Children and Youth — Issue No. 20 — Wednesday, May 27, 2015 (HTML)

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

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

• Doug Hughes, Assistant Deputy Minister, Health Services Policy and Quality Assurance Division

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 in British Columbia	464
M. Sieben
S. Wiens
D. Hughes
J. McCrea
J. Gallagher

J. Thornthwaite (Chair): Good morning, everyone. I’m Jane Thornthwaite. I’m the MLA for North Vancouver–Seymour and also the Chair of the Select Standing Committee on Children and Youth.

We have an exciting morning this morning. I’m going to be making a few preliminary remarks, and then we will be introducing members. Then we’ll get our head deputy minister to introduce his team.

I thank everybody for coming. I know that this week is really, really busy, and there are lots of committees going on. I’ve got at least a couple of my people on our side that are coming late.

This is our third session, third day, of getting presentations from people for our special project on youth mental health. After the component of the meeting dealing with our special project, we can also spend some time on some other committee business, such as discussing the committee’s draft annual report.

As the committee members know and as our ministry guests know, the committee issued its interim report on youth mental health in November of 2014. That report reflected the large amount of evidence received in our first phase.

I think the committee members would share my view that while it is urgently important to improve child and youth mental health in B.C., we also saw many inspiring examples of innovative, family-centred service delivery. The committee will build on the excellent input received in its first phase of work as we undertake the next phase of our work.

Our second phase involves seeking concrete and practical solutions to enhance youth mental health services and outcomes in British Columbia. So far in our second phase, we have heard from Dr. Bill Morrison and Dr. Patricia Peterson, who had a major role in New Brunswick’s implementation of their collaborative mental health services delivered in schools.

We also heard from Principal Jeremy Church from Mountainside Secondary School in North Vancouver — an excellent model of what an alternative school can do in terms of meeting youths’ needs.

Kathreen Riel from the WITS program gave us an overview of that leading, peer-reviewed, anti-bullying program. We heard many, many times that positive school environments are so important to promoting a positive mental health environment for our kids and for preventing some types of mental health problems.

Based on our findings, the committee will make recommendations to the Legislative Assembly. We are fortunate today that we have enough time on our agenda to allow a significant amount of time with our ministry guests — about 60 minutes for the presentation. We are actually probably going to be here on this portion until 11:15, and we really do want to encourage questions from committee members.

Given our goal of making concrete and practical recommendations, it’s very important for the committee members to have a good understanding of what services exist; the frameworks under which they are delivered; what is working well from the ministry’s perspective; where opportunities for improvement may exist; and what the ministries are doing together to collaborate services, programs and communication to cut down the silos and improve timely access and treatment for children, youth and families across British Columbia.

Since we don’t have the health authorities or the school districts, we have appropriate ministries that will be able to at least assist us as to where to get that information. But we really do want to focus on the collaboration of services between ministries, health authorities, school districts as well as care providers — and where the identified gaps are.

How can we do a better job of integrating the system and avoiding duplication, repetition and a waste of resources? In that light, the committee considers the ministries’ and health authorities’ perspectives to be crucial.

The proceedings are being recorded by Hansard Services. A transcript of the entire meeting will be made available on our website.

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

D. Donaldson (Deputy Chair): Doug Donaldson, MLA for Stikine, Deputy Chair of this committee, and I’m the official opposition spokesperson for Children and Families.

Just to follow on the comments of the Chair. If I can, for a couple of moments, as Deputy Chair say that…. Just to set the context, after our first phase, the major finding was that there is no system in place in the province overall, no overarching system around effective access for children and youth to mental health services. “Chaos” was a word that was brought up in many of the presentations, and a lack of services.

What I’m interested in hearing today is for the pockets of success that the Chair referenced that we did find, how do we scale those up? Is it possible to scale those up? What are the resources required to do it. How do we do it?

M. Karagianis: My name is Maurine Karagianis. I’m the MLA for Esquimalt–Royal Roads, and I serve in opposition on the files for seniors, for women and for child care.

J. Rice: Hello. I’m MLA Jennifer Rice. I’m the MLA for North Coast. I live in Prince Rupert. I represent Prince
[ Page 464 ]
Rupert, Haida Gwaii down to the central coast — Bella Bella, Bella Coola — and all the communities in between.

I am the opposition spokesperson for northern and rural health and the deputy opposition spokesperson for Children and Family Development.

C. James: Good morning. I’m Carol James, the MLA for Victoria–Beacon Hill, and I’m the opposition spokesperson for Finance.

D. Plecas: Hi. I’m Darryl Plecas. I’m the MLA for Abbotsford South and the Parliamentary Secretary for Seniors to the Minister of Health.

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.

J. Thornthwaite (Chair): We have both Mike Bernier as well as John Martin coming later, and we have Moira Stilwell on the line.

J. Thornthwaite (Chair): She’ll mute her phone while we’re listening, and then she’ll come back on when you do the questions.

I also wanted to just draw your attention, committee members…. Alayna has provided us with the questions that were proposed to all of our presenters, just to remind you of the type of questions that we did ask presenters to focus on when they are in front of us.

With that, I’m very pleased to welcome such a large number of the representatives from the many ministries with a role in child and youth mental health, and I thank you all for working together with your joint presentation and look forward to hearing your thoughts.

I will now turn the floor over to our first presenters and invite the presenters to introduce themselves as each of you deliver your portion of the presentation. I’d like to personally thank Mark Sieben, the Deputy Minister of MCFD, for organizing all of these ministries together and being the head leader on that. Perhaps, Mark, you could take that role in the introductions, as the folks are about to speak, and give their contributions to your presentation.

M. Sieben: Thank you, Chair. I, too, am looking forward to this. It’s not that it always isn’t, in a twisted sort of way, fun to come and speak with the committee, but this is a rare occasion. I feel a little bit like I’m playing in front of an all-star band here.

What I thought I might do is, in fact, make a point of introducing everybody now. What we have planned is…. Pursuant to your request, we’ll lead you through a presentation to speak to many of the questions that have been provided to all of the ministries, and we’ll try to speak to all of those questions in a holistic manner. Then we’ll also identify individual ministry examples to support, as the Deputy Chair has referenced, some of the areas of success that we would like to see, sort of, more of.

At the end of the presentation…. I promise not to use the 17 pages of speaking notes that the team provided, because I know it’s important to the committee that you’ll want to get to Qs and As and engage in the discussion. What we had in mind is that I’ll basically look to try to facilitate that and act as some form of moderator. If questions pop up to a few of the folks that we have in the background, I’ll ask them to come up and join me on the flank here, introduce themselves at that point, and take on the question. Hopefully, we can see to all of your questions, then, in an orderly fashion.

Up here at the front with me — I’ll start off from the right — is Jennifer McCrea. She is an executive director at the Ministry of Education. Doug Hughes is an ADM at the Ministry of Health. Sandy Wiens is executive director in MCFD. Also from MCFD is our ADM on the policy and provincial services side, Christine Massey.

If you will bear with me, I’ll just read through who we’ve got in the back here who are going to assist during the Q-and-A session. I think it’s also important to underscore the presence of each of the ministries both within the presentation as well as having made the effort to get somebody here in order to support me in this role, for which I am very appreciative.

In addition to Doug from the Ministry of Health, we have Mark Armitage and Pam Liversidge. From Advanced Education we have Assistant Deputy Minister Bobbi Plecas. From Social Development and Social Innovation, which is also the host ministry for CLBC, we have Assistant Deputy Minister Nichola Manning.

From Justice we have Assistant Deputy Ministers Brent Merchant and Joanne MacMillan. From Community, Sport and Cultural Development we have Lora Carroll. I think I got everybody.

With that, let’s proceed. I would note, too, that in conjunction with the presentation, there’s a short paper from Dr. Charlotte Waddell that we had included in the package. The team is intending to update the submission that was made to the panel for the first phase, and they’ll look to provide that updated presentation by the end of July, if that works for the committee.

J. Thornthwaite (Chair): Mark, just let me interject here. The Clerk right now is getting copies of Dr. Waddell’s presentation for committee members, because
[ Page 465 ]
it wasn’t included in our package. But we also recognize that she is presenting to us in June.

M. Sieben: Thank you. Yeah, I intend to reference one page on it at the very end of the presentation as a way of building a bit of a linkage to what we expect — her visit — to occur in July.

With that, and consistent with the questions that the committee asked, we are looking to speak to the items that are shown on the slide there. I’m just going to plow right into it and into the next slide.

We thought it best to begin to talk a little bit about the prevalence and the impact of mental health disorders in children and youth. Speaking of Dr. Waddell, she’s the Canada Research Chair in Children’s Health Policy, a practising child psychiatrist and a professor at SFU. She and her team recently provided these updated prevalence estimates for B.C. that are based on systemic review of the research.

This information suggests that 12.6 percent, or one in eight, of the children and youth who are aged between four and 17 years experience mental health disorders that cause significant distress and impair functioning, whether at home, school or in their communities. If somebody better than me at math puts that together, that’s approximately 84,000 children and youth in B.C. that may be affected at any given time. And 29 percent of these children and youth have two or more disorders, and 70 percent of disorders begin prior to the age of 25.

Now, it is not the case that 58,000 of the 84,000 are not receiving some form of service from their communities. However, it is the case that some of them are receiving services from someone other than a specialized service provider, such as a trained mental health clinician, child psychiatrist, mental health nurse, clinical social worker, psychologist or counsellor. That’s a component of the model that we suggest needs to continue to be augmented. There are additional services available in community through community agencies, schools and other forms of primary care.

We know that of children and youth who have experienced mental health or substance abuse disorders, there are impacts not only for themselves as individuals, but there are impacts for their families and also for their communities. The team here can speak to the nature of the impacts associated on an individual level, a familial level or a community level, if that’s of interest to the committee, a little bit later.

For the next slide, we’re going to try to address a couple of the questions that the committee had relating to information and data and outcomes, specifically how information is tracked, how outcomes are monitored and measured — or the extent to which they are and the extent to which they are not — and whether emergency room admissions are increasing.

In doing so, what we’re looking to do is use some of the national CIHI data and compare that to some of the information that we have specific to B.C. and indicate some of the trends in B.C. You see that comparison, then, in the slide before members.

I would note, first, that regarding data and information that is used to inform monitoring, planning and reporting, that is a challenge for us here in B.C., as it is a challenge nationally. The May 2015 Canadian Institute for Health Information report identified that the lack of availability of quality data is a challenge nationally within all Canadian provinces.

In B.C. there are similar concerns. That’s something that the Ministry of Health, MCFD and Education as a group are looking to address — to enhance the availability, the quality and the reporting of data related to mental health and substance use. This work includes partnerships with the Child and Youth Mental Health and Substance Use Collaborative, which we’ll talk a little bit more of in the presentation.

One notable area of challenge in this area is the tracking of outcomes for children and youth who are receiving services. The practice at a front-line level is that most clinicians monitor outcomes using an issue- or diagnosis-based scale. But what we don’t have is a common or core set of outcome indicators that is routinely collected and that can be used to help with systems-level planning. So what we don’t have is an aggregate rollup of what happens in those individual cases.

Secondly, the available data suggests that, overall, B.C. is experiencing service pressures consistent with what’s being seen nationally. The available Canadian data does not indicate an increase in incidents or prevalence overall in child and youth mental health service problems. However, the national and provincial data indicate increased service levels and, as a result of that, also service pressures.

