The committee met at 10:05 a.m.

[J. Sims in the chair.]

J. Sims (Chair): First of all, before we get started, I do want to acknowledge that I am sitting on the unceded territory of the Coast Salish, the Semiahmoo, the Kwantlen and the Katzie. I’m hoping every one of you will take a moment to acknowledge the territories you sit on. I raise my hands in thanks and gratitude to everyone who has gone before us and done this amazing work but also who shares this land with us. It’s always an honour.

We’re going to turn it over to our representative, to Jennifer.

Jennifer, I’m going to have you introduce the staff. We’re not going to introduce all the MLAs again. We’ve done that. But I would let you introduce your staff who are here with you. Then we will do the first report. You will do your thing. Then we will have time for questions.

Over to you, Jennifer.

Consideration of Representative
for Children and Youth Reports

ANNUAL REPORT AND SERVICE PLAN

J. Charlesworth: Thank you so much. It’s great to see all of you virtually again, so soon after our informal meeting. I’m very pleased to be back here with you today and tomorrow to present our latest reports from the office.

Before I begin, I’d like to acknowledge that I’m joining you today from the traditional and unceded territories of the W̱SÁNEĆ people.

Thank you so much for that beautiful opening, Chair.

We’d also like to acknowledge, as a team, that we’re living and working, with gratitude and respect, on the traditional territories of First Nations peoples of B.C. and to specifically express our gratitude to the keepers of the land on the traditional territory of the Lheidli T’enneh, the Songhees and Esquimalt Nations, the Musqueam, Squamish, Tsleil-Waututh and Kwikwetlem Nations, where our offices are located.

We’d like to acknowledge our Métis and Inuit partners and friends living in these beautiful territories.

I would like to introduce you to my colleagues. With us today are the deputy representatives, Samantha Cocker and Alan Markwart, and the executive director of reviews and investigations, Carly Hyman. They will be with us for the full morning, and we will be joined by other colleagues for each of the reports.

As a way of beginning, today and tomorrow are unusual days for us because first of all, we’re getting to know one another, our work and our interests in children, youth and young adults and their well-being, but second, because we’re bringing you an unprecedented number. Right out of the gate, you’re setting a very high bar. To bring forward five reports over two days is quite significant. This is not typical. As we go forward, I can tell you the pace will be sort of one report, March-April, May-June, and then a bit of a break until the fall.

We’re really proud of the reports and the work that has been done, so we’re excited to share these with you. I think it will give you a really quick grounding in the areas that are of significance to us — mental health, children and youth with special needs, young people aging into adulthood being key focal points for us — and the relational work that we’re doing with First Nations and Métis folks.

I’ll aim to hit the high points on each report and leave good time for your questions. From time to time, I’m going to share some slides, but I’ll pop out so that we can see one another. That’s my preference. But the slides might help us a little bit as we go forward.

We’ll begin. The first report I’d like to share with you is our annual report and service plan. This covers the 2019-20 fiscal year, which just seems like a lifetime ago. Many things have changed. But it also covers our service plan for 2020-21 and ’22-23.

Just so that you note, it’s a requirement under our legislation that we submit to you a report by September 30 every year, so this will be a regular occurrence.

I went through a great deal of information previously, when we did our informal orientation. I’m just going to hit the high points here but welcome any questions that you have during the presentation or thereafter. I’ll leave plenty of time for that.

The RCY, as you know, was created as a result of the work that the late Hon. Ted Hughes did in his 2006 independent review of B.C.’s child protection system. We consider Ted the father of our office, so of course, this is an important place for us to begin.

[10:10 a.m.]

He passed just a little over a year ago now, and there’s not a week that goes by that I don’t think of what Ted would say as we do our work. It’s important that we honour his tremendous legacy.

Our report spells out how we conducted our work in 2019-20 and lays out our plans for the current fiscal, the one that we’re in right now, and for the subsequent years. It is an important part of our legacy and our accountability to this committee as well as to the Legislature and to the people of British Columbia.

To refresh your memory, our responsibilities include assisting children, youth, young adults and their families who need help in dealing with service systems — including the Ministry of Children and Family Development, health authorities and Community Living B.C. — advocating for improvements to those systems and providing oversight of MCFD and other public bodies. This gives you a visual representation of the main teams and activities within our office.

In total, we have 75 FTEs, six of whom are attributable to our shared corporate services arrangements — that’s finance, HR and IT — with the Office of the Human Rights Commissioner. We consider them our sister organization. Our main office is in Victoria. We have advocates working in various parts of the province, and we continue to operate an office in Prince George.

As you know, our work is mandated by the Representative for Children and Youth Act and the regulations. We report to you as part of that. We also report to the Select Standing Committee on Finance and Government Services, which we did earlier this week. It’s been a busy select standing committee week.

Just to give you a sense, our budget for fiscal 2019-20 was $9.75 million, of which we spent $9.68 million.

This week we went to the Select Standing Committee on Finance and Government Services and asked for an increase of 1.5 percent for the ’21-22 budget. I’ll cover off a couple of highlights there, but that was basically to cover the mandated staff cost increases. We got creative in how we manage the significant growth, which I’ll talk to you about today, with respect to our cases coming forward. If granted, that would bring our office’s budget for next fiscal to $10.6 million.

So 2019-20 was another extremely busy year for our office. Our reviews and investigations unit…. This just gives you a depiction of our statutory responsibilities. Then we are enveloped and supported by our First Nations, Métis and Inuit relations and through our youth and community engagement work.

Taking a look at our reviews and investigations, the team responsible for investigating the critical injuries and deaths of children and youth in government care or those who have received reviewable services, we experienced a 16 percent increase in in-mandate reports of critical injuries and deaths during the 2019-20 fiscal year. That translates to 3,185 reportable circumstances reports for young people who’d received services in the preceding 12 months.

Each of these reports receives an initial review by our team. This might be tricky to read, but it is on page 37 of your annual report and service plan. It just gives you a sense of the flow. When we get a critical injury or death report submitted by, right now, MCFD…. In time, we’ll also be getting them from the health authorities. Each of these receives an initial review by our team. Then we determine what’s in mandate and what’s not in mandate. Of the ones that we received, 1,329 or 42 percent were determined to be within mandate.

The categories of critical injuries most commonly reported to us include emotional harm, suicide attempts and suicidal ideation, sexualized violence, physical harm, substance-related harm and physical assault.

To give you a sense, because this volume increase is important for us to pay attention to, in 2019-20, reportables were 65 percent higher than in 2015-16, when the office received 803. That upward trend has continued unabated through the first nine months of this fiscal, and we expect that growth to continue in the next few years. At the current rate that we’re receiving critical injury and death reports this fiscal, we’re projecting a total of 1,800, which will be more than double the number from five years ago and a 34 percent increase over last fiscal.

[10:15 a.m.]

It’s quite significant for us, as a responsibility we carry, because these stories are so important.

To be clear, we think that the main reason for that increase is because the Ministry of Children and Family Development, to their credit, is doing a much better job of complying with the expectations. Particularly, they have done a very good job recently in ensuring that child and youth mental health is fulfilling those requirements to report. Also, we will soon be receiving reportables from the health authorities delivering youth addiction and mental health services. So that will certainly contribute to our increase.

Now, we can’t say for absolute sure, but I would suggest that the combined impact of the toxic drug supply and the COVID pandemic are also driving the number of injuries up, and that will continue in the future as well. Happy to chat about that.

As you can see, we have a number of options available to us as to what we do with those reports. Sometimes we go into a comprehensive review. That’s a full, paper-based investigation to take a look at what’s going on. We can then share those findings with the public bodies to inform their learning. They’re not public reports. We can take a look at them and go full investigation, or we can aggregate and pull up themes that we think are important.

In November 2019, the team released Caught in the Middle, which was an investigative report into the overdose death of a boy who had been in contact with both Alberta and B.C. child-serving systems and who was moved 40 times, at least, while in government care. In this investigation, we worked very closely and respectfully alongside the young person’s family members to maximize their engagement, to ensure the young person’s story was told in a good way and to minimize the trauma.

As an office, we’ve always recognized that investigations are difficult for families and communities. It’s our hope that by utilizing more sensitive Indigenous approaches, we can minimize the trauma, continue to build trust and relationships, raise awareness and understanding and, most importantly, improve the experiences and outcomes for children, youth and young adults.

