who’s doing what as we follow.

We looked at models internationally of interprofessional approaches to teamwork within schools and communities. We had some wonderful discussions in the Netherlands around a model called the flexible assertive community treatment model, FACT teams.

What we did is we extracted from that particular approach a way of working within a team where we never refer the child. We use our resources to step up when we need to and then to step down, increase intensity at the right time, without waiting, with the team members, and then stepping down — where every team member has full access to the team, where the resources are there.

It’s not that now I’m a school counsellor, and I’ve been working, and I need some assessment that a school or a clinical psychologist might offer. They’re on my team. I’m not sending a referral. I’m not sending off…. I’m increasing the intensity of support.

If I’m a social worker and I’ve got a child that hasn’t been attending school and I want to make a home visit, but I don’t want to do it alone, I’m going to take another school counsellor with me. We’re going to go together to that home.

It’s not a question of making referrals, checking with the mandates to see whether it crosses. It is doing the right thing at the right time with the resources we have. Then we can look over missing resources.

What we found, at least in one of the demonstration sites that really had good integrity towards the model, is that what they had in resources almost doubled their output in terms of seeing children. We’ll, again, see some of that.

A different approach, as well, is that teams are focused on fostering development of all children from a strength focus. It doesn’t mean we don’t look at diagnosis. It doesn’t mean we don’t look at needs. But it means that children and youth are still growing. If you look at diagnosis, they change multiple times, oftentimes, as we see, and different labels get put at different times.

If we look at a developmental focus, we’re more interested in what we need to do at the right time to strengthen our approach. But also, we’re interested in the strengths of youth. What are their passions?

Patti mentioned her son. My daughter has had significant mental health issues throughout her adolescent
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years. It’s interesting. During the time that we were bringing this in, I had the opportunity to connect her with the same approach within our community. I’ll tell you she is doing well and continuing so.

I’m not just passionate about this because I’m an academic or a psychologist. I’m a parent. We can’t afford to continue doing it. I don’t want my children, my neighbours to fall through the cracks as we go.

Finally, the fourth one, positive mental health. Sometimes we say there are people that do prevention — they do universal stuff — and there are some people that provide treatment or services. They need to be integrated.

When we provide targeted services to young people, they need to go into an environment that is supportive of them fully, where they feel fully engaged. When you have targeted services that are supported by an environment, you boost that individual service because of what you have around children and youth.

Schools are not equal when it comes to environments. Communities aren’t equal when it comes to environments. There are things that we can do, and what we wanted to do was to make explicit what the practices are that contribute to building a positive mental health environment that fosters the development of children and youth, that builds on their strengths.

In the past, to be honest with you, since 2006 our focus within the Health and Education Research Group at the university has been looking at the evidence but also: how do you turn that into practical approaches that administrators, teachers, parents, children and youth can use in building positive environments? You’ll see a little bit….

Patti’s going to just show you really quickly. We’ve been working with the Pan-Canadian Joint Consortium for School Health, and we’ve had great support. The Pan-Canadian Joint Consortium for School Health is a federal body that incorporates all the Ministries of Health and Education from provinces and territories across the country.

We’ve had some wonderful connections with B.C. In fact, we ended up piloting our resources, validating some of the resources we’ve used, in British Columbia — hence, we were here a couple of years ago — as well as within New Brunswick.

Not that I want to brag or anything, but I think B.C. and New Brunswick, from the standpoint of positive mental health, have been leaders nationally. It’s kind of neat to be able to come back in this venue to talk about not just integrated services or targeted services or multidisciplinary team approaches in schools but also to say it’s foundational too. What’s foundational to it are our school environments and our community environments.

What you see up ahead for you is a positive mental health toolkit. It’s on line. We can send the link out to folks. It’ll give you an idea of where a school might begin. Similar to the integrated service delivery, there are benchmarks established and about 23 or 24 indicators where schools can actually say: “Where are our strengths, and where do we need to develop?”

Whenever we talk about any of the components here, there are evaluation tools that are used for strategic planning and for monitoring how we’re doing within our environments. Not just a secondary- or tertiary-level service system but also foundational in terms of the environment.

Again, when we talk about that from a comprehensive or health-promoting school point of view, it involves four pillars: our social and physical environments, teaching and learning, partnerships and services, leadership and policies.

I’m not going to go through this flip chart. This was one of the early flow charts, and there are a few changes there. But what we felt was really important is that within our communities we need to really integrate and braid all of our services in terms of continuums of services.

If we have an understanding of those, we’re not working in silos. It’s not just the government working together, but it’s in the community itself — through non-profits, through churches, through faith communities, through neighbourhoods — that we begin putting all of our services together to create the environments that will support needed services when we need to step up.

Patti, I’m not going to leave this, because this would take us a while to go through. This is some of the flow chart of how people work together across.

P. Peterson: Moving on to the actual demonstration. In September 2011 our demonstration sites were launched in New Brunswick. We had our multidisciplinary teams. They were comprised of psychologists. So psychologists from Social Development, from schools — school psych — and from community — our youth counsellors, child and youth care workers, educational specialists, addictions and mental health. They came together for training and to work together in the school context.

We had interdisciplinary teams who were responsible for regional clusters of schools. What would happen is that the team would be responsible for a catchment area and a cluster of schools from K to 12 in that area with the goal of the same team following the same kids from K to 12 and actually to 21, so even through the transition to adult services or to post-secondary or to work moving forward.