B.C. Ministry of Health data suggests a steady increase, over the years from ’09-10 to ’14-15, in the number of the relative proportion of children and youth seeking services. That’s reflected in the slide on the right-hand column.

In MCFD we know that there are increased numbers of children and youth receiving services from our community-based child and youth mental health teams. Our CYMH teams are now seeing almost 29,000 children and youth annually. For CYMH teams, the number of children and youth we have seen has almost doubled from around 11,000 at the start of the CYMH plan in 2003 to approximately 22,000 at the end of the plan in 2008-09. As I noted, the service levels have risen since then an additional 15 percent.

At the Ministry of Education there’s a significant number of children and youth, over 13,000 students, identified in special education categories for reporting mental health disorders, whether moderate behavioural support
[ Page 466 ]
for mental illness and intensive behavioural support or serious mental illness.

This necessarily presents all of us, collectively, with a large challenge. If there is a positive take-away that we might offer the committee, it’s that we think some of the work that has been done on the awareness and the prevention sides is having benefits. There are now more families and their children who are seeking services that they need. The challenge really is, then, how best to respond to that increasingly articulated need.

Still on the data side, we’ll speak to the service-use data across some of the systems. This graph illustrates increased national and B.C. hospital service pressures, showing data on the use of emergency departments and rate of hospitalization. Again, the CIHI — Canadian Institute for Health Information — 2015 report overall suggests an increase of service pressures: a 45 percent increase in emergency department visits and a 37 percent increase in patient hospitalization. Those are national figures.

The B.C. trends are fairly consistent with what’s found in the national trends: a 59 percent increase in emergency department visits and a 33 percent increase in in-patient hospitalization. The average number of hospitalizations, child or youth, is approximately 1.4. It is higher in the older age groups than in the younger age groups. The CIHI report also notes that B.C.’s rate of hospitalization for ’13-14 was close to the national average.

Emergency departments were the primary mode through which patients sought and accessed the acute services. In 2013, 76 percent of cases sought services by going through the emergency departments. The majority, 83 percent, of those seeking services through emergency departments, were in the 15-to-24-years cohort group.

It’s important to note and remember that the prevalence of mental disorders increases with teenagers and young adults, so again, in some ways the service levels are somewhat responsive to the increased prevalence rates as our children age into young adults.

We’ll speak a little bit now about how we got here. What this slide identifies are examples of work that has been done over the course of the last 12 years. In fact, there have been and continue to be points of progress which B.C. can note as indicative of progress in this province when compared nationally.

I reflect specifically on the five-year child and youth mental health plan that was implemented in 2003 through 2008. B.C. at that time was acknowledged as a national leader based on that plan, which incorporated input from stakeholders, staff, families, academics and service providers.

The child and youth plan created a strong foundation with the introduction of mental health promotion initiatives and evidence-based prevention and treatment intervention programs based on a population health framework.

A 2010 CIHR-funded review paper on access and wait times on child and youth mental health put a spotlight on the plan, which was the first of its kind in Canada at that time, and noted a number of strengths. It was lauded for its emphasis on upstream approaches, with a focus on prevention and early intervention and evidence-based practices.

A couple of examples that come from that are the program areas that we continue to benefit from. The evidence-based prevention program Friends, which is school-based, is supported through MCFD. Examples of evidence-based intervention include cognitive behavioural therapy, interpersonal psychotherapy and dialectical and behavioural therapy.

A fair amount of the work that went on then through the plan was really to bring some consistent approach to intervention to families that were seeking services through the child and youth mental health system.

The five-year plan also included development of mental health services and strategies for specific groups of children, youth and families, including aboriginal children, youth and families in their communities. Up until then things were pretty local.

Strong relationships were formed with academic and research leaders in children’s mental health, such as the Children’s Health Policy Centre. Active partnerships were developed with community agencies such as FORCE and the Canadian Mental Health Association.

Government also invested in early childhood prevention and intervention programs, such as Seeds of Empathy, Roots of Empathy and Fun FRIENDS. More recently we’ve done a little bit of that further through the B.C. early-years strategy.

In the school system many schools are using the Joint Consortium for School Health’s mental health promotion and substance use toolkits to support B.C.’s overall approach to school health. Family physicians have been trained through the practice support program to better equip them to screen and appropriately refer children and youth to mental health and substance abuse services and increase their linkages with community-based mental health teams and schools across the province to support collaboration.

New e-health services have also been introduced, such as on-line information sources, telephone parenting coaching and telehealth to remote and rural communities in the north, which are all increasing access to supports and services. Cross-government and cross-sector collaboration is improving, helping to ensure that individuals and families receive the services that they use and that we maximize the service availability, as it currently exists, to meet the growing need.

A few examples. The CYMH Collaborative, which I referenced earlier, particularly the local action teams now working in a number of places across the province — which include physicians, representatives from schools,
[ Page 467 ]
community agencies, hospitals, MCFD community mental health teams, health authority mental health teams, police mental health and substance abuse teams — is identifying barriers and solutions to improve mental health services in their communities.

Another example is the Community Action Initiative, which funds programs that are building capacity in local communities in order to address children’s and young people’s mental health problems. Combined, these collective, collaborative efforts are helping to, first of all, decrease the stigma associated with mental ill health and substance use challenges and are informing the development of innovative and healthy public policy programs and services.

I’ll talk a little bit now about what makes serving children and youth a little bit different than serving adults when we’re working in the area of mental health services. Because children and youth are continually developing, there is ongoing growth and change, both physically and emotionally, that impact their individual needs, strengths and preferences over time. This means that they need individualized treatment plans, which are frequently updated in order to meet their specific needs. The nature of the services often, necessarily, need to change.

Given their involvement with family — often their dependence on family, given the young age — the families also require our support, and it is critical that families are supported and involved in the children’s and youths’ care in meaningful ways. This is probably a learning that has really come through over the course of the last decade or so.

Most children and youth spend a significant portion of their time in schools, of course, in the school setting with their friends and peers. It is important that they are assisted to reach their potential and develop positive relationships in that specific school environment with teachers and other children and youth. We know that teens in particular, of course, are strongly influenced by their peers. Any of us who have kids in that adolescent phase can certainly attest to that. At times that’s an even stronger pull and factor than their families.

This is an animated slide, which I’m always slightly nervous about, but it seems to be working. Sandy is going to help me with that. I’ll note that here are a couple of examples of particular groups in children who may experience increased vulnerability and that our system necessarily has to find specific ways to respond to.

We know that children and youth who have experienced trauma of any kind also experience increased vulnerability in other ways. That’s certainly part of the business that we do at MCFD. Children and youth who have experienced neglect or abuse, or those who have been bullied, may be more vulnerable to emotional or mental health and substance abuse challenges.

All children and youth are more vulnerable at times of transition, whether they are struggling to achieve developmental milestones as a toddler or transitioning to a new school in their preteen years. A particularly vulnerable time of life is the transition period from youth to young adult. It is part of the reason why the committee, rightfully, is giving that transition point so much focus — when issues of identity; academic achievement; ability to work; and positive peer, family and extended family relationships, as well as connections to other adults, are all critically important to success.

When children and youth have very complex needs, it’s necessary to ensure coordination and consistency in overall approach by family members, caregivers and service providers with the children and youth involved. That can be comprised of many teams of different professionals. I’ll spare you the long list of professionals that people have provided me here.

Often children and youth have many more people involved in their care than is typical with adults so that the work becomes more complex, and the teams involved with them often are much more diverse and dynamic.

The next few slides really get to some of the meat of the questions that the committee had posed to individual ministries that we’re looking to represent and provide to you collectively.

This first slide depicts really how the system is supposed to work — a broad scope of services system addressing a range of needs that is a holistic and collective action.

Meeting complex child and youth mental health and developmental needs requires such a response. This type of systems-of-care model is common as an objective across jurisdictions, with slight variations depending on the context and the organizational and governance models in place in those jurisdictions.

This systems-of-care approach builds capacity across the system to support mental health needs in educational settings, in social and recreational services, in youth justice services and in special needs services, as well as in health and mental health and substance abuse service areas.

The strength of this approach is that it offers a continuum of supports and services available in multiple settings with children and youth — where they live, play, learn and work — provided by a wide range of people involved in children and youth’s lives.

I can reflect on some of the Hansard I’ve reviewed from the committee that many of the presenters that the committee has heard from, in fact, have depicted models where they’re seeking to develop such a cogent system.

Of course, there are also challenges in trying to approach such a system. There is no one-size-fits-all way of approaching the system to be consistently effective and efficient in meeting a wide range of specific needs presented by an increasingly larger number of children and youth. The structure for these services varies considerably across jurisdictions.

No matter how systems are organized and gov-
[ Page 468 ]
erned, there’s always a need for ministries to work more cooperatively and collaboratively together. We’re certainly attesting that today.

The 2015 Canadian Institute for Health report identifies that these challenges in the organizations of care are common across provinces and territories. That’s not an excuse. That’s simply a statement of observation that many of the challenges we are experiencing here in B.C. are consistent with what’s going on with questions being asked in some of our neighbouring provinces.

I’ll now look for help from Sandy and Doug to assist me with a bit more of a technical discussion about the stepped model of care that’s represented in the next slide.

This is one example of a tiered model. There are many different models out there. This is one that we’ve chosen to illustrate the system of children and youth mental health and substance use care in B.C.

The arrows in between the tiers signal the reality that children and youth often move between tiers from time to time or they may receive services from more than one tier at any given time. You’ll also see the arrows on the left and the right of the model that indicate increasing costs as services become more intensive and specialized and lower numbers, in terms of the need to receive those more intensive services.

Tier 1 is really foundational for everyone — all children and youth and families — in terms of supporting positive mental health and overall well-being. It’s also very important for children and youth who are experiencing mental health and-or substance use challenges in addition to specialized services that they may need.

This tier is divided into two sections. One section is self-care, mental health promotion and healthy living. There are many activities that occur in communities and a lot of information that’s available to people in various settings like community centres and physician offices and other places that we travel to in our day-to-day lives that supports us in making healthy choices, including media.

Schools are very important settings for mental health promotion and supporting children in having the information they need to make healthy choices. Programs such as Roots of Empathy and the ERASE anti-bullying program are important examples.

For the older group of young adults, a good example is the Healthy Minds, Healthy Campuses strategy that engages not just professors and counsellors in a campus setting but all of their administrative staff and many people who work on campuses to understand how they can contribute to positive mental health and reduce risky behaviours in those young adults who are attending post-secondary schooling.

In the second tier it highlights informal care, self-help and universal prevention. In this area, as well, there’s a lot of information available. There are some excellent websites, such as HeretoHelp in B.C. and the Kelty resource centre, that have a wealth of resources and information that can support children, youth and families to enhance their ability to cope.

This is important. These resources are helpful for many people, even if they don’t have a diagnosed disorder. They may have some mild symptoms of anxiety, and they can access resources such as this to help them in coping with those challenges.

I should also mention the importance of families. Families are very critical in this foundational tier in accessing these kinds of resources for their children and helping to apply that knowledge and reinforce what children are learning in the school setting or in community programs.

Tier 2 moves into primary and community care. This refers to family physicians, teachers, social workers, school counsellors, public health nurses, as examples. In this tier these professionals are not necessarily trained in specific mental health and substance-use interventions, but they have an important role in screening and identifying when there may be problems and then referring on to more specialized services.