Often, over the course of reviewing the reported injuries to children and youth in care, we identify cases of concern, and we bring them to the attention of senior MCFD officials, such as the provincial director of child welfare, or other public bodies for immediate action. That’s what I would call our quiet, behind-the-scenes advocacy work. Other times a trend in these injuries just can’t be ignored, and it may lead to me releasing a statement or an opinion piece in the media, where I’m bringing the issue into the public consciousness in other ways.

We’ve often pursued avenues other than the reports. For example, last year we released 17 public statements on a wide variety of topics ranging from proposed changes to the Mental Health Act to support for LGBTQ2S+ youth to a statement on our response to COVID-19 and a joint statement with the Human Rights Commissioner on family violence.

The reviews and investigations team continued to work on a number of other reports during this fiscal year, some of which we’ll share with you today and tomorrow. Others will be coming to fruition in the coming months.

I’m going to turn to advocacy now, which is where our office has the greatest direct impact on the lives of children, youth, young adults and their families. There are front-line folks, the people who meet with and take calls from children and youth, families, social workers, caregivers, teachers, pediatricians, lawyers and police every single day, and they help people navigate what can be a confusing web of government services. They teach youth how to speak up for themselves and to understand their rights. They also advocate directly on behalf of children and youth, when necessary.

In the 2019-20 fiscal year, our office opened 1,583 advocacy cases. Just to mention that our advocacy cases are family-based. So it could be that there are multiple children attached to one case, just to give you a sense. Typically, we’re serving well over 2,000 children in the course of a year. Since our inception in 2007, we’ve handled over 23,000 distinct cases with, obviously, many thousands more children connected to that.

[10:20 a.m.]

Just to give you a sense, in fiscal year 2019-20, which is covered by the report, 26 percent of our advocacy cases were complaints regarding quality of care or services received by children, youth and young adults and their families, 22 percent centred on ineffective or inadequate planning or absent planning, and 19 percent involved families looking for information regarding services. That complex web of services that I talked about is mystifying for many families.

Numbers alone don’t begin to tell the entire story of our amazing advocates’ work. What we’ve seen over the last few years is a substantial increase and growth in the complexity of the cases that our advocates handle. These include children and youth and families dealing with acute and multiple issues and with multiple service providers, typically three or more different service providers. Sometimes we’re dealing with a case team of 18 or 20 different practitioners along six different service lines.

As a result of that increasing complexity, the average length of time that we’re involved has almost doubled to more than seven months, which is quite considerable. So as I mentioned to you, when we did our informal review, changes have been made to our regulations, as of July of 2019, that expanded our jurisdictions to include young adults, ages 19 to 23 inclusive, who are eligible for agreements with young adults and tuition waivers. We’ll talk some more about that tomorrow, when we reflect on the A Parent’s Duty report.

We also are eagerly awaiting another expansion to our mandate, which should take place this coming fiscal year, which would expand our definition of “young adult” from those under the age of 24 to those under age 27. This expected change will increase the population of young adults eligible for our advocacy services by about 60 percent, not only for the agreements with young adults and tuition waivers but also for those eligible for CLBC services.

Just to be clear, this fiscal year we are seeing a reduction in the number of advocacy cases coming forward, a slight suppression. But we see that that’s very similar to what other service organizations and advocacy organizations are experiencing. We think that it’s largely suppression due to the pandemic. Of course, we anticipate that once we are able to be out in the community again and using the many different ways that we have of reaching those young people, our numbers will go back up.

I think it’s important that we talk about our advocates not just from the point of view of the individual work, which is obviously very important. But also, they offer us a very important insight into what the patterns and the trends are. That allows us to understand where we need to go in deeper, where we need to reach out to our colleagues to find out what’s going on.

They are also very involved in that outreach work. It’s across the organization. But the advocates undertake a tremendous amount of outreach work. That outreach work and that pattern-finding could lead us to do special reports. In particular, we did one that we’ll be sharing with you tomorrow entitled Left Out: Children and Youth with Special Needs in the Pandemic, which was released in December, so not part of this annual report and service plan that you have before you. But I think it’s important to mention and kind of situate the work of advocacy in that broader context.

In other cases, things we hear about in our advocacy work may result in us pairing with a university or a research institute to conduct some needed research and initiate some helpful dialogue on a subject. Again, although not in this annual report, I think it’s important to mention that we commissioned two reports with the Children’s Health Policy Centre at Simon Fraser University on COVID-19 and the impact on children’s mental health. We wouldn’t have done that had we not seen so clearly in our reportables and our advocacy cases what was happening in the increase in childhood anxiety, depression and behavioural challenges.

The other thing that is in the 2019-20 report was the advocacy team led a major report that focused on centring and honouring youth voice, and that was led by our executive director, Blair Mitchell, who will join us tomorrow; members of the advocacy team; as well as several other staff in the RCY. They worked with the wonderful Katherine McParland, a former youth in care with lived expertise with homelessness, who had been an ardent supporter of addressing youth homelessness throughout the province.

[10:25 a.m.]

Her project brought together a group of youth with lived expertise, and they led a series of 13 forums around the province. We helped release the resulting report, From Marginalized to Magnified: Youth Homelessness Solutions from Those with Lived Expertise in February 2020. That was featured in the report.

I want to take a moment to acknowledge that, tragically, Katherine passed away suddenly in early December. We’re obviously deeply saddened by the loss of this shining star, and we continue to be connected to and supportive of the work. We’re continuing to be connected to the young people that were involved. We’re coming up on a year’s anniversary, and we’ll certainly continue our work in support of all that effort.

Another important group is the monitoring team. The monitoring team members research, monitor, review and analyze systemic themes and patterns related to designated government programs and services. They provide insight into the ministries and partners about possible program and service improvements. So you can kind of expand out and see that we’re taking a look at the broader landscape through the monitoring team.

The monitoring team has been working through 2019-20 on a couple of things. One is that we instituted a new recommendations tracking process. That didn’t use to happen. The recommendations weren’t formally tracked, and we didn’t publicly report on them. It might, again, be tricky to see this, but it’s on page 58 of your annual report.

Basically, what we do is we now have a process whereby after we’ve released a report, we meet with the public bodies that are referenced in our recommendations, and we talk about action plans. They then submit so that there’s clarity about what we’ve been looking for through the report and the recs. Then, within six months, they submit an action plan. We review that. At one year, we ask for an update on progress that’s being made. Then we assess that — either completed or fully implemented. There’s substantial progress, there’s some progress, or there’s no progress. Then we feed that back to make sure that we have fully understood. It’s really an important focus of relationship.

Then we report out on an annual basis, on the annual anniversaries of those reports, and that’s located on our website. We will provide you with those annual reviews as well, and we will continue to monitor those recommendations for three years — or more, depending on what I think. Some of these things that we’re asking for are pretty big asks.

That’s an important role for the monitoring team. The other thing is that they do work on special reports. They’ve been working on one that we’ll share with you in March that is looking at the experience of children and youth with fetal alcohol spectrum disorder in their families, and how those services and supports can be improved. We’ve really centred the experience of children and youth in that, which, you will see, is a theme in many of our reports.

They’re also working on a report. It’s a multi-year research project — quantitative and qualitative research — that examines the areas of cultural planning for First Nations, Métis, Inuit and urban Indigenous children and youth, transitional planning for youth aging into adulthood and permanency planning across all age categories. That project is nearing the final stages, and we’ll bring small reports to you in the spring, with a large omnibus report in June. That’s the plan.

Just to kind of give you a sense, here are some of the things that 2019-20, 2020-21 look slightly different. We had four reports with recommendations, five reports overall. We had appearances before the parliamentary committees, lots of advocacy calls, lots of outreach. I think it’s important to note that our website is a big deal. We had a lot of hits on that. We also have very active social media, so that’s important too.

I just want to focus back on the ring around us, the First Nations, Métis and Inuit relations team. I’ll just give you a sense. We’ve got our three statutory areas, but we are held well and very importantly by the First Nations, Métis and Inuit relations team. It’s dedicated to improving services to Indigenous children and youth and young adults, supporting First Nations, Métis and Inuit communities in reassuming jurisdiction and helping the RCY to become more culturally attuned and culturally responsive.

[10:30 a.m.]

Two-thirds of the children in care in B.C. are Indigenous, while Indigenous peoples are also vastly overrepresented in the justice system. Interesting. We’ll talk about this in the next report. Despite this overinvolvement in the protection system, we believe and we see the data that they’re underserved in voluntary services, such as community-based child and youth mental health services and services for children and youth with special needs.