You have that continuity, not only that the kids in the school will see the same team, but so will the kids who go from elementary to middle to high school to transitioning beyond. We have that wraparound program going on. The students are followed all the way through.

Some of the things that we found right off the bat…. I’m going to let Bill speak to these. Waiting lists had been such a concern. One of the things that led us initially to be asked to create a framework was that kids were wait-
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ing too long for services. They were waiting too late for referrals to service.

We would end up with kids who were outsourced to mental health and addiction, or mental health services, for assessment, for intake, waiting, as we said, for months and months and sometimes a year before they could be seen. That was an initial concern that led to the development of this framework. It was one of the quickest things to come off the list as a problem area. It was one of the easiest things to take care of when ISD was implemented.

B. Morrison: When you think about wait-lists, you need to think about the number of people on the wait-list but also the wait times. The wait times were probably the most…. If you have a wait-list and you see them quickly, I suppose that’s different. But the wait times make a big difference.

What we saw here was a complete shifting of wait times and wait-lists. When the teams came together, there was a revisiting of all wait-lists and wait times. That initial responding actually, within the Charlotte County area, eliminated wait times completely throughout the opportunity. You’re looking at…. Within a ten-day period you had youth responded to and involved in services, if they needed, at the same time. It was quite something.

You’ll notice here, too, we looked at selected findings. We actually did the child and youth behaviour checklist, which is a well-known tool for looking at profiles of children and youth with emotional and behavioural concerns. You’ll notice that the blue is percentage falling above normal parameters but below clinical ranges, and the red is clinical ranges.

What we saw is that the utilization of services — in other words, the number of people, the number of children and youth and families that were seen by team members — doubled and tripled during the time. That’s because we’d lost our attrition rates of getting to services. Now we’re seeing two or three times more.

What’s ended up happening is that we are not only seeing children who are within a clinical range. We’re seeing children who are not within a clinical range who would be at a secondary level. It’s kind of interesting. We’re seeing more children at earlier points, hence making a difference.

What’s really interesting is that some of our school communities — some schools within New Brunswick, or in any location — may actually, if they don’t deal well with children who are having difficulties in adaptation, put children out quicker than others. There are some environments that are more flexible.

In one particular school area where the team was working and, again, connecting — they’re on the student services team at the school, so they’re part of the school community — they saw a lot of kids being suspended, going to an alternative school site. The student services team, with the child and youth team member, decided to meet with the administration to say: “Is there something we can do about our environment? Because we’re losing children and youth.”

What’s interesting is that here you have, typically, what had been secondary- and tertiary-level service providers talking about the environment of the school to make changes. That school made changes in terms of some of its environmental practices that reduced the number of children and youth that were put out of the school.

What you’re seeing is when you start an integration, you not only shift our practices, but you begin shifting the environment. Everyone has ownership. That was exciting, because here we saw, typically, where you send kids away. Now we have people working together in the context, in the setting. We start shifting our environment, because our clinicians, our teachers, our educators, our parents are involved together in saying: “How do make this a better environment?”

That was an exciting part, because you don’t see that: “I’m a clinician. I work in my office.” No. We work with children and youth. We are all helpers. We live in the same environment. That’s what made a difference — exciting, and it doubled utilization. We didn’t really increase resources in terms of the number of people, but it’s a different way of doing business in schools.

Finally, when we look at some of the outcomes, we saw that there was certainly a moderate effect size in the children that we actually did pre- and post-testing on. We saw changes in terms of benefits to the family and to youth, both in terms of adaptive functioning and also decreases in problematic behaviour related to internalizing and externalizing.

Give us an example of what those recommendations would be to change an environment in a school.

B. Morrison: Okay. If I take the one particular school where the child and youth team member and the student services team came and said: “Look, the zero-tolerance policy that’s being administered out of administration may not be that helpful because we’re losing a lot of kids. Is there a way that we can look at earlier points?”

These kids have been known in the school for a long time. There are ways that we can actually be connecting with these youth, finding out where their points of engagement are, so that we can actually find connections to increase school connectedness with these youth at this point. Not just for them, but for all youth who may find themselves in that same trajectory of going out.

This school actually began investing in positive mental health practices. Hence, some of the resources that we’re showing right now actually were used by this school in
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looking at training for staff around positive mental health practices, relationship practices, where we really look at three core areas: connectedness or relatedness, children’s strengths and their passions, and also how we support the autonomy of children.

Now, that’s not anarchy. That’s saying: how do we support the calling of kids when they feel that they have an interest in mechanics, in animals, in relationships? How do we connect that and embed that with curriculum? How do we being supporting those things?

That’s a different mindset than: “You come to school to adapt to our environment.” It’s creating greater readiness in schools to receive children and youth.

P. Peterson: We didn’t leave it to schools to hear about the theory and figure it out on their own either. We did provide tools. The positive mental health toolkit has a whole section on how to put this in action. What can you actually do? What does your mindset need to be? How do you assess yourself in terms of your positive mental health environment and your processes and procedures?

There are planning worksheets. These are all video clips that walk you through the steps to implementation. Those are all embedded in the toolkit as well — creating your mental health team, engaging students as leaders. Step by step, it’ll walk a school through the things that they have to do — practical suggestions and road maps to creating a positive mental health environment.