Tier 3 is becoming more specialized, but it’s focusing on community-based services. In tier 3 these are services that are provided by people who are trained in evidence-based interventions, such as cognitive behavioural therapy, interpersonal therapy. They include substance-use services such as outreach and home-based withdrawal services.

Sometimes there’s a little bit of a fuzzy line between some of these tiers. In B.C. a lot of pediatricians provide some of the specialized services to children and youth through their offices, but perhaps not to the extent that a community-based mental health team practitioner would. That would include clinical social workers, child psychiatrists, mental health nurses, etc.

For the record, it’s Doug Hughes, ADM for Ministry of Health. Thank you, Chair and committee, for the opportunity to present.

I want to talk, just briefly, about tier 4. When you start looking at tier 4 from a youth and a child perspective, things start to fall apart a bit for that person. They may not be doing well in school. They are struggling. They may have gone and talked with some of the community professionals and then need more of an intense practice or service surrounding them.

We also have, inside this category, services for children with developmental disabilities. There are two pieces to this. One is looking at specialized populations, like eating disorders, children with disabilities and the mental
[ Page 469 ]
health services to support them. Then we start looking at youth who start to not do well in school. They’re not doing well in the community. Parents are quite concerned. They’re showing up at emergency rooms.

We need to intensify. We need to look at that case management approach and adding more specialized psychiatrists. Some of the assessments would need to be done in a controlled environment. So we would bring children into an assessment centre and look at what would be the case plan which would be supported by the community.

We do have a number of in-patient, hospital-based mental health services across the province in Surrey, Kelowna, Prince George and Victoria — so adolescent youth beds, where we can then manage the environment. Some of the medications would become involved at that point, looking at: “Is this something that we need to look at controlling anxiety and working with early psychosis?” We’re needing to then have a closer look at that and a care plan that would then support that person to move back down and to be then integrated back into the community.

The point here is that there needs to be a strong connection between the community-based services and the acute services or services offered in the specialized tier 4 services. They need to have the pre and then the post. The community piece of the system is key to the acute piece because the number of services in this area are few and you see the costs are high. We have low high-cost, high-impact types of behaviours that we’re trying to look at.

On the youth justice side, we do include the youth forensic services. This is where youth have been adjudicated. We begin to look at, from a forensic perspective, what is happening with that person. Again, that holistic assessment could be done for the purposes of adjudication in court or looking at linking back into the community. So the sense of a system is always working between a youth who is involved primarily with corrections but then for a child in care and then when in the community.

We do have some youth residential treatment beds across the province — Nechako, Peak House. Then, we have a couple of others in the Vancouver area.

Tier 4 is that if things work well and the case plan is working for that individual youth…. The point is that the planning is child-centred and needs to look at what services are in that community and then how we access the provincial services if this tends to escalate.

We do have a number of those. We have Children’s Hospital. I think you’ve received material from them around their adolescent…. They have emergency psychiatry.

They have a small number of beds at Children’s Hospital where we’re able to, again, for a short period of stay, begin to stabilize, begin to look at, usually at that point, the high level of psychosis — again, looking at stabilizing, creating a care plan and then continuing to work with the community-based team.

We do have the Maples Adolescent Treatment Centre as well, connected to the community services through child and youth mental health. With people with disabilities, we do have a provincial assessment centre.

Health works closely with Children and Family, supporting the community-based services, and we work closely with CLBC around the transition periods for youth and adults who would then have disabilities. That’s a quick tour through our tiers of service.

M. Sieben: We’ll return to the deck now and get through a few more slides, including particularly where, I’m sure, the committee has got a significant amount of interest, where the team identifies some gaps that necessarily need to be addressed.

In advance of that, through this next slide, I’ll note again some existing work that is going on within the current availability of services and allocation amongst the ministries in order improve access through integrated and more flexible services.

A number of factors are at play in trying to find improvement and find ways to provide increasing numbers of service and improved services to an increasing number of people within the limitation of service areas.

The first factor that is considered is trying to provide a service within the best location for the individual. A service can be provided within a community, within a school, a home or by telephone.

Examples of location flexibility have included a Confident Parents, Thriving Kids program, which is an evidence-based intervention approach that provides telephone-based coaching for families who have children with mild to moderate behaviour challenges.

School- or community-based teams. There are pockets of promising practice in the Interior, in their CYMH and school teams; youth hub models in Kelowna, in the Fraser region and in the Granville Youth Health Centre, operated through their inner-city youth program at St. Paul’s; and mobile CYMH intake teams through MCFD, offering community-based settings for children and youth and families, typically accessing community-based supports and services.

Another factor that is of relevant consideration in seeking improvement to current service revision is then to match the right service to the need and finding the right provider.

Examples of work that’s being done in order to find improvement in this area is the practice support program model on children and youth mental health for physicians in B.C., which is a joint initiative of the provincial government and the Doctors of B.C. It’s a module designed to enhance family physicians’ ability to identify, screen and refer and also manage medical treatment such as medication, when appropriate, to address mental health disorders in children and adolescents.

Work is done quite a bit, through the team of people
[ Page 470 ]
behind me, with the youth mental health transition protocol. A key principle of this transition protocol is the concept of best fit when considering the strengths, needs and preferences of the young person and the family. There’s more focus that’s brought through the protocol through the collaborative that we’ve talked about.

Another factor is finding and selecting the right service. As noted a little bit earlier, some of the work was done through the earlier Child and Youth Mental Health Plan to identify consistent methodologies for use in practice. Cognitive behavioural therapy, recognizing and responding to suicide risk, interpersonal psychotherapy and early psychosis intervention and eating disorders have all taken focus over the course of the last few years.

Timely service is another factor and one that I’m sure the committee has heard lots about, about the means by which we’re trying to facilitate more timely service within the current service streams we have available.

Our navigation supports such as the recently identified on-line map and the Kelty resource, which Sandy just noted. Great materials are available through FORCE. Access supports such as the CYMH intake clinics. The PHSA use of a process for improvement and collaborative use of processes in order to facilitate increased services through PHSA resources like Children and Women’s Hospital. Walk-in clinics provide the opportunity for children and youth and their families to walk in and have direct face-to-face access to an intake worker.

Another factor is increased collaboration, coordination and integration. A collaboration example often used, again, is the collaborative activities through MCFD, Ministry of Health, Ministry of Education and the Doctors of B.C., through the collaborative and the local teams that are acting there.

We’ll move to the next slide, please, Sandy, just to speed things up. We’ll talk a little bit about the cross-government responsibility. That’s somewhat demonstrated by the crowd of people behind me here, and it’s indicated on the slide.

MCFD and the Ministry of Health, through the health authorities, have the primary responsibility for providing a range of child and youth mental health services. However, as the committee has noted by extending invitations to the various ministries, other ministries necessarily have a role too.

If you’ll bear with me for just a moment, I’ll have these guys sort of earn their pay a little bit for showing up and identify where some of the linkages are between some of their ministries and some of the programs and services that are relevant to the child and youth mental health context.

Within MCFD, again, but outside the child and youth mental health stream, the youth forensic psychiatric services is an evidence-based family therapy model that’s been implemented to support effective interventions with families and youth. In our youth custody settings trauma-informed practices have been implemented. A related evidence-based approach called TRI that applies a trauma-informed lens to an incentive system is also being introduced.

Through the Ministry of Education and through school districts…. They, obviously, provide many supports and services across the continuum.

In ’14-15 the Ministry of Education provided supplemental funding to boards of education to enable them to provide supports and services for students with intensive behavioural intervention and serious mental health needs. Available through schools are school counselling services, school psychologists, behavioural support teachers and specialist teachers, child and youth workers or teachers assistants working with students who require regular behavioural supports and interventions.

Through the Ministry of Advanced Education there is support for positive mental health and reducing risky substance use in post-secondary settings through a program called Healthy Minds, Healthy Campuses that engages all sectors of the campus constituencies.

Through the Ministry of Community, Sport and Cultural Development there is support for the after-school sport and arts initiative designed to help kids who otherwise may not have access to organized activities in their communities after school, when they may be inactive or at risk of participating in unhealthy behaviour. Currently, over 150 schools in 30 communities throughout the province are offering sport and arts programs through the program, which enables students to have the skills that contribute to a healthy life through participating in creative and physical activities.

Through Justice…. The specialized courts in B.C. are an example of innovative, cross-sectoral, collaborative justice practices aimed to improve outcomes related to community safety, victims and offenders. Examples include the downtown community court in Vancouver, the Victoria Integrated Court and the drug treatment court of Vancouver too.

The Ministry of Justice policing and security branch and the Ministry of Health are also conducting a joint project to review integrated responses to persons experiencing a mental health or substance-use crisis. The goal of this project is to promote best practices, expand successful information-sharing protocols and integrated police and health initiatives, provide clear and practical guidance to police agencies and health authorities on their respective roles and responsibilities and strengthen the interfaces between health authorities and police agencies across B.C. The Canadian child and youth mental health association has been contracted to complete this work in ’15-16.

Through my former ministry, Social Development and Social Innovation, also the host for CLBC, work continues on the STADD project, which is targeted at facilitating in-
[ Page 471 ]
creased effectiveness of transitioning from youth-related services to adult services through CLBC. That is the ministry, of course, that provides disability assistance to persons in British Columbia. Through CLBC, there is also the personalized supports initiative, which provides services to young and older adults who have significant limitations in adaptive functioning either through a diagnosis of FASD or ASD.

The next slide represents somewhat of a vision of a system of responses of mental health promotion, mental health prevention and early intervention treatment and support and specialized services.

What the members see sort of clustered beneath each of the columns are programs that align amongst those different headings. They would, we would submit, also be the basis for further work done in the future.

Again, without using the time available to the committee to plow through the summaries for each of these programs, I’m pleased to have a whole corral of people behind me, should there be questions specific to individual programs.

The next slide is one that I expect the committee won’t need any convincing of. It notes that from the ministry’s collective teams working in this area, the rate of return to investment for services for child and youth mental health is worthwhile, not only for children and families and practitioners but also for government as a whole.

When we’re working within existing resources, we need to determine where our efforts will have the most impact, and that’s really reflective of where work has occurred over the course of the last, let’s say, seven to eight years. While we have a great deal of pressure to provide more treatment services, we still need to continue to invest in evidence-based prevention and early treatment interventions to reduce the burden of illness over a longer period of time and thereby improve the quality of life for children and youth and families.

The next few slides, I’m hopeful, will be of particular interest to committee members, as they summarize some of the challenges, some of the gap areas that ministry see and some of the work that is underway in order to address some of those gap areas.

On this first slide, what I would note is in the area of prevention and early intervention services, some of the things that are being done…. We know that the rate of return on investment is highest when we intervene early in a life span. So if the effort has been done in order to increase support for early social and emotional development, that goes beyond the realm of specific child and youth mental health services.

We know that early healthy development sets the stage for success in schools, relationships and the ability to manage daily lives and contribute as productive members of society. That’s worked, for example, in MCFD, such as the early-years strategy. It’s related and integral to some of the prevention work that gets done through child and youth mental health itself.

Again, a list of programs and initiatives off to the side, all of which I’m pleased to have support behind me in order to respond to any questions. I’d note there’s work underway now, including evaluation of the nurse-family partnership program. There’s work done through the Parliamentary Secretary for Child Mental Health and Anti-Bullying to increase the uptake of FRIENDS and the Fun FRIENDS programs in school. There’s broadening the uptake of the ERASE anti-bullying program in schools and introduction of a new physical and health education program through the Ministry of Health and school districts.