As I mentioned, nations and communities are beginning a journey towards reassumption of jurisdiction over child welfare services, enabled by the new federal legislation An Act Respecting First Nations, Inuit and Métis Children, Youth and Families. The province, of course, is implementing the Declaration on the Rights of Indigenous Peoples Act. So obviously, it’s critically important that we keep this as the top priority of our office, and that’s why we have a dedicated team.

They’re actively monitoring the shifting child welfare landscape. They’re also closely monitoring progress that’s being made on a number of reports: the “Calls for Justice” of missing and murdered Indigenous women and girls; the Calls to Action of Truth and Reconciliation; the Jordan’s principle uptake; and Grand Chief Ed John’s 2016 report entitled Indigenous Resilience, Connectedness and Reunification. We have quite a beautiful piece of work that the team has done that is monitoring all of those, and that’s a reference point for anything that we do.

It’s also central to a key shift in the approaches we’re taking in all of our projects. We realize just how important a collaborative approach is that’s fundamentally grounded in those strong working relationships with First Nations and Métis governments and communities that have been left out for too long.

We have the notion, the concept, of “nothing about us without us” and view collaborators as partners rather than as subjects. Through our approach, we recognize the deep experience and knowledge that exists within communities. That’s with children and youth and young adults as well as First Nations and Métis communities and nations. It has involved building relationships and working through how we’re going to work differently.

We now have working agreements with the First Nations Leadership Council, Métis Nation B.C. — we’re very close on our Delegated Aboriginal Agencies, although we’ve been living into the principles for some time — and also with the B.C. Association of Aboriginal Friendship Centres.

I’ll wrap up my formal presentation on the annual report here, but I do want to give you a little bit of an important update.

With the arrival of the pandemic near the end of the period covered in this report, it affected all of us and many ways of doing our work. We did document that in the annual report and service plan, but we’ve carried on from that.

Of course, initially, all of our staff started working from home. What we’ve realized is that it’s actually worked really well. It’s worked for staff, particularly staff, I would say, living in the Lower Mainland, where some of our staff were commuting an hour and a half each way to get to our office in Burnaby — credit to our extraordinary staff. Also, we decided that there was a real opportunity here.

We have decided to close our Burnaby office and shift. The staff that were working there, primarily advocacy staff, will continue to work from home. But what we’re going to do is also hold clinics and go into the places where the young people are.

Our Burnaby office never served young people well. People didn’t come in. It was not a hospitable place. It wasn’t well located. What we want to do is go out to where young people are: the Foundry centres and the youth hubs.

I’m looking at you, Karin, and I’m thinking about the centres that you were a part of at family services. That’s where we can hold clinics. We’ve got experience in doing that with the custody centres, so we want to go where young people are. We think that’s going to be much more significant. We’ll rent the meeting spaces when we need them.

What we did was ask the Finance and Government Services Committee this week for permission to use the expected savings of $202,000 as a result of closing the office to address some continuing caseload pressures in our reviews and investigations team and help expand the work of our First Nations, Métis and Inuit relations team. What that will mean is we will be using the savings.

[10:35 a.m.]

Some of them will go, actually, to our online engagement. We’ve been investing a great deal in that, which will continue to be useful for us because of the vastness of the province, but also increasing our reviews and investigations team — our analysts by one — to deal with that tremendous increase, and also to recruit a knowledge-keeper Elder who will be working with the office on an ongoing basis.

I see that there are some questions. That ends my presentation on the annual report and service plan.

We’d love to take your questions. So I will pass it to you, Chair.

J. Sims (Chair): Thank you very much, Jennifer.

I really want to stress to our members, too, that we have three reports we’re doing today. This is the first one. I do have a number of people on the list for questions, and I do want to remind people that we do have some tight timelines. Please feel free to ask your questions, but let’s be succinct.

We will start off with Karin.

K. Kirkpatrick: I will make this quick.

Thank you so much, Jennifer. I’m really excited about the working out in the community. I think that’s a great idea.

My first question. I was going to say: what happens after the report is presented, and how do the public bodies issue some kind of response? You’ve addressed that.

I’m wondering. As part of the mandate for our committee, we’re looking at a review of the act. How does what you’re doing in these reports feed into the review? Or does it? The recommendations that you’re making — is that something that we are integrating, then, into the review of the act?

I don’t know if that’s a question for you, Jennifer, or for someone else.

J. Charlesworth: Thank you. That’s a great question. I’m looking to Alan, too, because he’s the one that’s the lead, really, on the legislative reforms that we would be bringing forward.

To answer your question, it’s actually virtually everything we do. We’re always taking a look at: is the act enabling us to do the best work we possibly can for children and youth? What are some of the things that we run up against and that might need some clarification?

In the review process that — for everybody’s benefit — is statutorily required every five years, we’ll be starting to come to you with our suggestions, as others will. You’ll be receiving briefs from others, such as the Ministry of Attorney General. We kind of keep a running list of the things that we think could be improved, especially in contemporary times, and then we will bring you a brief. You will consider that, deliberate, determine what you think is wise and make the recommendations yourselves.

I’m going to turn to Alan to add to that. We’re constantly attending to how it could be better.

Over to you, Alan.

A. Markwart: Well, certainly, that’s an area that has kind of crossed our minds. We haven’t arrived at a position on that yet. There are some possibilities of building some further accountability mechanisms into the act.

For example, we report to you. We make recommendations. We track those recommendations. Should there be, for example, a process by which the ministries report back to the committee itself on their progress? Now, we haven’t kind of fleshed that out, and obviously, that might be something for the committee to consider in its review.

S. Chant: Again, thank you for your great recap of the report. My questions…. I have a couple of them, but I’ll try to be very quick.

One is: where do homeless youths fit in? Two is: in your relationship with the health authorities, which looks a little back-y and forth-y at this time, are you also not just looking at mental health? I’m assuming that you’re looking at the injured and dead kids that come to the health authorities or that are within the health authority environment.

The third question. This is just for my clarity and understanding. If, for instance, for a four-year-old child, a parent comes asking for access to services that they’re not able to do, that also fits within “advocacy,” does it not? Yes, it does. Good.

Also, I’m very, very glad to hear about care plans. I mean, in my bad old-fashioned nurse-y way, I think they’re a great way of tracking how we manage. That’s great to see that we’re looking at care plans and recommendation tracking.

That’s it for me. Thank you.

J. Charlesworth: Would you like me to comment on a couple of those?

[10:40 a.m.]

S. Chant: You nodded on homeless youth, so they’re there somewhere. That’s great. Maybe sometime somebody can tell me where.

I guess the big one would be the relationship with Vancouver Coastal Health and looking at kids, not only through the mental health lens.

J. Charlesworth: Right. Well, I also turn to Carly and Alan, who’ve done the negotiations with health authorities.

You’re quite right. I haven’t thought about it as back-y and forth-y, but that’s a good way of framing it. It has been a challenge for a whole variety of reasons, and that’s as much our responsibility as the health authorities’. Having said that, Carly and — actually, I see other colleagues now — Jenn Morgan have been working over the last couple of years to sort that out.

Would you like to comment on the health authorities, Carly?

C. Hyman: Absolutely.

Yeah. Back-y and forth-y is not a bad way to describe it. We have had a working group with the health authorities. We initiated this work in June of 2018. We have a working group that’s actually led by Jenn Morgan, who has joined the call. We have representatives from each of the health authorities.

There’s a requirement in the RCY Act for the health authorities to report critical injuries and deaths of children and youth who receive reviewable services, which include mental health and substance use services provided by public bodies. Health authorities are public bodies. To date we haven’t received reports.

We initiated the working group to work toward health authorities reporting those. It’s a work in progress. We are making progress, I’m really happy to report, largely due to Jenn’s leadership on that working group. We do anticipate starting to receive reports this fiscal.

J. Sims (Chair): Thank you very much.

I just want to remind people that I have four other people before we move on to the next report.

K. Paddon: Thank you for all the work that went into this report. We can see all the work and passion that the team brings. I really just want to take a minute to appreciate that.

My question is kind of thematic, in that it came up in every report that I read. My question is about: where is CLBC? Where are the children and youth who are not CLBC-eligible, despite having been part of CYSN?

I also was asking, in my mind: where is STADD in these transitions? We know that they’re in transition as well.