The toolkit ended up…. It was created just before we went into or at the same time we were doing the ISD, but it ended up going hand in hand, because the school said: “Yes, we want it. We believe it. How do we do it?” The how-to is included in some of these documents, as are the tools for assessing how far you’ve come and if you have actually moved towards embedded practices and positive mental health.

B. Morrison: You have teams in schools working. The team member who’s working with the student services team within the school has access to a larger team and can access the services that are needed. Consultation that’s provided strengthens the teacher’s approach to working with kids and administrators within the school system. You’re not waiting to be able to have consultation.

There are times when just having someone say, “What do you think? How would you do this?” or stopping in the hallway and having a clinician provide support…. What’s really interesting is the growth and development was not just for teachers. It was for clinicians to see the power of an environment and the impact that a community could have on the health and wellness of children and youth.

One of the things that Jane talked to me about early on was how the heck do you actually pull this sort of thing together, especially from a governance perspective. That was a challenge. That was a long process, and hopefully, there may be some lessons learned from the couple of years that we went through trying to develop this and do something that was workable.

One of the things that had to happen and that was very effective was that there was an ISD mandate agreement that came down through…. This was signed by every deputy minister and ADM in the four ministries as well as the vice-presidents of the regional health authority that said: “We will be part of this. We will put this not at the side of our desk but as part of our mandate as a department.”

It was important in the development of working groups, because we needed to work this out. We needed to figure out how to move forward. So we had working groups on privacy, security and information-sharing that worked together.

Human resources. You have different contracts, different unions — all sorts of things that need to be worked out when you’re bringing interdisciplinary team members together to work under one umbrella.

The training framework. What training is needed? How do we move forward? What do we develop?

The financial planning and budget. What we found to the delight of our ministries was that it wasn’t about a lot of extra money. It wasn’t about creating new positions. These are the same service providers working with the same kids at risk and the same numbers, so let’s come together and do it smarter.

Although there was some financial restructuring involved in bringing these teams together and making sure that they had spaces in schools, and those sorts of things, to do the work that needed to be done, it was not a huge outlay in new positions to add on to a system that wasn’t working. It was a different way of using the system resources that we already had. The working group worked their way through that.

Communications and marketing. How do we share this information? The IT piece and case management. How do you move to one child, one file, and what does that mean in terms of our IT?

ISD also became a part of the strategic planning for every involved ministry. They had to be accountable for what they’d done each year. What have you contributed toward ISD? What has your department done? It was part of their strategic planning and built right into their reporting processes.

We went through the Attorney General’s office to request legislative analysis on sharing, collecting and storing of information. This was huge. This was very, very big, because we hold our information systems very tightly within departments, and we do it for very good reason.
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But when we start to become child-focused and student-focused in everything that we do in this whole process, you realize that there are some very good reasons for sharing information.

What the privacy impact assessment came down to…. After all of the time and effort put into doing it, it boiled down to: if families consent to have this team be part of their child’s lives, we can share information about the child. That’s what it took. It took a long time to get there, but it was a commonsense result in the end, so in the best interests of children and youth.

Then a MEC was created, a memorandum to executive council, to obtain approval to move forward. So there were some administrative and governance issues that had to be put in place and had to be written down and approved at your level in order to move forward with this. The will needs to be there and the process for moving forward.

B. Morrison: I’ll just mention some of the outputs which I think will be helpful. There are standards of practice for teams that have been created. When you talk about fidelity to a given model, there are standards of practice. The indicator framework for assessing integration is a key tool. The positive mental health indicator framework for school environments is a key tool. Currently we’re working on a series of e-books that can be used for training new teams. New Brunswick is rolling out this to be rolled out fully by 2018. So we’re in the midst of that.

We’ve been interested not only in practices but in terms of assessment tools that are validated that can be used to measure how we’re doing in monitoring our progress.

We’re going to play for you…. This is a video that was done, which we produced. On our team at the university we have videographers. Most of the stuff we’re working on now we want to put on line to make it useful, so this is a video that was produced on ISD — from some of the players.

P. Peterson: Melanie Doucet, who you saw, the young lady with the black hair in the video, worked with us from the beginning on the ISD framework. She was actually a youth who grew up in New Brunswick in care and foster care and all of the things that go along with that. She’s shared her story different times.

It was wonderful to have that perspective on the senior team as we did the planning because it was as important to hear from her and from Maureen Bilerman, the mom, and Zoë Watson, the ADM. All of these people coming together under this common purpose, I think, gave the flavour of ISD its richness. Each piece was absolutely necessary.

Melanie has a happy ending to this story. She’s now doing her PhD at McGill in this field. Some happy endings — not all endings are happy, but boy, we can make more of them happy just by stepping outside of our own comfort zones and keeping the child at the centre.

J. Thornthwaite (Chair): You’re going to provide us with your deck and the video as well?

We have just over a half an hour, and I’m sure that we’ve got lots of questions. I’ve got Maurine first, and then Darryl. Uh-oh — we’ve got everybody. And then I’ve got stuff to say, obviously. Let’s start with Maurine and Darryl.

M. Karagianis: Excellent presentation. It’s really exciting to see that kind of process put in place.

I have a couple of questions. I really loved your phrase “one child, one file.” I think that that’s a great baseline for motivation. Obviously, systems require a shift in order to meet these needs. I wouldn’t mind you speaking a little bit on how that has taken place. Obviously, it’s a different way of providing resources. How do you make that shift? So often, you can’t just stop the service here to provide it in a better way over here. I’d be interested in your comments on that.