Some initiatives to address specific service gaps include the Confident Parents, Thriving Kids initiative. There’s a telephone coaching program for parents based on cognitive behavioural therapy concepts that helps them support their children aged three to 12 years to manage their behaviours.

There’s also work being done in order to address wait times for service in communities through the e-health, including telemental health services and in MCFD the CYMH walk-in intake clinics that have been introduced as a result of an extremely useful sort of lean process that we’ve gone through in CYMH.

Here we have another summary of where we have some challenges and where there is current activity underway. Integration of primary and community care in order to enhance community capacity to reduce demands on emergency departments. Further work done, whether through the collaborative or otherwise, on hospital and community hospital protocols and developing services for children and youth with complex needs. We’ve done some of that with MCFD that’s been the subject of some discussion through different forms of this committee.

In order to explore broader implementation of integrated service models, there’s a need for them to be more youth-friendly and person-centred and that there be wrapping services around the youth and young persons. The services will include primary health services, mental health services, and a number of other areas relevant to children and youth you see summarized in the right-hand column. It says: “work that is underway.”

I would note, too, in the area relating to data, that’s something that all ministries are taking quite seriously. In MCFD we’re looking to try and find means, particularly in the child and youth mental health area in the use of CARIS, by which we might find better data, and to martial that up with the data available from the Ministry of Health to provide more of a cogent, holistic picture of what our services are resulting in.

For committee members, what we have here is a last
[ Page 472 ]
slide that really speaks to the committee’s question of what ministries would do more of, if the opportunity presented itself. It’s here that I’ll reference for you Dr. Waddell’s paper that I appreciate having been handed out to members.

Just as a foreshadow, on page 5 of that paper there is what I found to be a relatively simple depiction of a summary of where work has already continued but really can be augmented in order to meet this sense of working across the continuum of the system, where we’re talking about mental health promotion, prevention and early intervention, treatment and support and specialized services. There isn’t one aspect of that continuum that requires a focus; it’s really each of those continuums receiving support.

Within the evidence strengths, I would also note just in summary of that, in some of the work that Dr. Waddell provides us is the need for strengthening evidence-based interventions. You’ll see that reflected in her paper. There is work being done in this area too. MCFD’s core training continues to approach cognitive behavioural therapy to prevent anxiety and depression and to treat anxiety, substance misuse, conduct disorder and major depressive disorders.

There’s also work to enhance acute care services, some of which Doug has spoken to and is available to answer more questions about. Enhancing substance abuse services — necessarily something that I know is important to committee members, where there may be some questions.

Of pivotal importance and something that I think has really been demonstrated and learned over the course of the last decade or so is the need for increased family involvement, not only in planning for individual services for children and young people but in approaching how changes to the overall system can best be facilitated — expanded telehealth services and further support for service for transitions between the different service systems.

Just in closing now, to wrap up the presentation, I’ll use the deputy’s prerogative — as I’m the only deputy here, I’ll note — as somebody who’s been around for a while, having reflected on what I saw as some significant work done between 2003 and 2008 through the five-year plan. In B.C. it was a great stride forward. I think that’s reflected in some of the discussion that we’ve outlined in the PowerPoint today.

However, much of that work was largely MCFD-based. There was some work that was done that was linked to the Ministry of Health as well as to the Ministry of Education.

The strength of that plan, though, was that it was a multi-year, multi-funded plan that had specific outcomes and specific ramps, almost, of expectations for service delivery that were associated with each of the years. It was service-oriented rather than policy heavy, and that certainly appeals to me.

Again, I would suggest, supported by the team behind me, that there would be a need for it to be influenced strongly by families’ experiences and presented as one system, regardless of the specific ministry responsibilities, and that it would be improved from a previous version if it was broadened to include the older cohort of younger adults, up to the ages of 24 and 25.

With that, committee members, I’ll have to admit that I’m a little bit hoarse. I’ll take another drink of water, and we’ll look forward to your questions.

J. Thornthwaite (Chair): Thank you very much, Mark. That was good and a good overview. I’m referring to everybody else around you and in the back as well.

D. Plecas: Thank you very much, Mark, as usual, for your presentation, and to others who presented.

I really like your articulation of what you do through your five stepped-up model of care. It seems to me that one thing which would be useful for us to have, with respect to each one of those steps, is: what are the numbers of people — children and youth — who are entering at each level and exiting at each level? What is the routing to get to each level? I think that would be important for us — having an understanding of the extent to which interventions work in general and prevention initiatives work in general.

It seems to me particularly important because it’s troubling to see that whilst we have all of this going on…. I know you obviously have so many good things going on. You know what to do. Yet we have this…. Unless I missed something, there are indications of an increase, a 2.8 percent increase. Why is it that we have this increase going on when every year we’re doing more?

I know some of that probably relates to diagnostics, but at the end of the day, it would be good for us to say: “You know what? Year over year, this is how many people entered at a particular level and exited.” Assuming we consider an exit a success, we should expect to see those numbers decreasing.

It would be good for us to know, with respect to the model again: what is the difference across regions? Even more ideal, what are the differences across schools? For example, is there a school out there that has a population of youth whereby there’s almost nobody needing the top level? Most people are entering and exiting at the first level or second level.

Finally, it would be helpful for us to know, which I’m sure you do at some level: who are we talking about? Again, one indicator of that, of course, would be: are there differences across schools? But, more specifically, drilling down: what are the characteristics of those people who enter each one of those five levels? And again: what is the difference between who enters and who exits successfully at a particular level?

M. Sieben: I think I do. There are a number of inter-
[ Page 473 ]
esting points offered by the member. I’ll sort of look back to my team here.

I’d offer, first, that where we can’t offer today the specific information relating to numbers, perhaps that might be something that, through the team, we might put into the paper that will be offered in July.

However, I’m going to turn to…. I’m betting this is a Sandy and Doug — or perhaps a Mark and Pam — question, to speak to MLA Plecas’s question relating to if we know how many young people are going through the different tiers and what the individual characteristics might be.

D. Hughes: I can just add a little bit. In one of the slides it did talk about the challenge of data and the data in the community particularly. On the acute side or the hospital side or the health side, we’ve been doing some work around looking at, primarily, the age cohort of 12 to 24 and trying to focus in on there. We’ve been accessing some of our PharmaCare data, some of our hospital data and MSP data. We’re starting to build a picture of the youth.

We are particularly concerned about the increase in emergency rooms. That’s a real worry for that population in the demands, because emergency rooms are not the right place for youth to come who are maybe having some sort of an episode with their mental health at that time.

Data is key to this. Charlotte Waddell’s report, her research, paints a good picture when she talks about 84,000. You begin to get a picture of what the magnitude is — and then when you start looking at how many children and youth we are getting to.

What we do look at is…. I think it’s a flow. It may be a snapshot in time that we would be able to give you. The hope is that we are able to provide a level of clinical support if someone is requiring that, that they’re able to return to being…. I would look at trying to return to a higher level of functioning.

Now, you mentioned schools. There’s a high number of the youth that come to Health that are not in schools. They are on the street. They are maybe on some outreach education, but their education piece is a harder one to pick up with. We are working with Social Development on looking at that cohort as well, because they may end up moving on to Social Development. So you have to look at, then, the cross-ministry data.

S. Wiens: Just to add a little bit from an MCFD perspective. We do know how many children and youth we are serving through the community-based mental health teams and through youth forensic services and Maples in MCFD.

We’re actually in the process of implementing some improvements to our client electronic data system. That’s called CARIS. That is going to give us an increased level of detail about the actual services that each child or youth is receiving in the community-based child and youth mental health teams. It will take a little while for us to have accurate data — probably at least six months before we feel that that data is reliable — but that will be a big help to us.

With the implementation of the walk-in clinics in child and youth mental health, we are seeing an increased use of the brief child and family phone interview, which is a screening tool that identifies challenges in terms of functioning.

We can do it as a post–service delivery measure as well, so that’s something that we’re moving towards. That, again, will take a little bit of time to have enough data to be meaningful, but we’re well situated to improve our understanding of the services that we’re providing through those processes.

I think it is challenging, though, if you look at the tiers, to ever have a complete picture. For example, at the community-based level there are private practitioners, like psychologists and clinical counsellors, working in the community. There isn’t a mechanism currently for us to collect information about how many children or youth they see and exactly what services they’re providing. Those kinds of challenges will be difficult to overcome, I think.

The other thing that I think we talked about, the complexity in terms of meeting the needs of children and youth and their development, which changes over time…. There really is no one path. The experiences of children and youth and their families are so unique that there are many different pathways in terms of moving between the tiers.

Really, ideally, our goal is to avoid children and youth even needing to receive the services, making sure that we are implementing prevention interventions and supporting positive mental health as much as we can in settings like schools, in community centres and in homes. But there are many, many different experiences. That’s one of the challenges in terms of depicting…. You know, there’s not one clean pathway.

I guess it’s what I was thinking all along, which you alluded to. It’s just the whole business of getting to a place where we’re sharing information and being evidence-based. All of it’s for naught, and it’s hard for any of us to have confidence in anything that’s going on if we can’t, at the end of the day, demonstrate that it’s having an effect.

It seems to me that if somebody enters at tier 1, we should have an information system which allows us, regardless of what path somebody takes or multiple paths, to know whether or not that individual ever entered level
[ Page 474 ]
5 — 4, 3, 4, 5 — and exited or ever came back. I guess all I’m saying is that it would be wonderful if we could have a database system which enabled us to have that kind of information.

All of the program evaluation you would do on any specific program, including all of the ones referenced within the SFU paper, would ultimately have to have, as a start, the kind of analysis that I’m referring to, the global picture. In particular — because what you’ve been talking about this morning is so process-oriented, so systemic that individual programs would fit under that — it would seem to me we could end up with such a rich picture of what works or doesn’t work, for whom, under what conditions.

Anyway, I think you all know what I’m talking about, but I’m just emphasizing how important I think that is going forward.

M. Karagianis: Maybe not unlike the previous questioner, I’m interested in the fact that, I guess, you referenced a lack of data on this — Dr. Waddell’s report here that 69 percent of youth are not getting any kind of service. I think you’ve alluded, early on, to maybe some questions about that number, but in any case that’s a large number of youth.

One of the things we have consistently heard throughout these hearings from families was that they have reported a fractured system that is difficult to navigate and that often they only can access services by entering the acute system in some form. I didn’t necessarily hear anything in the presentation today that says that families are going to find it less difficult to navigate. In fact, when you see the whole presentation, it is complicated.

One of the most, I think, successful presentations we had here, which I thought was particularly good, was from the New Brunswick folks who came and talked about “one child, one file” and how successful that is. No matter what way the child enters the system — and we talked about the various ways that children could enter the system — it’s one child, one file, and services go to that child rather than families having to seek it out.

I would say that your presentation, for me, magnifies the complexity of this for families to understand this. Maybe as bureaucrats, that makes sense, all of this, but for families to try and enter the system, it’s very challenging. It seems to be provincewide. Although your five-step program is very laudable, is this the same experience for every community? If you live in the Lower Mainland, are you having the same experience as if you live in the Interior or if you live in the north? Do these tiers work in all of those settings? That concerns me greatly.