The definitions that are reportable, such as the “emotional harm” definition, are not critical incidents that are reportable in a body like CLBC currently. They came up especially strong for me on page 41, when I was looking at the age distribution of in-mandate critical injuries and deaths, where for over 19, evidently nobody dies. I just wanted to ask where CLBC fits.

I know you were talking about MCFD reporting and eventually health reporting. But CLBC, as a designated service — where do they report?

J. Charlesworth: Great question. Our mandate covers advocacy for young adults receiving CLBC services — 19 up to the age of 24 — but not reportables. We have an advocacy responsibility, but our team, in reviews and investigations, doesn’t receive any reportables. That’s why you’re seeing that drop. It’s something to consider.

I think that’s the fundamental answer — that we don’t have authority over CLBC, other than being able to assist young adults in advocacy for a period of time.

Certainly, the STADD is starting for 16-year-olds and up. Our advocates are very involved with the STADD navigators and for a child under the age of 19, where there is a reportable because they’re receiving services from Children and Youth with Special Needs, which might include the STADD services that come before us. But really, it drops off at 19.

I hope that helps. Emotional harm I think is an important one. Emotional harm includes the loss of a loved one or mistreatment at the hands of a caregiver. There are some elements there that I think are really important for us to be paying attention to. But again, because we don’t receive reportables, we’re not seeing the phenomenon in the over-19 population receiving services from CLBC.

I’m happy to chat with you about that. Also, we’ll talk about it a bit more with the Left Out report tomorrow.

[10:45 a.m.]

J. Sims (Chair): Thank you, Jennifer.

I’m just looking at the time. I know we were very ambitious to schedule three reports in one meeting. I am going to allow the questions. This is our first meeting, and I want people to feel comfortable. I am going to ask everybody to be really succinct with their questions and then try to be brief with our answers as well. We’re supposed to be on to the second report already, and we’re not. But that’s okay.

F. Donnelly: Chair, I’ll be brief.

Jennifer, thank you to you and your team for presenting the annual report. I just wanted to pick up on the toxic drug supply impacting youth in care.

A second question is…. You’ve mentioned about the increased complexity doubling time for assisting those youth. I’m wondering if there are impacts or recommendations with this toxic drug supply that you could comment on that the ministry may do or needs to do differently.

J. Charlesworth: We actually released a report in the fall of 2018 called Time to Listen. That was with respect to the experiences that came out of Carly’s team, and that was with respect to the experiences of young people with substance use concerns.

One of the things we spoke about in that, in a recommendation, pertained to having a robust array of services. That would also include harm reduction. It was very important to us, in light of what we were seeing, that we recognize that even if there is treatment available when it’s needed — and I can tell you that oftentimes there isn’t — youth sometimes are not ready for that, or they’re not willing to participate in that at that point.

We have to figure out how to keep them alive and safe as much as possible in order to increase the likelihood that we can connect them into appropriate services. We have spoken about that, and we continue to speak about it.

We did a review that was released in March, actually, that provided information on the array of services that were available and where we saw gaps. That was done with the health authorities.

I’m only partially answering your question on that, but it is something we want to come back to as well, as we’re trying to understand the impact of the pandemic on the toxicity and the overdose events. We’re certainly seeing increases there.

The complexity — yeah, it’s attached to it. When we see things, it’s never just substance use; it’s substance use, mental health, placement instability, histories in care, sexual violence. It’s a big package, and we’re doing some work on that right now.

I hope that answers your question. Happy to follow up.

J. Sims (Chair): Fin, did you have another question? I think you asked both of yours at the same time.

F. Donnelly: I did.

Thank you for the answer. Thanks for the follow-up, Jennifer.

J. Sims (Chair): I really appreciate…. I’m learning a lot. I don’t want people to feel they can’t ask questions because we have time restraints. I’m trying to juggle what happens with items we don’t have…. I’m getting some guidance on that.

C. Oakes (Deputy Chair): Thank you, Jennifer and your entire team, for all of the work you’re doing.

Maybe, first, a comment on how we can support you as MLAs in getting the educational aspect out. I love, on page 26 of the report, about bright spots and how we could be working with our post-secondary educations — each of us, in our communities — to encourage working with and supporting former youth and care. That’s a challenge, perhaps, to my colleagues who sit on this committee — anything we can do to help.

The second piece is just about the decision to close the Burnaby office and to look at more advocacy. I’m in support of trying to find ways to do more advocacy and get out into communities. I can share with you as an MLA that my office has been supporting a family, an Indigenous family. We’ve had two suicides in our…. It’s been really difficult for our First Nations communities.

I would say COVID — absolutely. But having gone through two years of significant wildfires, then floods and then to be in a situation with having COVID has really stretched the capacity and has significantly impacted the mental health of our communities. Understanding how climate change and impacts on our communities can have significant impacts on the ground in the community and trying to support this family navigate…. We have a young teen who, tragically, committed suicide.

[10:50 a.m.]

What I can say to you is that more advocacy on the ground is required, because when we began COVID, there were a lot of agencies working collaboratively together, and as we’ve continued, we’ve seen some of that not work as collaboratively as possible. We need to get back to that point where agencies are talking. I can share with you that this family definitely fell through a lot of cracks, in how things should roll out and should be provided for support. Having read your reports has provided me with the ability to understand how things should work. I appreciate that, but that’s something I think we need to be looking at.

J. Charlesworth: Yeah. You raise some really important points. I’m so sorry for your communities going through that. It’s devastating when we lose our precious young people.

I’d like to suggest, actually, that Samantha follow up with you, because I think Samantha — holding the role of advocacy and First Nations, Métis and Inuit relations — would be really helpful. It’s also a reminder. In terms of helping, many people still don’t know about us. We will provide your constituency offices with packages of information and resources. Feel free to connect us to these families, because it can be a very scary and lonely place.

I really appreciate you talking about climate devastation and the impact on families. Sometimes we see emotional harm where a child has lost their family home or is no longer able to live there because of what’s happened with climate devastation — the wildfires and the floods. I think you’ve raised a really important point that we’ll put more attention to. We’ll connect Sam and you, Coralee. Thank you.

H. Yao: Thank you, Dr. Charlesworth, for your lovely presentation.

I also want to thank my colleagues for asking a lot of really good questions. Some of them covered mine.

I only really have one question left, and I’m not even sure whether this is the right place to ask it. On page 94, for research grants, the actual is at $235,000, where the budget is only $5,000. That’s quite a dramatic difference. I also realize there are a lot of savings overall, due to the fact that there was no office. There were a lot of savings in every aspect of the budget. It’s very well balanced. Maybe you can enlighten us on how that money is being utilized to maximize your ability to provide us with good information and good knowledge.

J. Charlesworth: Great catch.

Over to Alan.

A. Markwart: We typically do research grants towards the end of the year, depending on our fiscal capacity. Two of the primary grants were both to universities. One of them — I believe it was $120,000 — went to the University of Victoria, in order to retain co-op students from the law faculty and from graduate studies programs in the social sciences, the School of Social Work, and so on.

The other, as Jennifer mentioned, was that we had commissioned a couple of studies on mental health services for children, particularly on the impact of COVID. There was a grant to the Children’s Health Policy Centre at Simon Fraser University — $60,000, I believe — to enable that research to be done and for those reports to be produced. Those are the primary examples of the grants. We typically do that kind of thing, from year to year, as our budget allows.

H. Yao: Thank you for the explanation.

J. Sims (Chair): Jennifer Rice with a question.

J. Rice: It’s not a question; it’s just a statement. It goes back to something someone said earlier about making sure our offices have the information. I used to have all kinds of little cards, RCY cards, and I don’t have any RCY stuff. I was wondering if you could send a package to each and every one of the MLA offices. I know that’s a lot of offices. You can put me at the top, because I know we need you.

[10:55 a.m.]

J. Charlesworth: I’ll put you at the top. In fact, we’re a little bit delayed. We’d hoped to get it out last week, but we’ve actually redone a lot of our materials because we now have a text and chat function that we’ve implemented since COVID, so we’ve had to redo a lot of our materials. They’re just getting printed off, and you will get a lovely package for your constituency office as well.

We’ve redone our website as well, so that it’s more accessible to young people. Yes, it’s coming. Apologies for the delay. I’d hoped we were going to have it a little bit earlier, but we’ll get there.

J. Sims (Chair): Thank you, Jennifer, to you and your team, and to the committee as well. This was our first look at a report. We’ve asked questions, and you’ve been very, very, generous with your answers and in providing us with the information.

We’re now going to move on to the second report.