Also, if you have…. Maybe your process is too early on to provide evidence of the cost implications — whether there’s been a decrease, a status quo or an increase in costs for these kinds of services versus the outcomes provided.

So often we look at…. I’ll take something like homelessness. We know through much study and gathering of data that it’s more cost-effective to put people in homes than it is to leave them homeless. I’m thinking the same thing. If you’ve been able to provide any data…. It may be too early in the process, but those two issues, I think — I’d be interested in your comments on.

B. Morrison: So you’re looking at readiness — in other words, actually making the transition across departments and then the cost-effectiveness part, right? The cost-benefit side.

In preparation, there was a two-year period where we
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actually not only created the foundations for ISD…. When I say ISD, that was the adopted name. I might rename it, because ISD is one that you saw as a component of it.

There was a time of realigning. There was a transition period because everyone, all of the professionals involved from the different departments, had their files. So there was probably about a six-month transition where people transitioned the files, where every waiting list and every assessment list was revisited and revised and where we started saying: “Okay. This child is being seen across three ministries. They will become a current client or participant with the child and youth team.”

There were opportunities where files…. There are some times that we have files that are open for a long time. We’ve only seen the person once or twice a year, but the file is still open, or it’s still maintained as an active file. So it was really looking at where we were with everyone in terms of children and youth and the duplication. If you have a child that’s across four different ministries, well, we don’t need that. That child can be seen as an individual, as a participant of the team.

There was about a six-month period where waiting lists, wait times, current files were reviewed and were brought into a common centre of the child and youth team. That took some time. At the same time that was happening, the team was also being provided with interprofessional training. We did about 20 days of training with each of the teams. That’s being rolled in a little bit more succinctly now. We’re kind of in our second round of training teams, and we’re actually creating a much more, I would say, sleek approach to training.

We covered all of the bases so that people would feel comfortable with coming on the team, because it’s different. I’m a professional. I’m a psychologist in mental health. I work from my office on my own, and I use the…. You know, I’m with the College of Psychologists. I work from their ethical stance. Now we’re saying: “You’re coming into an interprofessional team. You will still be valued. You will not lose by being part of a team.”

Leaving our offices to go into a school environment, boy, that’s a little different. I mean, that’s a different feel. So having the time…. Our team leads were absolutely critical to helping the teams process what it’s like to work together in a school and community setting where we’re outbound as opposed to being office-fixed. The team leads were absolutely critical for helping us process through.

We learned a whole lot of lessons. It’s not just the departments’ integration. It’s the professional associations that become important — to understand that this is an approach…. Because everyone, if you said multidisciplinary: “Yeah. We’re good with that.” But it’s different to go from multidisciplinary, where we still belong to our separate departments, to being on a single team now processing things. There are benefits, and there are also the challenges of saying, “Will I lose something here?” and building trust.

Team-building was absolutely critical. And it’s not just with the teams themselves. It’s the school communities and making sure that this is not imposed on schools but that their current frameworks and strengths are part of what we do together and that there are educators on the team.

P. Peterson: Sure. Just thinking in terms of the shift and some of the lessons learned, we did a lot of the training with our child and youth development teams at a point where they were seeing clients. It was a very intensive training program. One of the lessons learned was that there was too long a period where kids weren’t being seen because everyone was coming through for training.

That’s something that’s being, as Bill said, done a little bit differently in this second round. We have a lot of on-line training opportunities. There are still meetings. There are still times to come together and debrief what you learned in your on-line video training. There are some face-to-face full group trainings but not pulling people out of the system. That was a strong message that came through. We need to continue to see kids during this shift, during this transition period, and it has to be seamless for the families. That was a good lesson learned.

Around the financial piece. I mean, we’re consultants. We’re not with government. We’re consultants to government. What I do understand is that there has not been a huge allocation of new budget dollars to the individual ministries taking part in ISD. There has been a repositioning and a re-profiling of the team members who are already doing the work, already seeing kids. Then you pull them together. What we do know is that many more kids are being seen and serviced with the same number of staff, who are just working differently.

There is a new position. Bob Eckstein, who you saw on the video, is provincial director for ISD. That was a new position. He was seconded, in fact, from Public Safety to come over and lead the development of this, and he has an assistant who works with him. But it’s not a huge infrastructure to actually do this, because you’re working with people who are already seasoned professionals working in the ministries.

It’s my understanding they have been pleased with the fact that this was, I think initially…. I mean, there was a budget of a couple hundred thousand dollars to pull this together and start the development process. But it has not meant we need 50 new positions in the province and we need to recruit new people, new social workers. It’s the same people, because it’s the same cohorts that they’re working with.

The other thing is that they do collect operational data at each of the sites. So we can see the number of kids be-
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ing served, the number of referrals, the number of meetings with kids. That is being tracked and compared to what existed in the individual departments prior to ISD. They have an opportunity longitudinally to look at those data and to say: what are the dollars being spent? What have we saved? And the big question, which will take a few years for it to work itself out, is: are we decreasing the dollars spent on tertiary-level care and the number of kids going that route because their needs have intensified to that point?

We will be able to see, over years, what those data mean. We are in beginning stages at this point. But I know the initial outlay has not been prohibitive.

B. Morrison: I think what amazes us is that you double the number of children being seen within existing resources — so seeing children at an earlier point and in different ways.