The issue around finding the kind of service you need when you need it is very real in communities. I have an example in my own community of a teen who has been on suicide watch, by his parents, for several years. We have tried every conceivable way to find supports for this family. After kind of trying to navigate the system for some time, they were eventually told that the child should probably be in group therapy. Yet there’s no group therapy for teens on the lower Island here.

So they continue to run in this circle. They are still on suicide watch with their son, although he is now in the later stages of schooling and may be entering the system in some other way, more severely, in the future. I don’t know, but it was a vivid example for me of, again, how disjointed the system still tends to be.

I see here in your action plan that there are a lot of things that seem to be in a planning process. When you talk about all of the challenges, it says: “Actions underway or planned.” I’m not clear on how many are planned and how many are currently being undertaken. Or are they future plans? When and where will these services be available?

Your walk-in clinics — how many of them are there? Are they in every community? Are they in the north? Are they available to some communities that find it very difficult to even do a walk-in service — aboriginal communities, remote communities? We heard frequently from presenters that this is not always the complete solution that it could be.

The reliance here on family physicians. We know that the crisis around family doctors for families is very real. If you don’t have a family doctor and you’re relying on a walk-in clinic to go and help get a diagnosis for your child, how does that work?

I’m just a little bit concerned. I was expecting, perhaps, something more clear on what the experiences for families today are, what the planning process is, how much of this is future-forward, how much of it is being implemented right now in communities and whether or not it will be easier for families to find their way into the system in the future and be captured and find that they are held within the system, as I think Darryl mentioned. You know, if the youth finds himself needing services early on, then being able to leave the system for a short time and find their way back in — all of those things.

Families are very distraught, many of them, over their inability to put this complex system together in a way that works for them. I wouldn’t mind hearing a bit more about when and where the action plan is and how much of this is sometime down the road. And is there going to be some effort to make this less complex for families? Because all these great puzzles….

I mean, if you’re a family member who’s got a child in distress — and we’ve heard some really disturbing stories in our hearings here — how meaningful is any of this? How do you just get into the system and get help right now for your child wherever you live?

M. Sieben: The presentation, as the member has commented, does depict a complex system with a number of challenges. It also depicts the work that’s going on in or-
[ Page 475 ]
der to address the very goal that the member has articulated — to make it more accessible and more simple for families and their young people to be able to navigate.

What I might offer is, in conjunction with the slides indicating the different activities that are underway, either now or planned…. I’m not aware that any of them are planned in a distant sort of way. They’re all more or less underway now.

What we might do, within the paper that the team is going to be submitting to the committee, is include specifically where the timelines are associated with each of those. That probably would be useful. There are three different slides with a number of different initiatives associated with that. In a comprehensive way, it probably makes the most sense for us to look to doing that within the paper.

However, I might ask my colleagues here whether there’s something that comes to their minds that they might like to underscore — that may be misrepresented as planning when it’s actually underway.

D. Hughes: I could add a couple of comments in that the data and the absence of a strong IT system make it very challenging. I mean, an electronic medical record, an integrated case file, that’s been…. The IT support it needs, to support the picture for a journey of a child or youth entering into adulthood, doesn’t exist.

What we’ve tried to do is look at other places to get the data. Working with police — that’s one indicator. We’re looking at the health system, trying to look at some of the public health systems. We’re trying to use our health database to try and paint a picture.

For Health, our primary initiative that we are putting our focus on in mental health is really looking at the number of children and youth and young adults, because I think the data shows that early onset is in your teens — 13 to 14. It tends to lessen as someone enters into their mid-twenties.

Again, what we know about the development of the brain is that the brain for young people tends to develop to the point that they’re either managing a mental health condition with appropriate professionals or that they tend to be not showing up as much on the health side.

What we’re focussing in on is that we are looking at the emergency room visits. We want to understand what is going on. What can we do on the community side? That’s why we have a strong emphasis on a primary and community care approach. We are working closely with the Doctors of B.C. We are looking at….

We have one successful approach — I think you’ve had Dr. Steve Mathias come to the committee — around a youth hub. There’s a subset of the population. From that perspective, we have a mixture of professionals — being a physician, a psychiatrist, a nurse practitioner — and they’re connected to housing. So they can begin to build that model.

We’re in current conversations with Dr. Mathias around the success of that and looking at what can we do to move that out. Those are current discussions that are happening. We see that if we can have more of those approaches at a community-based hub, a youth hub — the model that Dr. Mathias has; we consult quite closely with him — it is youth-friendly, so we have that voice of youth that are involved in that as well. That is an action that we are doing.

We are doing a review of our acute services. We’re looking at the emergency room response. Emergency room physicians who don’t know, maybe haven’t worked closely with youth…. But then they don’t have, maybe, the expertise in child and youth psychiatry. How can we work with emergency room physicians to then not look inward to admitting but look at what the community resources are in their community that they can be connected to?

We are trying an approach of getting down to smaller bits of geography so that we can understand the population in those geographies and look at the needs of the youth. Particularly in rural communities we need to look at how we can support rural practitioners who are isolated, who don’t have the expertise — if they are in Terrace, you know, a psychiatrist maybe in Vancouver that comes in and visits. We have to look at telehealth. Rural health and rural services, again, is a focus that we’re engaged upon as well.

The collaborative model was talked about before. That’s an ongoing initiative that is happening, and I think it’s beginning to build a system at the community level, with those action teams. We’re starting to see people who are working together, breaking down some of their past hierarchical barriers, and they’re beginning to focus in on children and youth.

The other piece I would add, and we haven’t talked about it as much, is the addictions or substance use and how we need to consider substance use. Substance use is the responsibility of the Ministry of Health. We’re engaged, as well, in looking at mental health and substance use, looking at youth around substance use and in looking at, again, how those two treatment services come together.

Those are ongoing concrete actions that we’re engaged in. I think some of them…. The question will be: “Well, when is that going to happen? You’ve been talking about planning.” The community hubs with Dr. Mathias — I’m hoping we can see something happen within the next six to eight months that will help us move closer to something concrete. It may not solve all the problems, but it would begin to bring a couple in.

M. Sieben: Sandy’s quickly going to respond to that
[ Page 476 ]
question relating to walk-in clinics, if that’s okay with the committee.

S. Wiens: Just to say that they are now available across the province, and it has made a very significant difference in terms of families and youth being able to access information — not always services immediately, but at least knowing what the best service is for them. We’re also providing them using an outreach format. So in those rural communities where travel is an issue, the clinical staff are going to communities and also hosting them in community-based settings, not just in office settings but in community centres and schools and in places such as that.

We’ve also pulled together a toolkit of resources that’s being used when people come to a CYMH intake clinic. Regardless of whether they are able to move immediately to more comprehensive assessment and services, they are given information, and they may have the opportunity to participate in a group while they’re waiting for a more comprehensive assessment. For example, they may be able to participate in a group that supports them in managing symptoms of anxiety or depression.

There is quite a bit of change in that area. Parents and youth have given feedback on the process and are very happy with the experiences that they’re having through those walk-in clinics. We can, in our report as well, provide you with some more detail in terms of some of the statistics and feedback we’ve had from parents and youth.

M. Sieben: MCFD implemented the walk-in clinics over the course of a period of about a year and a half. We were able to get around through all of the province. I would note that one of the dynamics that is different in our doing that is we actually spoke with the ministries of Health and Education as we were doing it. A decade ago, it would have been more with some folks with MCFD.

Jennifer has a comment from an Education perspective in response to the member’s question.

J. McCrea: One of the initiatives under Education that is very much alive and well is the ERASE strategy. It’s much more than an anti-bullying program. We’re in year 3 of the program, and we have over 10,000 educators and community members trained.

This was very much a holistic approach when we asked school districts to engage with us on this. We invited them to include their partners — child and youth workers, mental health, probation, police, whoever in their community needs to be connected.

It does start with changing culture and climate within a school. There are five levels, and we’re in year 3 of our training program. Because the training is very much dynamic in nature, when we envisioned the program three years ago, we didn’t have mental health as one of the topics. Year 3 of the training in our level 3 training is absolutely dedicated to mental health.

There is a large component on that as well as social media. We know, as Mark referenced, that peers as well as social media are huge influencers in the youth in our schools. I just wanted to mention that.

C. James: Thank you for the presentation. I think your opening comments around that one size doesn’t fit all and the complexity of dealing with youth mental health is not lost on anybody around the table. I think it’s a really important point when looking at youth mental health services.

But I’ll echo what others have said. I think the emphasis in the presentation that I really have seen is that I believe the services are child-centred. I believe that each of the services and programs that are put in place are child-centred and have good intentions and great staff working in those areas.

But I think the problem is we still have a group of child-centred programs all over the place without any connection for families. That’s really the frustration that I feel from folks who go through the system.

The step level of service is a perfect example of that. People will get into one step. They may access it at different points. But getting out, getting back in again, being able to connect that service, being told there’s a year wait-list and being told that the service isn’t available in their community — that’s really the huge frustration that people continue to hear.

I think the individual services are certainly child-centred, but I don’t think we have, at this point, any kind of system that is child-centred and child-focused. I appreciate your comments, Mark, about bringing forward a progress report on what work is been done, because that’s really the missing piece, from my perspective, that needs to be looked at throughout all of these programs.

The issue of the use of emergency rooms — there’s no doubt in my mind that the increase in use of emergency rooms is because people can’t access those services. That’s the only place they know to go. They can’t find service anywhere else, and so that’s where they head. And it’s not a good experience for most parents and most kids — what they go through. I’d be interested in hearing a little bit more about that work going on.

Two questions, though, and I know we’ll have further discussion later. One is the issue of the discussion and debate that has always gone on — and I think will forever go on — around where youth mental health services should sit in ministries. I think that’s still something that I hear out there and that I know that other committee members have heard. Should it be based in one ministry rather than spread out over two ministries? Is it a challenge?

I do hear some concerns around stigma for families going to MCFD offices to be able to access youth mental
[ Page 477 ]
health, particularly if they already have a child protection issue. They can often feel uncomfortable and worried about going — that it may jeopardize their child and them having their child.

On the other hand, the concerns about moving it to the Ministry of Health, of course, come forward around a medical model. That’s not the model, in most cases, that we want for youth mental health. We want to be able to access early. We want to put the prevention pieces in place. We don’t want to medicalize youth when they first come forward with anxiety or other issues. I’d be interested in whether there has been any discussion or debate with the ministries that are here, around that issue.

The last piece I want to touch on is the issue of new resources and new programs that come into place.

I appreciate, Mark, the last example you used, where you raised the fact that you actually had discussions with the other ministries about putting the walk-in clinics in place.

If we’re truly going to make it child-centred, regardless of where it sits in ministries, is there a place where…? When new resources are being looked at being put in — whether it’s Education, or Health or Children and Families or other ministries — is there ever an opportunity for those ministries to come together?

I think the other thing you hear from families is on the one-off programs. We start some great programs. It’s a great idea. It’s a great approach. But nobody ever talks to the other ministry to find out whether it could support a program they’re doing. Or we don’t need to fund it. We could fund it over here and just support an existing program.

Is there a common table or a common place where that discussion — around, “Okay, we need new resources. Which ministry is going to go forward? How are we going to look at it? Where is it going to be implemented? How will it support the bigger direction that we’re looking at?” — ever occurs?