Illuminating Service Experience:
A Descriptive Analysis of Injury
and Death Reports for First Nations
Children and Youth in B.C., 2015 to 2017

J. Charlesworth: Well, thank you.

By the way, we have five Jennifers in our office, and I will happily introduce another one of them. Jennifer Morgan is joining us. She is an investigation analyst and was integral to the next report that we’re bringing forward to you. Karen Nelson, also, is the acting manager in the reviews and investigations. They are joining us, and they are the content experts, of course, along with Carly. This is part of Carly’s team as well.

This next report that we’re going to present to you is entitled Illuminating Service Experience. It’s a descriptive analysis of the injury and death reports for a three-year period, three calendar years from ’15 to 2017. We released this in December. This is the second report we’ve done like this. The first we released in the summer. It pertained to Métis children and youth.

With these publications, there are some interesting connections here. It has marked a significant shift in our reporting practices that aligns with what I had described in my presentation on the annual report and service plan in terms of grounding our data and trying to make sure that we are in service of and being of use to the communities. Of course, when we receive critical injury and death reports, as you can imagine, these are children’s lives. They’re so much more to us and to their communities, of course. Even just hearing your story, Coralee, reminds me of just how precious our children are. These are really significant impacts.

We are trying very hard to make sure that as we share our information, we bring forward the lives, the beauty of these young people, and share information in a way that lifts up what’s important in their stories so we can continue to improve the service delivery system and so their communities can understand how best to be in support of their young people.

We’re not the owners of this data. We kind of look upon these as our being stewards of this data. We have significant responsibilities to the owners, if you will, to ensure that our work serves them. Of course, what were very aware of is that the way in which data pertaining to First Nations and Métis children and youth has been used has not served their communities, and they have been seen as objects rather than partners.

What we decided to do was to make sure, to the best of our ability, that we weren’t perpetuating that colonizing approach. So with this report and the Métis report, we tried to change our practice in such a way that we are really recognizing this time that we’re in, the resumption of jurisdiction and communities wanting to know more — and also what the Office of the Human Rights Commissioner brought forward in The Grandmother Perspec­tive on the disaggregated data — so that we can become more nuanced in our programs.

To give you context, we use what we call the six Rs. What we try and do with this is we do our work based on these Rs, the first being relationships. Our work in grounded in relationships that we build with communities and with the people served.

[11:00 a.m.]

The second is that we do that in a way that is respectful, so we include the Indigenous knowledge, values and traditions as guiding principles in the project. We listen intently to try and understand how we can be of service. We value those different perspectives, and we try and honour the protocols. We do this responsibly, so we try and be very responsible from an ethical point of view in terms of making sure that we’re doing the checking in with people and sharing the information in a way that is accountable to the community.

Of course, we talk about things that are relevant. It’s important that we tell the story in a way that ensures that we honour and respect the cultural and historical context and acknowledge where colonization and systemic racism is having an impact.

Our next R is reciprocity. We’re trying to do this work in a way that strengthens the capacity within community and to give them information that will help them as they do their work, as well as receiving information and guidance from them, so that notion of reciprocity. These are things that are very important to us. We’ve recently added a sixth R, which we call repair, or restore. It’s really about our office being actively engaged in reconciliation.

I wanted to just give you a context for that. As I say, we’re moving forward in the best way that we can. We’re making mistakes; we’re picking ourselves up and trying to learn. But this report Illuminating Service Experience was something that was very important to us in really exploring how we could be of service.

We knew we wanted to share some information about the injury and death reports. We got feedback very early on: “Don’t just lump everybody together as Indigenous. Take a look at the Métis experience and the First Nations experience.” So that was very helpful.

Then my staff, Karen and Jenn and other colleagues of theirs, met with delegated Aboriginal agencies. We met with the First Nations Leadership Council. We went to an All Chiefs meeting, and we shared information about what we could offer and then received feedback from them about what they would find most helpful, both in terms of the content and the analysis. That feedback was generously provided by many participants. We’re very grateful for that. There wasn’t always consensus on what needed to be reflected, and we didn’t always have the opportunity through our data to find those answers, but we started with this.

Some of the things that were very important to the committee: respected mental health, connection to culture, where children were living. So we’ve tried very hard with this report to address some of the questions that people had.

We also found that we needed to go beyond our injury and death reports. We looked through electronic records for a sample of 200 children and youth in care with injuries, and their care plans as well. That enabled us to enrich…. And that’s why it’s more than quantitative; it’s more descriptive. That’s all backdrop to this.

Again, the things that we’ve tried to address in this report are concern about mental health services under the Aboriginal child and youth mental health umbrella and whether these services are culturally appropriate, questions about cultural interventions or traditional approaches to wellness and healing in response to the injuries and deaths, concern about urban Indigenous children and youth and their specific needs as being quite different than land-based, concern about transition planning and aging out of care and the lack of supports, and concern about the complex needs of some young people and the lack of appropriate services.

We also had a few questions that we weren’t able to answer. That was: is there a relationship between cultural planning and injuries and deaths? We’re going to be taking a look at that in other ways. There were questions about supports and services in rural and remote communities — again, something for further inquiry. There were queries around prevention services and whether those had been received and whether that affected the trajectory for a child — again, things that we are taking a look at in the future.

Just before we get into this, I think it’s important that we emphasize that we didn’t wish to define children in this report by what’s happened to them. They are so much more than their injury.

[11:05 a.m.]

Although this is a pretty focused report with lots of very difficult information shared here — painful to see what’s happening to our children and youth — it’s just important to remember the richness, the vitality of these children and that they have gifts, aspirations and stories.

This is an unusual report, in that we didn’t have recommendations in it. Instead, we were just, as I say, trying to be in service of the communities as they go forward. But we do hope that the information is going to be helpful, both as a baseline and also through suggestions — the things that people are taking a look at. It’s going to inform planning. Each community will determine the best way to use it.

What did we find? I’m just going to situate this, first of all, in terms of…. It’s important to take a look at, of all children and youth in care, what the indigeneity is. So 54 percent are First Nations, 37 percent are non-Indigenous, 9 percent are Métis, and then the remainder is not defined. I think that’s important because it really shows how significant the overrepresentation or, as we like to say, the over-involvement of the child welfare system in the lives of Indigenous people is.

Moving ahead, here’s what we found with the injury reports by indigeneity. It’s actually very, very similar to the breakdown of the number of children in care. So there wasn’t an outsized number of injuries pertaining to First Nations relative to the number of children in care, but certainly, if you take a look at children and what their exposure is, you’re seeing that 53 percent of the injuries reported to us involve Indigenous children. That’s important.

The most commonly reported injury for First Nations and non-Indigenous children, in fact, was sexualized violence. The highest proportion of the sexualized violence injuries was reported for children ages 13 to 18.

Suicide attempts were also commonly reported, and as with sexualized violence, suicide attempts were more commonly reported for female rather than male children and youth.

Physical assault injuries were reported significantly more than we would have expected for First Nations youth, less than expected for non-Indigenous.

The report really goes into taking a look at this data and then going beyond the numbers, to say: is this expected or not expected? Would we have assumed that this would be the profile, or is this kind of sharing information that was unusual or that needs further consideration?

In terms of physical assault injuries, those were reported significantly more than would have been expected for male youth, less than expected for female youth, and the highest proportion of those injuries, once again, was for youth ages 13 to 18.

Substance-related injuries accounted for 14 percent of injuries reported for First Nations children and youth and 16 percent of injuries reported for non-Indigenous children and youth. That was interesting for us. Again, the 13-to-18-year age group.

I think it’s important to consider what it is that we’re seeing. Is there greater prevalence in one population or another? If we take a look at accidental injuries, actually, we saw more reported for non-Indigenous children and youth. That’s 10 percent. And First Nations children and youth were 8 percent.

This is an important one. Caregiver mistreatment injuries were reported significantly more than expected for First Nations children and less than expected for non-Indigenous children — again, more for male children and significantly less for female children.

Caregiver mistreatment is an interesting one, and we’ll actually be coming back to you when we talk about residential services in the future around caregiver mistreatment. But we saw the highest proportion for children aged 12 and younger. More than half of that caregiver mistreatment occurred in foster homes, which is 59 percent. Just over a fifth occurred in staffed resources. By comparison, only 19 caregiver mistreatment injuries, 14 percent, were reported for those in the care of their family, and only three injuries, or 2 percent, were reported for those in restricted foster homes.