There is a cost-benefit analysis. It has not been released from government at this point, but I understand it’s in a positive direction. That’s probably all I know on that front.

P. Peterson: We’re professors. We give very long answers. We’ll work on that.

D. Plecas: Thank you, Maurine, for your question. That was one of my questions, and the tying it to effectiveness.

I liked your answer. Let me just say I think what you’re doing is so inspiring. My thinking was, as you were talking, it would be nice to clone the two of you and bring you to B.C. But you can’t be too smart, because you live in New Brunswick.

P. Peterson: I would agree with that. Looking out the window — yeah, I know what you’re saying.

D. Plecas: It’s all wonderful. Looking forward, what do you see as the challenges, the biggest challenges? I guess, in part 2: what has been the biggest challenge to get this to where you are now? It sounds like you’re there, but in terms of rollout, you’ve still got…. I think you said 2018 is when you’ll be finished. At some level one might think: “Well, what’s the holdup? Let’s get going.”

B. Morrison: Maybe just to say 2018 is the government’s rollout date. We’ve been through three governments since the inception of ISD as an idea. I think there is always a catch-up point, when you change government, to….

B. Morrison: Listen, that’s probably…. If you ask the biggest challenge — and I’ll have Patti comment on it as well — it’s the paradigm shift. It’s the paradigm shift on how we do business: whether we’re going to remain as system-focused, turf-protection mandates, or we make the decision to return to a value that puts children at the centre, that values development and strength-focused approaches, where we build those through our relationships in our social settings and we refuse to see prevention and intervention as separate, where we have a fully integrated system where we are on the same team.

In 1995 I was…. Actually, I was living in B.C. at the time, in Langley. So I was in B.C.; there’s some smartness there. I came back to New Brunswick. I was hired to help set up regional teams, which were called multidisciplinary teams, across four ministries. We set them up across the province of New Brunswick. They’re still ongoing in several regions — 14 different teams.

We would come together and plan for children and youth, from a community perspective, school perspective, on youth that were having challenges and difficulties in terms of internalizing and externalizing behaviours. They were great teams. People loved working together. But when the meeting was over and people left, there was really no ownership — or I should say some people did take ownership, because they kept and they became the team lead, not because their ministry said they could but because they chose to move forward.

What we saw was that in two-thirds of cases through that, children still fell through the cracks — too many — because we still weren’t on the same team. We sat at the same table for long discussions, but we were not on the same team, pooling our resources. And it’s not pooling. It’s using the resources we have as a single team within our community systems as opposed to….

I don’t know. When we start shifting, we stop talking about building buildings and mortar to house children and youth. We talk about keeping children and youth in our community systems through relationships, not building more…. And I’m not against tertiary level services where we house…. Well, maybe I am.

I believe that we need to make a decision that we are going to keep our children and youth and do our best for them within our systems from a strength developmental point of view as opposed to saying: “I can’t deal with you any longer. I’ll have to send you away.” That’s a big shift.

P. Peterson: I think, ideologically, that was probably the greatest challenge. Logistically — probably putting the governance in place and having the ministries work together and figure out what our governance structure looks like and how we can make sure that it becomes embedded as part of the way the province does business.

It can’t be at the whim of any politician or of a Premier. It has to be able to survive past changes in government because this is the way B.C. does business. That, I would say, is going to be a challenge that will be unique to you. We’ve been through it. There may be some lessons learn-
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ed that can be shared, but you need to make sure that you come to a point where there is a will across ministries to say: “We do business differently, and the kid is at the centre, not our systems.” Those logistics are tough.

D. Plecas: If I may just have one more question. I know everybody has questions, and I’m not going to ask all of mine.

I guess two things. One is in terms of a lead. Somewhere there must have been a lead. Who does that? That’s one question. And did you have a situation in New Brunswick where you had enough people doing the work in the first instance? Some people might say: “Well, that sounds fantastic.” But you’ve got to have the bodies there. You’ve got to have psychologists, etc. Was that an issue?

P. Peterson: First, around leadership. There was a provincial ISD coordinator who was seconded from Public Safety, Bob Eckstein, who we mentioned. He is sort of overseeing this. The provincial ISD committee came from ADMs and directors and others who already existed among departments that came together and served on working groups. But there was a lead. That was a position that was created for oversight of ISD.

On the teams themselves, the structure of leadership within the teams…. The teams, as we’ve mentioned, do their business in schools and include all sorts of disciplines. The clinical supervision or the lead on each child and youth development team comes from the regional health authority. So we do have RHA leadership.

Now, when you bring an RHA leader into a school setting, you’ve got some fireworks initially. You have educators saying: “Don’t come in and tell us how things work in schools.” You have health care professionals saying: “We know how to do assessment.” Then the paradigm shift that Bill talked about with multidisciplinary teaming needs to come into place, and the training becomes important.

You’re right. There’s leadership at the top of the ISD umbrella, and there’s leadership within the teams where you need clinical accountability as well as educational resources that come together and realize we have the same goals, the same purpose.

B. Morrison: It’s interesting. You have four departments. The Department of Social Development goes from top to bottom to direct service delivery. Education and Health do not. You have the departments, but you have your health authorities and school districts. Part of it is establishing those relationships at the regional level with the folks that are involved with education. I have a school level, a district level as well as the health authority. Seeing them come together as a single team, on the field — that’s a big thing, especially when you’ve got a difference between who does policy and who does practice. That becomes a major….