M. Sieben: Maybe I’ll try to take that one on. I’ll respond first to the member’s question relating to: where does child and youth mental health fit? I can confirm for the member that probably the discussion is as active amongst staff in the ministry as it is out in the public. I will note two things, as the deputy for MCFD.

The first is that, in my mind, that’s a political decision. That’s something that one response or the other would require transitioning the work of…. Where there has been significant discussion between, particularly, myself and my counterpart at the Ministry of Health is not to be distracted on the issue of where it should be, in order to get on with the effort to improve the system, with a focus on system.

It’s for others to determine where child and youth mental health should be. At present and over the course of the last 15 years or so, it’s been with MCFD. We think, particularly, in the lead-up to 2003 and up till about 2009 there were substantial developments. If it hasn’t come to the committee’s attention, there was a report done reflecting on the implementation of that plan. We’ll include that in the package. The summary, in a nutshell, is: great start; there’s more to do.

Unfortunately, we’re now in 2015, whereas that review report was done in 2009. What has happened is that there has been a lot more engagement between the ministries. It is of benefit to me that the Deputy Minister of Health is the former Deputy Minister of MCFD, so we can take a shortcut. There is an active table among social deputies, particularly between the Deputy Minister of Education and Health and MCFD, on the social matters. That table sometimes gets extended to our colleagues from the ministry behind us, but the three of us meet a lot because we have a lot of common business. Increasingly, we’re looking to manage it together, as one.

Particularly in the area of child and youth mental health, I am increasingly confident that regardless of where a decision might be made about where child and youth mental health is going to be placed, it will necessarily require other participants from all of us anyhow. In the meantime, we’ll look to just get along with the work.

J. Thornthwaite (Chair): Thank you, Mark. We have about 13 minutes left. I’ve got Donna and then Doug and myself. Go ahead, Donna.

D. Barnett: Okay, I’ll make mine short. I have a whole bunch of questions, but I’ll make it very short.

It appears to me…. I agree with my colleagues over here. To me, the concern is, and to a lot of the public out there and people who are looking for service, that it appears we’re more concerned about the process than the results. To me, listening and reading and talking to constituents and people and parents, it is very clear that that we have more process than we do results.

We have lots of volunteer agencies that deliver mental health services in our rural and remote communities, and thank goodness that we have them. Of course, once again we go back to process. They get yearly funding, and then they have to wait and see if their application for some kind of a grant is going to be funded again the following year, when they are the only ones providing the services such as child development centres and things like that. They’re doing a fantastic job. Yet we don’t know if they’re going to be able to carry on.

Once again, I go back to: we have to look at what’s working out there. We have to look at the results in these communities more than the process, and to support the ones that we have now and build on those successes. So how can we get there?

M. Sieben: Doug has spoken a little bit to some of the
[ Page 478 ]
challenge associated with getting the data to focus on outcomes, part of what we’ve spoken to. I think it’s rather indicative that there’s a whole lot of process in play. I think all of us would agree that the family experience and the child and youth experience is the one that’s going to guide us in order to get to outcomes. It’s by listening to that voice and by acting as one as opposed to many, I’m of the view, that we get more to the outcomes rather than the individual ministry processes.

The report that I referenced and that we’ll include with the submission was a reflection, really an analysis and evaluation, of the successful implementation of the five-year plan by Alex Berland. It was called Promises Kept, Miles to Go.

D. Hughes: Just to respond on the “How to get there” piece. What I believe is that you do need to get to the denominator in some areas so that you can start looking at the population. Our approach that we’re taking is to look at local health areas or service areas in MCFD. Their geographies are similar. Then we have to look at education.

Building a complex data system for the province may be a challenge at this point, but I think we can do some work at that community level. Some of the work that has been happening through the collaborative is to capture the demographics and the challenges in the communities through a geographic area, beginning to look at, then, the service gaps. We’ve been primarily focusing in on physicians, but there are allied professionals that need to support the community — so holistically looking at that. It’s work that happens with children and families.

I agree with you around the hardening up and the data. That’s something that we’ve identified, that we know we need to demonstrate to the public so that we’re able to show results. We did talk about the process today, absolutely, because the process is key around moving ahead. But it’s not lost upon us around also being able to demonstrate some of the numbers and the results, particularly for families, and making sure that we’re moving ahead on that as well. So it’s a live conversation.

D. Donaldson (Deputy Chair): Likewise, I have a number of questions, but I’ll narrow it down to one.

Thanks for the presentation. It was obviously a lot of work to put it together and to pull in all the different aspects, so I appreciate it — from Mark and from everybody who is attending today. Lots there.

I’ll make a couple of comments and then just a question. This particular slide, “A spectrum of responses,” is one that to me really typifies what we heard in phase 1. It’s overwhelming. It’s overwhelming for me, and I can’t imagine how it would be overwhelming for a person trying to access services when there’s this smorgasbord of services. I agree with some of my colleagues here. We don’t even know how available they are in communities such as the ones I represent.

That’s one aspect. I also think that — and I agree with the member for Abbotsford South — the whole…. We’ve talked about it a little bit — the very first or second slide about identifying gaps in data. How are you able to even know whether the vast amounts of money that are being spent on this issue are making a difference if we don’t have outcome indicators that are understandable between the different ministries, let alone the ones that are lacking?

I think, for me, there is lots of analysis that needs to be done and services that need to be provided. But in the bigger picture, if we don’t have outcome indicators that are understood and shared between ministries, then we have no real firm, rigorous way of knowing if the money we’re spending is actually making the difference that needs to be made with the families.

With that preamble, I’ll get to my question. I think, again, it’s in light of the massive amount of information that you’ve even just gotten as far as the tip of the iceberg here. Who is in charge of pulling together an overall coordinated plan, with a timeline for implementation, around the coordination of these services? Who is in charge? How often do you meet? When are we going to see an overall coordinated plan between ministries with a timeline about implementation?

M. Sieben: That’s a shared responsibility between the three deputies and the ministers. The development of a plan with such timelines, I think, is going to be dependent in part on the committee’s reckoning and in part on the discussion that happens amongst the ministers relating to the government’s agenda and priorities. This work is underway. We’ve offered a glimpse into the work that’s currently in process in the existing ministries right now.

The work forward in putting the plan together, as I somewhat tried to simplistically depict in my final comments…. That’s going to have to be the coming together of the work that has been expressed within the slides the member has reflected on, as well as the input from this committee and the direction that comes from the minister. So we’ll look forward to putting that plan, with the timelines, in place when those processes are complete. We’ll look forward to your report.

I’ve got a couple of comments and then some questions just to wrap everything up. One of the things that keeps coming up, that we heard numerous times and that has even been mentioned just by the committee members here is the coordinated approach and getting to these kids early.

That’s why I appreciate having the Ministry of Education here. The New Brunswick model was brought up today. As well, we did have them as a presentation. The idea of the one child, one file…. We get to these kids early so that,
[ Page 479 ]
hopefully, they don’t end up in the emergency department or in the justice system.

I appreciate Doug’s points about data. We recognize Dr. Steve Mathias…. He’s actually coming back to talk more about HeadStrong, that program which, to be fair, is a national program in Australia. We understand that, so there are federal responsibilities that have to come into play.

But the fact is that we have to get to these kids earlier. My question — and I have lots of them, but I’m going to bring it down to just one — is: have the ministries, the joint ministries, had a conversation about the viability of a program that is similar to the New Brunswick model?

M. Sieben: We’re aware of the model as it has been presented to the committee, certainly. As I think Sandy had commented on a little bit earlier, part of the dynamic is taking a model, whether it’s the Head Start model from Australia or the model from New Brunswick, and seeing how it would represent and cope with the challenges that are specific to what we described in B.C.

B.C. is, arguably, a little bit more diverse than New Brunswick. That’s not to say that there can’t be learnings that can be brought from that model to influence the development of a more cogent and responsive model here in B.C.

So yes, in response the member’s question, it’s known to us. We’ve spoken with people too, and it receives discussion amongst the leaders in the participating ministries.

J. Thornthwaite (Chair): Then my last question, to just follow up on that, is to Doug. We’ve heard the collaborative. We’ve heard Val. We’ve heard Dr. Mathias. I think the committee agrees that that’s an excellent direction, and we know that it’s expanding. We do have some members of the collaborative that have talked about the working model in schools.

My question, then, is: where do you see the collaborative? I know that it’s creeping to other districts. Where do you see the collaborative and their emphasis on these school-based models as well?

D. Hughes: The collaborative is funded through an agreement with Doctors of B.C. and the Ministry of Health, so it’s funded at a Shared Care. There’s a period of time when the funding will end. So the hope is that once you get a collaborative approach at the community level, and you have the health authorities, you have MCFD, and you have all of the partners together, then the sustainability should hold around the way the work is being done.

As you know, when you go and you meet with the collaboratives when they come together, education is strongly represented. There are principals that are big supporters. I’ve never met a school principal that wasn’t looking to try and have services come into the schools.

My response, a bit, is to your earlier question about the educational model in New Brunswick, in that here we, I think, have invested a lot into a community-based approach which links into the school system. We have numerous examples where some school districts have been quite open to having social workers and mental health clinicians actually into the school, setting up and working with the youth. In other districts we need to work on them around what they’re going to be doing around trying to support that.

The collaborative is something that I see — as it expands and brings in the resources of the broader community and the health authorities — is the right thing to do. I don’t see it as not progressing, because it just seems to make sense when you talk to the people that are doing the work.

That’s the important thing to understand. It’s the staff who work in MCFD or in Health or in any of the ministries who are sitting there at seven o’clock with a youth who is suicidal, and they’re trying to reach out for help. That’s where I’m sure the committee has heard some of the frustrations as well. The collaborative is a place for them to get together and look at: how are they going to work on trying to put a plan together for that individual youth?

The response to your question is that at this point it’s a key part of what we’re using to knit things together.

J. Thornthwaite (Chair): Yeah, we did have a presentation from Mountainside Secondary in North Vancouver. We know that we’re having the Nanaimo people coming. There definitely are school districts that are really promoting this integrated service delivery model.

D. Hughes: The South Okanagan also has a very strong tie-in to the school district. It’s a model where we actually had funding where we were able to cost-share positions in that area between counsellors who were school-based — part of those school-based teams — as a way of having the mental health services there.

School districts, again, across the province are very innovative in other approaches.

J. Thornthwaite (Chair): We appreciate your presentations. I’m not seeing anybody else that wants to have another question.

I just wanted to comment. As much as some of the folks in the back didn’t get an opportunity to speak, I think it’s important that you got an opportunity to listen. If you’d read the previous report, you’d know that this is definitely a cross-jurisdictional and a cross-ministerial and also a cross-government issue that we’re trying to grapple with here in the committee — not just with the special project that we are embarking on right now but also in our other role of receiving the reports from the Representative for Children and Youth.

I just wanted to express my thanks, on behalf of the
[ Page 480 ]
committee, to you, Mark, for corralling everyone and getting them here to be able to co-present; and to Christine and Sandy, your team at MCFD.

Thank you always, Doug, for your leadership from Health. We really, really do appreciate that.

Certainly, all of your information and your presentations were very well done. Without further ado, I’d just like to thank you very much.

We’ll move on to our second…. We’ll take a recess for five minutes and then resume.

J. Thornthwaite (Chair): Hi everyone. Just for the members to know, and for our special guest, many of our members have to leave by noon. They’ve got other appointments, so we will have to speed it up, unfortunately. I think Mary is getting copies of your presentation to pass along.