Now, we can parse out that data and look at it in a number of different ways, but I think it is really important to understand that when a child is in care, we really need to make sure that they are getting the best care possible. It is concerning to us when we see caregiver mistreatment in foster homes and staffed homes.

[11:10 a.m.]

Emotional harm injuries made up the smallest proportion of injuries and were reported equivalently for First Nations and non-Indigenous children and youth. But it was reported significantly more than expected for male children and youth and for children aged 12 and younger.

For a lot of those, interestingly enough, we do see children who are losing their loved ones connected to the toxic drug supply — their parents, their caregivers, their aunties, their uncles, the significant adults in their lives. That’s a lot there.

We went through the data. We also looked at a sample of 200 care plans for children and youth in care with injuries. This was interesting to us because it appears that some First Nations children and youth with injuries might not be accessing the services they need to thrive.

What we found was that many of the young people that were experiencing injuries had one or more confirmed mental health concerns — anxiety, depression, PTSD, etc. Yet what we found was that only 4 percent of these children were accessing Aboriginal child and youth mental health services and only 5 percent had access to traditional healing or Indigenous mental health practices. These are questions for us, and it really was helpful to the nations and the communities as they were looking at this.

It’s important to note that the First Nations Health Authority promotes land-based healing practices. We identified that in the report as being very important for those experiencing mental health concerns. We know that culture is a protective factor, so it’s of concern to us that there was that lack of engagement in the mental health services that have that cultural component.

We also found in the care plan analysis that in almost half the cases, we couldn’t find any evidence that the child or youth’s nation was involved or informed in their care planning. It gets to what Susie was talking about, of how important planning is.

Those were some highlights there. The federal act and MCFD practice now promote cultural continuity. Remember, these are somewhat dated. I don’t see that the trends have changed dramatically, but it is important to recognize that with the federal act and with changes to the Child, Family and Community Service Act brought in by MCFD, there is more promotion of cultural continuity and maintaining emotional ties to families.

With this as a baseline, we’ll be able to go back and see how that has changed in terms of the involvement of nations in the lives of their children.

One of the things that was interesting with this report is that, of course, as you probably know, more than half of the Indigenous people in Canada live in urban areas. That tells us that space must be made for Indigenous youth with diverse and complex identities, because they’re living in urban areas, and they might see themselves as urban Indigenous and other identities attached to their home nation.

What we have been looking at is what our responsibility is as advocates to ensure that there’s representation of the interests and the presence of urban Indigenous youth. We found some really interesting things in the report that take a look at the experiences of urban Indigenous youth — for example, higher likelihood of substance use injuries as compared to those that are in rural remote or smaller communities. Seeing those differences is also something that the communities can take away.

This was the start. We’re committed to continuing to hear from and work with the First Nations leadership, governments, their communities and the delegated Aboriginal agencies. We recognize that there’s a lot more work to be done to figure out how to respectfully share that meaningful information.

We continue to have the conversations about how we can share information in meaningful ways. This is a start. It gives you an insight into some of the new things we’re trying.

I’m happy to take any questions and will draw on my colleagues for their specific responses as well.

J. Sims (Chair): Thank you, Jennifer, for giving us the highlights, or the lowlights, of this report.

Also, it struck me as you were giving us the report how important this work is and how much I’m always in awe of the people who do this work day in and day out and manage to keep such a positive demeanor and a smile on their face.

[11:15 a.m.]

This work has to be done. So thank you for everything you and your staff do in this area.

I do have people with questions, and I’m going to be turning to them now.

S. Chant: Just really quick, what is your estimate of the number of children and youth in British Columbia, exclusive of the ones you focus on and work with? What is the estimate of the overall number?

J. Charlesworth: Good question. I’m not prepared for that.

A. Markwart: You mean the total number of children and youth in the province?

S. Chant: Yes, just so I can kind of get a grip on how many are an absolute, direct focus of Children and Youth relative to the overall pop.

A. Markwart: It’s about 900,000 between the ages of zero and 19.

S. Chant: Thank you. I appreciate that.

H. Yao: Again, thank you so much, Dr. Charlesworth, for your report. We all knew there was a disproportionate Indigenous representation, but I never realized how skewed the number has been leaning towards that direction. Thank you for that enlightening opportunity. I read quite a few of your reports so far, and they all have been pointing to one very simple, interesting concept about keeping family together and improving the cultural continuity.

I guess my question right now is: is there any kind of exploration regarding working with Indigenous seniors to connect with youth in care? Is there any kind of report or exploration regarding what we can do to reconnect the family and reconnect the cultural differences?

J. Charlesworth: I think that’s a beautiful question. In fact, in our A Parent’s Duty report that we’ll share with you tomorrow, we have a bright spot within there of one of the delegated Aboriginal agencies in Kamloops that’s created a beautiful housing environment in which young people in and from care are co-housed with Elders. It’s a beautiful, beautiful space. We’ll bring that forward as a bright spot.

We do see…. I mean, it’s part of Indigenous practice, Indigenous ways of being, to connect Elders and young people. Because of the impact of colonization, some of those ways of being have been stolen or lost. So I think that’s one of the promises, actually, of the resumption of jurisdiction. Part of that is with the transfer of authority to what’s called an Indigenous governance body. They actually go back and are taking a look at what their traditional laws were, what the practices were, what the ways were in which they raised their children up intergenerationally.

I think we’re going to see more of that. We have not done a review of it. Having said that, we are taking a close look — we call it keeping families safely together — at what the kinds of things are that are important in those early years to wrap around families. Certainly, others have brought up the importance of Elders and seniors and having intergenerational connections as being a protective factor.

I hope that answers your question.

H. Yao: That’s perfect. Thank you so much.

J. Sims (Chair): Any other questions?

K. Paddon: On page 30, I’m noticing the comments around FASD, ADHD and ASD. I find it particularly concerning and notice that it isn’t really included in the recommendations that you’ve put forward at this point around the assumptions around FASD. But FASD has very stringent diagnostic criteria, which are often incredibly culturally insensitive. We also know that it’s a requirement to meet that eligibility criteria during that transition phase from youth to adulthood.

I’m curious to know not only whether there’s any discussion about how to make that a culturally safe transition and the resources available to actually have the diagnosis if it’s still required. But also, I can’t help but note that autism funding is much easier to access than anything to do with FASD. So that word “assumption” has me very concerned.

[11:20 a.m.]

J. Charlesworth: Thank you so much for picking that up. You’re going to love the FASD report that we bring to you in March because we actually explore that differential diagnosis and that we do see — and, in fact, clinicians have pointed it out to us that we are seeing — far fewer Indigenous children being diagnosed with ASD than would be expected, given the population, and that there are implicit assumptions being made when a child is displaying what could look like very similar behavioural challenges — it could be an ASD diagnosis; it could be an FASD diagnosis — that they get streamed into the FASD.

You also raise a really good point about accessing services. There’s a very significant difference between what you can get with an ASD diagnosis compared to FASD. So this information, actually, in the report, is going to come back in a more fulsome way in the FASD report. We take a very close look at the pathways and also access to resources. So, to be continued. Thank you for raising that. I think it’s a critically important point.

F. Donnelly: I wanted to build on Henry’s question, Jennifer, and to your team.

In the report, is there anywhere that addresses systemic issues that are recommendations not just to the ministry but to the government? You’ve mentioned the complexity of just how hard this is in terms of overrepresentation for First Nations. The required effort may be beyond just the ministry; it could involve multiple ministries. I’m wondering if there were systemic recommendations that your team made or could make.

J. Charlesworth: Thank you for that.

Well, it’s interesting. What we’ve been doing is that for almost all of our reports now, the recommendations are going to multiple ministries or public bodies because we recognize very clearly that it’s not an MCFD problem. This complexity requires a whole-of-government approach — a whole-of-community approach, for that matter. So when we talk about it, it’s not just the ministries either. It’s about how we work differently with the community-based agencies and the community leadership, etc.

We have been trying to put our recommendations out, recognizing the whole-of-government challenge. Sometimes one recommendation might go to three public bodies in recognition of that complexity and really encourage that collaborative work, which seems to have been working reasonably well. Certainly, the pandemic has brought ministries together in an unprecedented way.

In terms of the broader systemic or structural piece, we did try and speak to that in this report a little bit and try and contextualize this phenomenon of injuries within a broader systemic challenge and structural challenge. It’s something we were just talking about yesterday, actually, in terms of how we deal with this tremendous complexity, this long history and contemporary colonization, and try and figure out how you intervene in that in meaningful ways and not just have recommendations kind of nibbling at the edges.