P. Peterson: Your second question has left me entirely. We had leadership and….

P. Peterson: People, yes. We were short on psychologists, which is always a challenge sometimes, especially in rural areas, to get psychologists who are willing to work. There was some recruitment involved in bringing in a couple of new psychologists to work in the demonstration regions.

One of the things that has been most gratifying from a rural perspective is that this interdisciplinary team — and the fact that there are itinerant teams who actually go and travel into these schools, even the ones on the little islands — has, to some extent, levelled the playing field for rural schools, where they had such a hard time getting services.

They’re not going to recruit a psychologist to work on Grand Manan Island, which has 300 people, yet now they had access to these services. So once a week they’re going to have these professionals in their school — or more so in times of crisis.

It wasn’t a lot. We had enough social workers. We have enough educators. We have youth care workers. We had most of these positions. Psychology was little bit more challenging because we were short on psychologists in schools.

B. Morrison: I want to add to that. In B.C. you require a PhD to be a licensed psychologist within the province. New Brunswick is moving in the same direction. We’re halfway there.

Across Canada the counselling profession — people trained at a master’s level in counselling or counselling psychology…. There is not legislation or regulation in many provinces around counselling. I’m not sure here. The B.C. counsellors, I think, were looking at it for several years or are still in process. I’m not sure where it is, because I’ve been away for a while. But what we saw with ISD is that counsellors — school counsellors, community counsellors — came on our teams and were valued.

In New Brunswick, typically, mental health and addictions, hospital services, Social Development — we don’t hire anyone that’s not a licensed social worker or a licensed psychologist. Now, the school system has counsellors with good training. In fact, they’re part of our department in the province of New Brunswick.

What we saw is that there are professionals that were not being validated in terms of practice. What we saw is that counselling, actually, has really become more respected on the teams. We see that counsellors who have good training at a master’s level can make a big difference for kids with the support of the team of professionals.
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I would say we actually didn’t do too badly, especially in Charlotte County. We did not add positions there specifically, but what we saw was a valuing of counselling professionals which hadn’t happened in the province before, especially in the health sector. Typically, right now, if you look at hospital services, we’re still not employing counsellors as far as I know. But on the ISD teams, they’re there as participants. To me, that’s a big cool for seeing people come together.

Youth care is another example. The youth care profession in a lot of the provinces has not had the support. Yet youth care…. When you talk about therapeutic milieu — working within an environment — these are professionals that have…. You’ve got some of the best programs at UVic here in terms of youth care nationally. It’s seeing people with that professional background being valued as team players.

It’s not just shifting what kind of position. It’s also making the professional associations begin to respect one another and work with one another at the same time. That’s a positive by-product, I think.

C. James: : Thank you for your presentation. It gives a lot of hope, I think. I really appreciate your description around the embedding of the teams. It’s that deeper lever that I think other provinces are missing. I think many of us and most community organizations have the round tables, have people who sit at them from across ministries who come together, but to actually be part of a team together…. I think you defined it really well. It was a really good description and really helpful.

Just a few questions. One is on the indicators of change, the assessments that you’re doing. I wondered where youth and families come in — what opportunities they have to give assessments as they go through.

I wondered how long your demonstration sites were when you first began — what kind of timeline you gave to those.

Then I guess my third question — I think one of the most important ones — would be: can you describe for us what a parent would do? If their child is having struggles, often they access through the police system or the emergency room or their family doctor or the justice system. Given this model and given the process, how would a parent access it? What would happen if you were a parent with a child?

P. Peterson: I’ll start with that one. I follow your questions, and then I remember the last one you asked.

With the referral sources for ISD, most of our referral sources, as we suspected would be the case, have come from the student service teams in schools. Teachers, school counsellors, administrators will bring it through the student service teams to the child and youth team. There are other areas of intake.

Doctors’ offices, families themselves, parents can call the child and youth team. They call the same line, in fact, that they used to call for mental health. We use the same line that now goes through, only if they are within the catchment area and within the age level, it’s referred to a child and youth development team. They can still call mental health services; they’re going to get child and youth teams.

Doctors’ offices have brochures. Every doctor’s office in New Brunswick in the ISD areas has brochures with the information on them. They can make referrals. Youth organizations can make referrals. It all comes back to the same place. It’s every door the right door. You can’t go wrong. If you call mental health, you’re going to get child and youth development. If you call the school, you’re going to get child and youth development. It all funnels through.

They have referral criteria. There are intake questions that take place when they call to make sure it’s an appropriate referral to child and youth development, and then it goes on. But every door will lead them to the same place.

B. Morrison: In terms of roles, in each of the teams there’s one clinician who’s involved in answering the phone. You don’t reach an admin person. You reach someone that’s actually functioning on the team.

The work that’s done up front in each of the regions of looking at continuums of service, it is the right door, because the team is meant to assist people. Let’s say you don’t really need…. You’ve got a parent who’s struggling, and you’re saying: “I’m not sure how to work with my adolescent, and here I am.” Well, the team will connect the family with a service in the community that could be offered by a non-profit. That’s why understanding the continuum of services….

The team helps facilitate access. It may not be, “We’re going to set up an individual appointment,” but: “We will help you get to the service that matches the appropriate level of need at the same time.” So the answer is not: “Sorry. We don’t take them. You don’t fit our mandate.” That’s why we actually spent time looking at continuums of services across the regions as something we did before the teams were put in place.