I’d like to mention that we could, briefly, go through the people that are on the committee, if you could be very, very quick. Then we’ll let our second presenter, Joe Gallagher, the chief executive officer for First Nations Health Authority, present.

If you could — we will get the copies of your presentation — recognize that you’ve only got about 20 minutes. Then we’ve got to start wrapping up with questions, etc., because most of our committee members are going to leave by noon. We want to make sure that we have an opportunity to have some questions directed at you.

D. Donaldson (Deputy Chair): Doug Donaldson, MLA Stikine and official opposition spokesperson for Children and Family Development, and Deputy Chair of this committee.

M. Karagianis: Maurine Karagianis, MLA for Esquimalt–Royal Roads and responsible in the opposition for seniors, women and child care. And we do apologize for the short time frame that we are giving you. It’s regrettable.

C. James: Carole James, MLA for Victoria–Beacon Hill and Finance critic. Welcome.

M. Bernier: Hi Joe, thanks for being here. I’m Mike Bernier. I’m the MLA for Peace River South.

D. Plecas: Hi Joe, thanks for being here. My name is Darryl Plecas, and I’m the MLA for Abbotsford South.

J. Thornthwaite (Chair): I forgot to say who I was. Jane Thornthwaite, the Chair, and I’m the MLA for North Vancouver–Seymour.

J. Rice: I’m Jennifer Rice. I’m the MLA for North Coast. I live in Prince Rupert, represent Prince Rupert, Haida Gwaii and all the way down the central coast, including Bella Bella, Bella Coola. I’m the opposition spokesperson for northern and rural health and the deputy opposition spokesperson for Children and Family Development.

J. Gallagher: Thank you for having me here today. I’ll work through it quite quickly, then. Just in terms of having an opportunity to share some information with you, first I thought it would be helpful to have a bit of an understanding, moving forward looking at….

The work with us in the First Nations Health Authority with our B.C. First Nations has come a long way in the last ten years. I’m not sure how much each of you knows about it, but basically we’re working with B.C. First Nations under one new health governance structure. That’s allowed us to really look to engage our First Nations communities across the province, to have a very robust engagement process with not only leadership but our health leads in our communities.

Through that work we’ve been able not only to achieve the political support we needed to create the new governance structure — which includes the creation of the First Nations Health Authority as an element of it — but really to launch a new health partnership with B.C. and Canada. We work closely with the Ministry of Health, and we work closely with the government of Canada through the Health Canada First Nations and Inuit health branch.

In addition to that, we are also working now, as part of some of the commitments in our health plan, with the province of British Columbia and the government of Canada. They include the Deputy Ministers Table on Social Determinants. There is a space that’s being explored now by the First Nations Health Council on what that would look like — recognizing that health is an outcome and that health service improvement only addresses certain elements of this.

You probably heard from Deputy Minister Sieben, previous to this, on the work that they do that impacts health and well-being of B.C. citizens, including First Nations
[ Page 481 ]
youth as well. For us, with our processes of engagement we’ve had an opportunity to gather information from First Nations through various mechanisms. What we have listed on this first slide are a number of those areas and work that we’ve been doing since the work has been moving ahead.

One of the interesting pieces for us is around the idea of creating regional health and wellness plans. For the first time ever, First Nations are aligned through a regional table, which we’ve purposefully aligned in a way that every regional health authority has a geographic administrative area. The First Nations communities located in that administrative area sit together at a regional table, and those nations now put together a regional health and wellness plan.

Interestingly enough, in every one of our five regional health and wellness plans, mental health and wellness is the number one priority. That’s been one level of engagement for us, and we’ve also done work on First Nation aboriginal peoples’ mental wellness and substance use. There’s a ten-year approach being put together on that and other pieces related to maternal-child and family.

From their tripartite committee, we’ve actually made a commitment to look at youth suicide — aboriginal youth suicide specifically. The tripartite committee is where we sit with the deputy minister, the CEOs of all the health authorities and our regional representation from the Health Council, the First Nations Health Authority and the provincial health officer. We’ve started work in that area and have moved that work forward. There are other areas like that that we work on.

The focus of this presentation, just briefly, is to talk about the work that we do in terms of the shared vision and strategic context of the First Nations Health Authority and our work as a health and wellness partner to our communities, including the area of child and youth mental health, and then to respond to some questions.

I’ll go very quickly. I am trying to sort of figure out the best focus. The kinds of pieces that we have heard, gathered from the various activities that we’ve taken on over time…. The focus that we have, as I mentioned, from a regional point of view — working with each of our communities that align with the regional health authorities — provides a very effective way of working.

Interestingly enough for us, now that we’ve been running the federal operations as well for the last three years, we can actually develop a regional summary, where we have what we think is a fairly good sense of the health and wellness issues for First Nations communities in the various regions of British Columbia, based on the five regional health authority regions.

We could never say that before, because for our communities the way that Health Canada worked with us really kept us apart. The regional health authorities provided some very inconsistent level of services to First Nations people and communities across British Columbia.

It wasn’t until the Transformative Change Accord: First Nations Health Plan in 2006 that the province really acknowledged that being the major service provider of health services for British Columbians included B.C. First Nations people regardless of where we lived — in other words, at home or away from home, on reserve or off reserve, that whole mix of the transient population that we have and our folks that live in the urban areas, as well as the fact that our people are living in communities and moving to and from home quite often.

A very interesting sort of statement on aboriginal world view, kind of reaffirming that health and wellness to First Nations people is looked at from a holistic perspective, is this diagram that you see — a compilation of our various conversations we’ve had with First Nations communities to develop a First Nations perspective of wellness, which we use as a common denominator, if you will, in entering a conversation around health and wellness with B.C. First Nations people.

It starts with a human being in the centre, and it looks at how we look to ensure that each human being is at their best every day of their lives, from the youngest to the oldest and those kinds of things. It talks about all the other elements and how we look at holistic wellness.

I mentioned a number of documents — some of which were done at the tripartite level with B.C. and Canada — that look at some of the issues and the considerations we have on our health plans. An important element of this work is that it’s really vested in First Nations decision-making. First Nations have taken control over making decisions on health and wellness. We are in a situation now, through our health partnership with B.C. and Canada, that the governments no longer do anything to us or for us without us. That’s been an important translation of how things work.

Now there’s the implementation of the First Nations Health Authority, recognizing the capacity we have in communities with mandated health organizations or band administrations that are providing services to community, recognizing that there’s a decision-making framework in place now that starts at the individual level and that every First Nations person owns their own health and wellness journey. Through families, nations, through regional processes and provincial processes, we now take decisions over things accordingly, based on working with our partners, B.C. and Canada.

We’ve done some work in this area in relation to children and youth mental health. We’ve got programs that we fund currently. These are programs we inherited from Health Canada that are delivered through a funding mechanism that Canada had put in place with First Nations communities. We’re in the process now. The opportunity in front of us is to look to transform those programs and to ensure that First Nations communities understand that they can now, with these programs, set
[ Page 482 ]
their own priorities, that they no longer have to abide by policy developed in Ottawa for what they thought the programs might look like in First Nations communities across the country.

This is a new development for us, where a lot of these resources can be realigned to support youth and child mental health, to better meet needs that are identified by approaches driven by communities. Really, it provides for a space of building on the asset base in our communities and recognizing that the solution to mental health and wellness is a lot more than just bringing clinical practitioners into the situation and that First Nations communities, owning the issues with B.C. and Canada, need to work together.

We have these resources that we can bring to the table. Communities have ample resources based on culture, knowledge, traditions, access to lands and resources — which is a bit of an ongoing challenge, based on the environment we have in British Columbia — but also just the teachings of our elders and others that are part of that solution moving forward. To address a lot of the issues that you’ve heard around the impact of colonization and other things — really, it’s about us finding the way forward ourselves and working with our partners to respect what that looks like and helping our partners provide better services to us.

Some of the other areas around what we’re doing. Through the regional process with the regional health authorities, we’ve actually created a new envelope of funding. That is part of a relationship, an agreement we negotiated with the provincial government through MSP premiums. That allows for us to provide the regions the opportunity to determine for themselves what program service delivery should look like — also, from the standpoint of looking at the opportunity of determining service level models and designs that would work for the regions and the nations.

We’ve seen quite a number of new and innovative ideas that look at integrated care teams to provide some new approaches to dealing with First Nations health and wellness.

We, ourselves, have some staffing support. Because mental health and wellness has been identified as a major priority, we’ve recently just identified and hired regional mental wellness advisers in each of the regions to support the regional processes that we’ve put in place. Regional teams are supporting First Nations communities working together to address not only their involvement in the tripartite First Nations health plan but their work at the regional table, their governance work, as well as their service delivery mechanisms and priorities moving forward.

We have other staff in place, as you see here. We’ve recently just created the new chief medical officer shop for the First Nations Health Authority that will have senior medical officers. That will be, basically, with all of our capacity, a lot more community-facing than what Health Canada used to do, to ensure that we’re on the ground proactively working to address First Nations health and wellness issues as they’re identified in the regions.

We’ve got a lot of partners that are part of our work. We’ve developed different kinds of relationships over the last ten years — in particular, the last five years as we’ve moved to implement the First Nations Health Authority and the service responsibilities that we have. So here’s an example of them.

We’ve done a number of things that are starting to really support First Nations–directed wellness approaches, both at an individual level to support First Nations people owning their own health and wellness journey as well as things we do with communities.

We also have an opportunity. We work with the B.C. association of friendship centres at their annual youth forum, Gathering Our Voices, and use that as an opportunity to introduce a conversation around health and wellness with youth. It becomes a focused conversation where we’re looking to enrich what was done before, with the focus on health and wellness.

Youth mental health and wellness is an important part of that conversation moving forward as we learn about not only the work that you’re doing in this committee but other relationships we’re having with the Representative for Children and Youth and the reports that are coming out like Paige’s Story, for example, and the recommendation that identifies us to do work, not only as we see it with the Downtown Eastside area but really across the province in relation to youth mental health, as well as other issues around protecting youth and ensuring that our youth have better health outcomes across the board. The partnership work continues.

I guess, relative to the time…. I know there’s only nine minutes left, so I really would like to turn it to you for any specific questions you might have. In the PowerPoint we tried to identify some of the ways we could answer some of the questions that you had for us from our context. We’ll leave it at that and maybe engage in a little bit of conversation.

J. Thornthwaite (Chair): We really appreciate this. This is very impressive. Now, just in recognizing that some of our members have to leave early and we don’t want to jump away…. Donna has to leave, but she’s got a question. She’s got a lot of issues that she has to deal with in her riding.

D. Barnett: Thank you very much for coming. I sort of scanned through the questions that you answered for us here. I really appreciate it. I have four different First Nations languages within my region. Of course, as you know, every language has a different type of culture, etc.

My biggest question is: how are these rural and remote reserves going to be serviced by First Nations
[ Page 483 ]
Health Authority? Does some of the funding from the First Nations Health Authority go to each community so that they can hire professionals to go in and deal with a youth mental health issue, or will it be more on a regional collaborative?

J. Gallagher: What we inherited from Health Canada were pre-existing arrangements with First Nations Indian bands in British Columbia. I guess you would call it the legacy of colonization. In B.C., as you know, we have 203 Indian bands. Located where they are…. It’s, I guess, a current look at how our people are organized under federal legislation, the Indian Act, and all those kinds of things.