I don’t know if that answers your question, Fin. I think it’s something…. I think this is a great conversation for us to collectively continue to have. We can have recommendations, and they’re just going to nibble at the edges if we don’t deal with the broader systemic issues.

Does that answer your…?

F. Donnelly: It does. Thank you. Obviously, your team is looking at that, and that’s the important thing.

M. Morris: A good report. A couple of concerns I have, but I’ll just go back to the comments that you just made.

We do so poorly in integrating our government resources to address the needs of the individual. I’ve seen that in just about every aspect, whether it’s police service delivery or mental health or addictions treatment or whatever the case might be. I think we need to really put our minds together to see how we can better do that — whether it needs to be legislative changes or what we need to do to knock down those siloes so we have that integrated approach.

Really concerned over your numbers with the continuing, plus the orders and the injuries related to sexualized violence and whatnot.

[11:25 a.m.]

It’s a major concern. Is this isolated? Is this broad, right across the province? Can we pinpoint this to any geographical area of the province where we can have the right resources in place? Have you done it that way? Have you looked at the geographical percentages that we have across the province?

J. Charlesworth: Great question.

Can I call upon you, Karen and Jenn, in terms of the analysis? I think they would be the experts.

You ask a really important question, because we often do look at what the geographical difference or regional difference is to see if one is doing something better that we should pay attention to and whatnot. But I can’t answer that specific question on the sexualized violence and whether it’s consistent throughout the province.

Jenn or Karen or Carly?

J. Morgan: I was just going to say that we did do a geographic look, in the report, where we looked at geography in terms of population size, and we used population size as a very broad stand-in for access to resources.

We know, in some of the rural and remote communities, the number of resources that are available for youth who experience these complexities, the number made vulnerable by systems…. They don’t exist, or they have long wait-lists — those kinds of things. Whereas we also know that in higher population centres such as the Downtown Eastside, there’s more access to things such as substances or those kinds of things.

One of the things that we did find was that sexualized violence was common across both population centres — both small population centres and large population centres. That’s one of the things that we continue to see in the injury reports — that there seem to be other systemic factors going on other than geography for children and youth who are sexually exploited.

There are issues of belonging or identity. There’s the intersection with gangs and those kinds of things. That’s one of the things that comes up for us. Length of time in care, instability in placement while in care, ability for a child or youth to stay connected with their culture if they’ve been moved. One of the things that can happen is that kids are moved from places where there are not a lot of services to a place where there are more services — those kinds of things.

It’s a really complex issue that we just kind of scratched the surface of in this, but it does seem to be something that occurs across the province. Geography doesn’t seem to be the most important factor, but it can play a role, for sure.

J. Charlesworth: Thank you for that question. I very much appreciate the comment around the integrated supports. Particularly when we have children with these complex needs — the intersection of sexual violence, placement instability, poverty, all of those things — it really does require…. It gets to what Fin was talking about, the whole-of-system approach.

S. Chant: This kind of follows along with what’s already been said about populations and how it’s working, but it really comes very clear that between 13 and 19, there just seems to be a really big lift in terms of physical injury and death. Emotional injury — I recognize the other piece.

I just wonder if we’ve got the capacity, maybe when we’re relooking at the act or something, to build something in that says something about enhanced support or enhanced focus or something in those age groups. We’ve recognized this; what are we going to do about it?

J. Charlesworth: It certainly is that age group, especially 15, 16, 17, 18. When we take a look at our data, we certainly see that big bump. That speaks to the acuity of mental health concerns, substance use issues, if children are disconnected, of course, and don’t have that sense of belonging or attachment and connection.

It’s a huge area, and we’ll be bringing lots more information to you to try and understand what’s happening there and how we, as we talk about it, back up the bus, because it’s not just what we do when they’re in crisis but what we could do that prevents that crisis in the early years. That’s a really important part of the equation as well.

[11:30 a.m.]

J. Sims (Chair): Thank you, Jennifer. I think that was the last question.

With this, we’re ready to move on to our third item.

Jennifer, over to you and your team to give us the highlights.

Detained: Rights of Children and
Youth Under the Mental Health Act

J. Charlesworth: All right. Well, I will do a quick screen share again, here, and move on.

Our third report. Thank you for these beautiful questions too. I’d like to introduce you to our colleague, Jordan Watters, who has joined us. Jordan is currently the manager in our systemic aspect of reviews and investigations and was also an analyst that worked very closely on this report along with her colleagues Jenn and Karen. And of course, this is another one from Carly’s team, so gratitude to that extraordinary team.

This report dives deeply into a topic that our office actually hadn’t addressed before that has major ramifications for young people who experience it, which is the involuntary detention under the Mental Health Act.

Through the critical injury and death reports that come into our office, we see a lot of concerning examples, actually, of young people who are detained under the Mental Health Act, where it’s not clear if they’ve been aware of their rights and supported in exercising them, if they’ve had any involvement in their treatment decisions and, most significantly, how effective these periods of detention are in their journey towards wellness.

We are standing on the shoulders of two other reports, one done by the Ombudsperson, which took a look at the Mental Health Act and involuntary detention writ large across all ages, and the Community Legal Assistance Society, CLAS. Both of those outline serious concerns with compliance and oversight on the safeguards in the Mental Health Act, but neither looked specifically at children and youth who were involuntarily detained and impacted, and neither amplified the voices of youth or looked at what the long-term impacts of involuntary detention are upon young people. This report, which we released last month, endeavours to do that.

When children and youth require treatment and can’t be treated voluntarily, B.C.’s Mental Health Act allows for involuntary mental health treatment.

Before we get into this, I just want to acknowledge the work of health care professionals who work diligently every day to treat children and youth with complex mental health issues. It’s also important to acknowledge the struggles faced by parents and young people and those who love those young people in the face of mental health challenges. We hear from parents who are desperate to try and find treatment to keep their children safe and alive.

In doing this report, we’re not saying that there isn’t a role for involuntary detention. It is an important mechanism in order to keep young people — or patients of all ages — who are at risk to themselves or others safe. Having said that, we started with the premise that young people have the right to participate in making decisions about their care to the best of their ability, and that importance of voice in self-determination and participation is grounded in the Canadian Charter of Rights and Freedoms and in the international human rights conventions and declarations, such as the UN declaration of the rights of the child.

Within this, we particularly felt it was important to acknowledge the impact on First Nations, Métis, Inuit and urban Indigenous children who experience mental health detentions, given the many ways in which Indigenous peoples have had their rights, liberty and dignity stolen as a result of colonization, residential school and their vast overinvolvement in the child welfare system.

We did this in a way that really centred young people’s voices. Here, in the report, you’ll see their voices are woven throughout. I draw your attention to the appendix, in which we have a number of cards that basically tell the stories of those young people — that they approved that that was their story that they wanted to share — and also some metrics around their experience of being detained. Now, not all children would have experienced their involuntary detention this way, but what we did find was that their voices really spoke to us tremendously about how we need to attend to what’s happening to young people in involuntary detention.

[11:35 a.m.]

These really are the most intrusive measures that a state can impose on people. Much like imprisonment, these detentions result in deprivation of liberty. Under the Mental Health Act, a young person can be admitted and detained against their will, have treatment imposed on them and be subject to discipline, restraint or periods of isolation.

To understand how the Mental Health Act functions and how to improve the experiences, we drew on a number of sources. We looked at our data. We looked at external data. We looked at current legislation, regulations, guidelines, policies. We had interviews with key stakeholders, and we engaged young people who had been detained.

What we found is that the problems with involuntary detention of youth are myriad. Although the objective in mental health detention is to keep young people safe, it’s a powerful tool that is not always protective or therapeutic for these young people. In fact, the fear and confusion expressed by young people when they describe their experiences such as you see here is troubling to us.

Of the young people we heard from, detention is largely experienced as one more trauma on a trail of traumas. As one young person said, “I am medicated, but when does the healing begin?” because that was not their experience when detained.

The Mental Health Act is from 1964. It was not designed for children and youth and certainly not designed for the 20th century realities that we’re facing. It’s not meeting the needs of the young people in this province.

We found that the number of young people detained under the Mental Health Act increased 162 percent during the ten-year period that we have data for, from 2008-09 to 2017-18. This sharp increase brings into question of what is the adequacy of the voluntary system of care. Ideally, we would be treating young people within the community on a voluntary basis.