P. Peterson: There was a service inventory done in each of the demonstration regions so that you ended up with a nice little spreadsheet that showed you: here’s what the call is about; here are the services available in this region.

B. Morrison: Similarly, if you had a child or youth who actually had very intense needs, at a regional level they had an integrated committee of all the ministries where they would pool resources for accessing additional resources to help the team if we needed to step up, if there was a crisis or something that happened where we
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needed to actually have residential services for a short period of time. The team is always connected. It is not referring away.

D. Donaldson (Deputy Chair): Thanks for the presentation. That was thought-provoking and a lot of yes, aha moments. That’s what we need, and that’s what we’ve heard.

A couple of brief comments, then a quick question. My role is oversight as official opposition of the Ministry of Children and Family Development. I just want to point out that we’ve had three ministers and four deputy ministers in the last seven years, so it doesn’t take a change in government to disrupt continuity.

The other part was on the first phase of the report. It was very evident that northern rural areas are lacking in service delivery. In the northwest part of the province we don’t have a PhD expert in trauma counselling for youth in an area where thousands of people have experienced the residential school system or are family members of those who directly went to residential schools.

When we’re talking about putting together a team to visit numerous schools in a vast area, I think we’re talking about resources and a resource gap — although I do take your comments to heart around where there’s some local expertise, maybe not credentialed to the extent of a PhD.

I find that ISD is sometimes being practised unofficially in small communities. I think my question and the real crux of the matter for me is the paradigm shift you talked about. If local people are trying to do that as good community members, maybe with not the expertise that’s needed, then what’s the role of government from a legislative point of view?

I think we often get presentations by the Representative for Children and Youth saying: “Accountability — who’s legally responsible for these children?” In the team model in New Brunswick has that been an inhibitor of the team approach? Is there, from a legislative point of view, something that could support and advance and encourage the ISD model?

P. Peterson: There had to be. Around the privacy act, absolutely. Around sharing of information, that had to be a legislative initiative, where it moved forward and commitment was expressed to doing this on a provincial level.

That’s part of the whole process. The whole consultation and awareness process had to start with Legislature and had to start with executive council and work its way through every arm of government. You don’t want this to be dependent on an individual minister who says: “It’s not really my thing. I don’t really want to go forward.” It has to be both from the ground up and the top down. We found that that was absolutely necessary.

I take your comments about the resources necessary to go into huge geographic areas that are rural and perhaps isolated in B.C., where we’re talking about lots of them but they’re small in scope. You could take a day to get a team to a more rural area. That would be an issue that would be very important for B.C. to look at. What would it mean to actually get these supports?

I was reminded as you were speaking too. One of the things that we’ve been working on for several years and are bringing into the discussions about having ISD scale up provincially is the First Nation perspective and the fact that when you’re going into those communities, approaches need to be specific to the culture of the community.

We undertook an engagement process with several First Nation communities through Health Canada in New Brunswick where there were some wonderful lessons learned that came out of that process. In the voices of the community members, we heard what it takes to engage. We heard what it takes to hear their voices and support autonomy and to not dictate “here’s how it’s going to be and what it’s going to look like in your community.”

I would suggest strongly to B.C. that you undertake that as a parallel process. How are we going to engage all of our communities, all of our cultures, all of our diversity in ways that are respectful of their experiences? Coming in and mandating that “this is what ISD is going to look like in your community” will work in some communities. It’s not going to work in others. That whole cultural piece needs to be undertaken as well.

That is a resource issue. You’re correct in that, that we need to be able to resource those efforts to make sure that we’re being culturally sensitive to all of our communities.

B. Morrison: I’ll just respond to one area you mentioned — children in care, where there was a designated social worker as parent, or as guiding that, as well as youth who were in the care of Public Safety, when they were received because of things that had happened either to their family or related to law.

What we looked at there was making sure that there was collaborative case management between those individuals responsible from Social Development as well as from Public Safety, but co–case management. When you think about the Youth Criminal Justice Act, and they talk about conferencing, pulling together a team…. In the past, at least in those demonstration regions, people would say: “Well, who’s here? Who’s around?” They’d have to pull together a team.

The child and youth team is the team. When you talk about conferencing, it is the conferencing team that immediately is part of…. We do talk about collaborative case management when we talk about children that are in the care of the government, either on the Justice or on the Social Development side. We do not lose the linkage with the school, community and family, but it becomes something that is expected as collaborative and integrated case management as you move forward — not starting over at
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zero because you’ve now become in the care of ministry and everything gets dropped and we start all over again.

J. Thornthwaite (Chair): I’ve got some questions as well in the remaining five minutes.

Thank you very much for your presentation. You mentioned, Dr. Peterson, that it might be too early to assess this, but you must have an idea, given the fact that you’ve cut attrition to virtually zero. Job satisfaction has gone up. Wait-lists have dropped tremendously.

I would assume, therefore, that your ER visits have gone down, if Health has actually itemized child and youth mental health ER visits; then perhaps your police statistics of issues with children with mental health issues.

Do you have any preliminary data that shows that these stats have drastically reduced?

P. Peterson: What I know there is data related to is the type of work that was done before and is done now by the same type of clinicians.

I’m sure the province is looking at…. We’re not the official evaluators, because we can’t evaluate something that we developed. We’re not involved in that piece of it, but I’m sure that they’re looking, over the long term, at things like ER visits. Now that they have the information-sharing barriers down, they can start comparing and saying what’s happening.