What Canada did in continuing that effort, I guess, was to fund a lot of communities by themselves individually and worked with First Nations in a way where it actually kept them apart and created competition among one another, competing for resources. A lot of times smaller or rural-remote communities with less capacity wouldn’t be able to submit for proposals, as Canada was trying to put things out by proposal.

The other challenge was, because of so many small communities, when they do the per-capita formula breakout, everybody just gets such a little bit of money. They really can’t do much with it. What we’re doing now is we honour those agreements that Canada put in place with the First Nations communities, those funding levels that were there and the way that communities are providing health services. Sometimes Health Canada was providing the services directly, so we provide nursing services or environmental public health services, for example. There’s a whole mix of that.

What we’re doing right now at the regional tables is talking about the health issues and priorities of all the First Nations within the region and looking at that collectively, recognizing that it’s not only the federal resources, which we now have and we continue to support communities with; it’s also the provincial resources. We need to work together to address these same issues.

The other part around that is there’s an opportunity to explore service modelling into the future that could look differently. If First Nations agree that by getting their portion of the pie the way that it’s been divided, if they can’t do enough with it, there needs to be another mechanism. Everyone’s competing for the same resources. The number of trained clinicians that might be available that are interested in working in rural-remote parts of British Columbia are limited. Northern Health Authority has that problem recruiting nurses, for example. We encounter the same situation.

We know that our communities, at a very small scale, are not being successful, so we’re looking at more collaborative approaches when they make sense. But there are situations where there are unique services that should belong locally and be delivered by the community directly. So there’s a balance there. We’re at the beginning of that conversation.

The funding levels haven’t changed. We have made more resources available in the regions, and new things are starting to take shape as regional tables are coming together. All the First Nations are part of that, and they are now deciding how to use some of these new resources.

We’re starting to see new primary care initiatives based on integrated multidisciplinary care teams now coming together, leveraging the nurse practitioner piece from the province to leverage those resources into First Nations communities and putting that together into a more systematic service delivery piece that has never existed before.

M. Bernier: Thanks again, Joe, for this. I wonder if you can explain to me, because I’ll be a little naïve on some of this: is there any difference, do you find, in the service models of delivery whether the band has been treatied or not? What I mean by that is, obviously up where I live, Peace River, I deal with the entire Peace River regional area, which is all under treaty 8. Sometimes it feels like it’s a different discussion, but it would be under your mandate. I’m wondering if you can explain that.

J. Gallagher: A lot of that really depends on the nation and how they interpret their treaty. Treaty 8’s historic treaty is with Canada, so there’s a sort of expectation on what that would look like.

Canada funded them and treated them like they did every other Indian band in British Columbia that didn’t have a treaty. In essence, there’s a unique relationship that the nation has issue with Canada on. They weren’t really treated any differently than any other non-treaty Indian band in British Columbia. With only a few modern-day treaties, most of our First Nations in British Columbia are without treaty agreements.

C. James: Thank you for the presentation, Joe. I think there are some exciting opportunities ahead — some huge challenges but some exciting opportunities to be able to really ensure the programs meet the needs of the communities.

I think your point around identifying the individual programs and the individual bands and pitting bands and funding against each other is certainly an example I’ve seen, as well as very small bands, which we have many of in British Columbia, that just don’t have the capacity to be able to provide the services and programs, don’t have the numbers to be able to get enough resources. I’m optimistic about the opportunities that could be there.

My question, though, is around work with the existing health authorities in British Columbia and how that’s going and how those discussions are taking place. I think you mentioned on and off reserve. That’s a huge issue around funding.
[ Page 484 ]

I talk to families who are able to get services. They have to move off reserve to be able to get services and then move back on reserve and don’t have the services, or the other way around. I wonder what kinds of discussions have begun with the Ministry of Health itself and the health authorities around how some of those issues will be worked on over the next number of years.

J. Gallagher: We’ve had significant discussions. In the governance structure that we negotiated with B.C. and Canada, we have the tripartite committee of health, which I think I might have mentioned, co-chaired by the Deputy Minister of Health, the chair of the board of the First Nations Health Authority and the senior ADM from Health Canada. It consists of the COs of all the health authorities, a representative from the regional table, as well as myself and the PHO.

That’s the beginning of the conversation. We’ve been developing some work in relation to the notion of reciprocal accountability and what our responsibilities are for us collectively to achieve the outcomes we’ve set for ourselves in our health plans.

That’s one area. More specifically, every regional health authority…. I’ll back up one step. The work that I had been doing with the deputy minister was to ensure we had a commitment from him that First Nations Health would be a common thread throughout the entire provincial health system, to honour the obligation of the province that their services were there for First Nations people regardless of where we live.

We’ve been able to reach an understanding and have the notion of us being hard-wired into the provincial process and systems, which has been very exciting. Now, for example, myself as the CO, I sit with the leadership council and COs of all the health authorities and engage in the conversations. First Nations Health Authority is invited into the discussions with the minister as he meets with the board chairs and the COs, and we’re talking about the bigger “where’s the health system going?”

At the same time, my work directly with each of the authorities, as CO to CO and my senior team to their senior teams, is looking to enable the work that’s been identified through the regional table. Each regional table has a partnership accord where the regional health authority sign on to an agreement, through the First Nations collectively, through their regional caucus — how they’ve represented themselves, through their own governance design — and us as the First Nations Health Authority.

We’ve agreed to joint commitments. Within that context, in many situations we’re talking about that very issue of how we deal with these things. What we think we’re able to see is, now that that jurisdictional gap that used to exist is starting to fade away a little bit, where we’re talking about taking care of the services first and having the ability to deal with some of those issues after the fact. But there are still issues to be dealt with.

The other part about it that I think is quite exciting for us is that the regional health authorities…. I’ll use crisis response as an example. We now both recognize our commitments in areas of crisis response, and we’ve worked to improve the way we do it based on how Health Canada has done it. Because we take the approach of being not only owned by the First Nations Health Authority, by First Nations communities, but working with communities as partners, we’re there with community when things happen on the ground.

Now what we see is that our regional partners, the regional health, are actually there with us — and sometimes there before us — recognizing that they need to respond. They’re now involved through that regional table in a very robust engagement with First Nations in their region in a dialogue that is no longer just a token dialogue from a First Nations point of view because they have a partnership accord at more government-to-senior-organizational level with board chairs and so on, and then the operational levels fall underneath.

There are a lot of exciting things happening, but there’s a lot more to be done.

C. James: I’d just add a little point. I appreciate that, and I think the good modelling, as you’ve described the opportunity for the health authorities to learn from the work that you’re doing, is a real plus. It’s good to hear that.

I think it’s also important, and I guess the other piece — the reason I raise it — is to also not have the health authorities now feel: “Okay. All First Nations issues are now with the First Nations Health Authority. We don’t have to worry.” I would have a little bit of a concern about that, so it’s good to hear that those dialogues and discussions are continuing.

J. Gallagher: Yes, we pushed that issue really hard — about their responsibilities. We quite, in a lot of ways, recognize that for us, the health partnership with the province of British Columbia is what’s going to make this work. First Nations all along have said: “We can’t do this by ourselves.” Not only did First Nations have to learn how to partner with ourselves as 203 communities — as you know with lots of the other issues in this province, we’re separated all over the place — but we had to learn to partner with B.C. and Canada.

Canada, in their piece, has not walked away from the responsibilities to support the conversation. But they recognize that through this administrative arrangement they’ve given First Nations the control to make decisions over the federal resources.

The provincial partnership is having us hard-wired in and recognizing that the province…. The minister’s letters to the health authorities have written in real accountabilities about working with the regional partnership accord tables and accountabilities as we talk about, when
[ Page 485 ]
we all meet together at the tripartite committee around our collective responsibilities, ensuring the health outcomes of First Nations people are improved, as we’ve tried to achieve in our health plans.

D. Donaldson (Deputy Chair): Thanks for the presentation. I’m sorry about the rushed nature, but I’ve got a lot of questions for you. Now that we’ve met I can get in touch with you beyond this committee.

D. Donaldson (Deputy Chair): I just wanted to go over a little ground of what my colleague was asking you about. You know, it’s exciting, and congratulations on the ability of the First Nations Health Authority now to really deliver and tailor services to First Nations. What I see is it’s another…. Really what it should be, in my mind, is a government-to-government approach now between First Nations Health Authority and the province.

I guess my question is — that’s at a political level, and you seem to be, from what I understand, dealing at the operational level — are you involved, and this is from the mental health aspect, in the planning that we discussed in the previous presentation around the delivery and optimizing services around children and youth mental health in a really integrated manner? Are you involved in a weekly or monthly sit-down with those in the different ministries we just heard from in how to develop the best model and address the gaps?

J. Gallagher: We’ve had different levels of involvement. The way that it works…. At the political level, the First Nations Health Council, which is apprised of political leadership and advocacy on behalf of B.C. First Nations, has signed on to the political agreements that tie us together through this health partnership. Through that, the deputy ministers table is where they’re now exploring the notion of social determinants of health. From that, there is a very specific discussion going on around MCFD and the issues around child and family.

There’s a bit of an overlap. We work at an operational level, in terms of on the ground, supporting the kinds of things that happen in communities. When MCFD resources need to be part of it or are part of it, we engage at that level.

At my level as a CEO, I engage with the deputy minister, and we talk about work with other ministries all the time. Because we look at services holistically…. Deputy Minister Brown, coming from MCFD — we’ve met and had discussions. I’ve had discussions with Deputy Minister Sieben and Deputy Minister Brown, been in discussion with them with communities about the kinds of issues that are happening and recognize that there’s a lot more that needs to be done.

We’re at that stage where…. I’ve described that the provincial health system recognizes that First Nations health is hard-wired in. The first is to get us hard-wired into the very big and robust provincial health planning systems. As we say that, we are aligned more informally right now with some of the other ministry work. It’s almost as needed.

As a result of the work that’s coming out of, for example, Paige’s Story, in my last meeting at leadership council with the CEOs and with the deputy minister we talked about the work and how the ministry wanted to proceed from their end and how it involved the other ministries. We’re going to be full partners in that. That’s a new piece moving in. There are a number of pieces.

For us, it’s about trying to figure out where we start, in terms of not being stretched all over, where the provincial responsibilities rest — but ensure that it comes back to us. That’s part of my discussion with the Deputy Minister of Health. As these things come along, where do we strategically get placed in the process so that we can be effective and we don’t chase all the different things that are happening because we have a thousand expectations on us?

J. Thornthwaite (Chair): Thank you very much for your presentation. We apologize for the rush, but this whole day has been rushed. I would assume that if anybody has any further questions, they can contact you after they’ve had a chance to digest your report. Your report is very comprehensive. I appreciate your answering the questions before we asked you.

I really appreciate your comment about partnerships with all of the health authorities as well as the ministries. That was one of the comments. Many of the comments that we received throughout our report was the lack of cohesiveness between ministries, including First Nations on and off reserve. As much as we can possibly do to collaborate and work together with everybody for these kids, the better.

I appreciate your work, and thank you very much for coming and presenting. I’m sure that we’ll keep in touch.

Hansard Services publishes transcripts both in print and on the Internet.
Chamber debates are broadcast on television and webcast on the Internet.
Question Period podcasts are available on the Internet.

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)
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