Now, it’ll take a little longer over time to see what the outcomes are for criminal justice and those types of things, but I’m sure they’re looking holistically at those things. We don’t have that data. We do have data on utilization and on attrition rates for meetings and on efficiency rates.

Are our psychologists actually seeing more kids with the same resources — the same number of psychologists but more kids being seen? That data we have, because it’s embedded into the evaluation framework for ISD.

The other sort of cross-tabs that they might look at — what’s going on in terms of ER visits and those — that’s not something that we’d be privy to.

B. Morrison: Within the province, schools that have invested in the environment from a positive mental health perspective…. There is data around retention rates — in other words, attendance and so on — of kids within school.

I kind of smile a little bit. It probably would be interesting to look at the emergency rates. I don’t think that has necessarily been done so far. When we think about admitting to tertiary-level services, we don’t have much. There’s not much data to be gathered when you don’t have…. In those rural areas there are no tertiary-level facilities. Typically, kids are sent out of region if there is need.

It’s kind of interesting. Those options haven’t been there. I mean, I think there’s a lot of on-scene loss that goes on in these regions where there are no services when we talk about emergency response.

I think the sense of doing a more proactive…. I think school attendance is a big one and engagement with kids that are remaining within our systems and are not populating our alternative school sites. I think those are some of the things that there is accessible data on.

J. Thornthwaite (Chair): My last question. I’m thinking about the presentation we had from Dr. Mathias a few months ago. He’s working with the collaborative and has actually opened up an inner-city….

B. Morrison: We know Steve. We met him at a conference here not too long ago. Talked about ISD.

J. Thornthwaite (Chair): Okay. He’s been quite vocal with regards to issues here in British Columbia as well. I’m thinking of something that he would say and has said to me: “That’s great” — about the model of moving these services into schools — “but how do I get my youth that are between the age of 18 and 26…?”

I know you had said 21. How do you get a 21-year-old that would want to go back into a school? Or do you have those actual facilities somewhere else?

J. Thornthwaite (Chair): Yeah. You’ve got somebody that’s in the age group of 18 to 21. Where do they…? Do they physically go back into the schools, or do you go to them?

P. Peterson: Usually not. There’s a combination of things that they could do. Now, the team would still be responsible for them until they’re 21 and would work with them towards their transitions.

In New Brunswick there are a couple of options. You may put a 21-year-old back in the school if they wanted to do it. If they didn’t, they could be involved in a GED program with provincial support in order to get their equivalency, and there are also alternative sites where they can do more practical, hands-on work to come out with a diploma at the end.

The team would then facilitate that individual’s entry into those programs and stay with them until they finish. So there are options, and yes, in some cases you’ll have older kids going back into the school. In many cases those are kids with physical disabilities who will stay right in the high school setting until they’re 21.

In other cases you find a kid who’s 20 who’s been out for a couple of years or dropped out at 16. They generally don’t want to go back to high school. But the team is still responsible for the transition plan for that individual and will get them into alternative education.
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B. Morrison: Post-secondary education has, really, quite a good range of services in New Brunswick that can be offered to youth. I’m just reflecting on some of our own clients that Patti and I have had through post-secondary.

We see a tremendous amount of children and youth at the high school level that, because of anxiety and behaviour, don’t finish school. When they don’t finish school, they go out and try to get a job, and that’s not very satisfying because without a high school diploma, accessing jobs where you can actually become self-sufficient…. They are not there. Then they come back, and they come, through you, to the post-secondary approach. They’re trying to get their GED, and it’s a long haul. And it’s a sad haul.

We should not be having our children and youth that have internalizing-related concerns…. We should not be letting them go. To me, we need to prevent where we’re looking at…. We need to keep kids connected with school and successful, seeking their passions.

J. Thornthwaite (Chair): Thank you very much. We do have a lunch that the committee is having with you, so we can continue our conversations there.

Just before we break this meeting, I wanted to put forward a recognition that Dr. Bonnie Leadbeater is here from UVic. We’re going to get her to come and talk to the committee at a future date on the WITS program. We’ve got our own specialists here, right in Victoria.

We didn’t get a chance to say hello to Jennifer from Prince Rupert — our MLA from Prince Rupert, Jennifer Rice — because she came in a little bit later. Now you’ve met everyone that’s here.

I think that everybody has got to get going, but we will, obviously, resume our conversations today at lunch. Thank you very much for a very, very informative, excellent presentation.

K. Ryan-Lloyd (Clerk of Committees): Just a reminder for those members who are able to join the lunch, it will begin at 12 noon in the Nootka Room, which is a small room off to the side in the parliamentary dining room. We hope to see many of you there. Thank you so much.

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Chair:	* Jane Thornthwaite (North Vancouver–Seymour BC Liberal)
Deputy Chair:	* Doug Donaldson (Stikine NDP)
Members:	* Donna Barnett (Cariboo-Chilcotin BC Liberal)
	Mike Bernier (Peace River South BC Liberal)
	* Carole James (Victoria–Beacon Hill 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

REPORT OF PROCEEDINGS(Hansard)

SELECT STANDING COMMITTEE ON CHILDREN AND YOUTH

REPORT OF PROCEEDINGS
(Hansard)

SELECT STANDING COMMITTEE ON
CHILDREN AND YOUTH