As my office has recommended in previous reports, we must have in place in this province a comprehensive system of culturally appropriate, youth-specific, voluntary community services so that involuntary detention is only used as a last resort. If necessarily detained, it’s done so in a manner that is culturally attuned, trauma-informed and respects and responds to the diverse cultural needs of the individual and that they have robust follow-up services in the community after discharge. It’s one thing to detain, but then what thereafter?

We also found that young people are not always aware of their rights. Here are just some of the things that it felt like to be detained. Many of them said they had no idea what was happening to them. No one explained their rights. They didn’t know they had a right to get a second medical opinion or had access to the Mental Health Review Board or access to legal counsel. They rarely exercised their rights as well, so we felt it was important….

I’ll just give you a sense. There are a number of things that are built into the Mental Health Act that provide some safeguards. It’s hard to read, but it is in the report. There are some checks and balances. But one of the things that we learned was that we don’t have confidence and the young people, certainly, that we connected with said that it was not their experience that those safeguards were routinely or consistently applied.

We feel that the need to ensure protections are in place and that young people are supported to understand the reason for their detention and what their rights are while detained is vital. The ability for young people to understand their rights might be lessened by their mental state, so we have to make sure that as they go through, there are multiple opportunities and we come back to them, depending on what their mental health state is.

We also had some interesting findings around data collection. We found that important information was either not collected or varies from one health authority to the next in a number of significant areas. For example, the Ministry of Health told us it believes, anecdotally, that Indigenous children and youth are disproportionately hospitalized involuntarily, but there’s no data that’s monitored on the number of Indigenous children and youth who are admitted under the Mental Health Act.

We were also unable to use data received from the Ministry of Health regarding the length of time that a child or youth is detained because the health authorities said that data was not accurate. We had data, but then we couldn’t rely on it. We don’t even know how long children are being detained.

[11:40 a.m.]

There are further examples. The number of children under age 16 who are hospitalized at the request of their parents and without their consent is not known. Health authorities were not able to provide data on the frequency of second medical opinion requests, and it was impossible to assess compliance and effectiveness of the use of secure rooms in seclusion unless we did individual patient files. But the young people told us that they virtually all experienced some seclusion or separation in secure rooms.

This lack of data on vulnerable young people leaves a gap in understanding what the full effect of the Mental Health Act is. Data assists in finding patterns and identifying those population impacts, in ensuring rates are upheld and in recognizing areas for improvement, which are really important to us, even more so when the deprivation of liberty is involved. So we feel it’s really important that we attend to that data.

We also found that oversight of restraint and confinement measures which may be experienced…. In fact, all of our young people said they experienced it as traumatizing. We didn’t find that that was provided with sufficient oversight or documentation of it. We felt that something like that requires rigorous oversight and accountability. In fact, if you take a look at the quotes throughout, a standout memory for many of the young people we spoke to was being isolated and restrained. And we know relationships are healing, so that experience of being isolated is really important.

We felt it was troubling that the legislation and regulation to guide the use of the measures of restraint, isolation and seclusion are not in the mental health legislation or guidelines. However, we see it in other legislation, so it’s not impossible. The Community Care and Assisted Living Act also addresses the issues of restraint and confinement. We also see that with youth custody. So we know it can be done.

A couple of other things, and then I’ll open it up for questions. Other important findings in the report included the lack of opportunity for young people detained to have a say in their treatment options. There is opportunity in other jurisdictions for young people to have a say in their treatment. We also found that treatment options were not…. They did not experience them as trauma-informed or relational or attached to culture.

Many of them said that they had limited opportunities to stay connected with family and culture during their detainment that might have helped them with their healing journey. We heard that what young people most yearned for while experiencing detention was connections with family, friends and community to support healing instead of this loneliness and separation that they experienced.

The service providers that we consulted with also told us that there’s a serious lack of community-based supports for young people on discharge, which results in young people having to stay longer in detention, in hospital, because there isn’t a place to discharge them to. I can tell you that with some of our reportables, we also see situations in which children are discharged into completely inappropriate environments — sometimes shelters or sometimes on their own. That’s of concern to us and was validated by the service providers.

We included 14 recommendations, more than we typically do. Again, to pick up on Fin’s comment, this went to a number of public bodies. It focused on admission, rights, treatment and ways to improve the system of treatment and voluntary mental health care.

We wanted to understand. Our recommendations call for better understanding of why this number of involuntary detentions is increasing; ensuring that there’s an independent body that’s notified every time a child is detained, to provide rights advice and advocacy; enabling First Nations, Métis or Inuit children to notify their community or nation of their involuntary admission so that their community can be engaged; ensuring that First Nations, Métis, Inuit and urban Indigenous children receive trauma-informed, culturally safe and attuned mental health services; and ensuring that the children and youth who are assessed as being capable of making their own decisions actually have the opportunity to participate in decisions.

We spoke to the standardization of collection and reporting of key data and the expansion of that. We also spoke to the amendment of the Mental Health Act to ensure isolation and restraint are only used as a last resort and that there are some criteria for that.

[11:45 a.m.]

We also suggested, through consultation with the Mental Health Review Board, that there be a hearing process that’s designed for children and youth and that’s trauma-informed and culturally attuned.

We think there are many opportunities to improve the Mental Health Act and, of course, the more robust array of services for our children experiencing mental health crises and substance use crises. They often co-exist. And given the stakes associated with involuntary admission, it’s essential to us that there’s a robust system that we lean into and ensure that there are strong procedural safeguards when the extraordinary power of detention is used so that it’s only used that we learn about it and we also use it only to the extent it’s necessary.

I welcome questions. Whew, three reports in one morning. That’s very ambitious. So thank you for listening.

J. Sims (Chair): Well, you’ve had to do all the heavy lifting.

I’m going to turn to Susie first.

S. Chant: Two things. Thank you very much.

I’ve had a daughter involved in the mental health system. I’m a pit bull with lipstick, and we had a hideous time. She was secluded for 30 days straight, and we were not allowed access to her. And we are in an area that there is supposedly good resources. I’ll just put that right out there, because I absolutely hear you.

Where I am concerned about also is the overlap of the freedom of information. You know, the child may be considered a child or youth, but then information is, I’d say, withheld from the parent, or the parents’ information is passed perhaps to the care team but is not passed through to the child, etc., etc. There was real collapse of information flow. Everybody cited freedom of information, which I’m very familiar with and a little concerned about.

The other piece that I’m concerned about, and you mentioned it briefly, is that the follow-up post-discharge is not only in terms of shelter or where they’re going home to, but do they have an advocate to help them get through to the next levels of service? Once again, my kid got an advocate from hell, and we had a really hard time getting services for her. And again, we are in a relatively well supported area.

Absolutely agree that this is an area of huge importance and want to be able to support however we can.

J. Charlesworth: Thank you very much for sharing your own experience. That’s hugely helpful. I think that lived expertise for families and young people is so important as we design the system.

You’ve identified a number of areas, like: how is it that we wrap around our children and ensure that those that can be connected in terms of their care and well-being are part of that human journey? I think there are some really important conversations we need to have — you know, the post-discharge and how it is that that healing journey continues.

We often see situations. We reviewed a comprehensive review this week where there were all these disconnections between the professionals involved. That area of: how is it that we integrate? It was raised earlier today. How is it that we see an integrated approach to the well-being?

Thank you for your comments on that.

J. Sims (Chair): Thank you.

Over to you, Henry.

H. Yao: Hi. Thank you, Dr. Charlesworth. An unfortunately difficult report to read. It’s very heartbreaking, especially the story that you inserted in there. So thank you for all the sharing.

Bear with me. I’m not an expert. So I might be asking some dumb questions as I go through this process. But I felt like the more I read your report, the more it feels like “detained” and “involuntary detention” are very punitive language. It’s very problem self-driven. It’s almost like: “Well, the youth have a mental health issue.” That has several problems. I love the way you put it. I would love to see more of a healing process, something driven more as maybe initial stabilization and follow-up therapy. I echo Susie who mentioned about this.

Is it because the Mental Health Act actually uses this kind of language, or is it because we just want to emphasize the fact that we have somehow absolutely turned our system upside down to make it a punitive system instead of a healing process?

J. Charlesworth: Beautiful observations.

Jordan, would you like to…? You’ve been nodding. Would you like to add in…? The power of language is so significant.

[11:50 a.m.]

J. Watters: Yes, absolutely. I’m just nodding because you’re exactly correct. It is the language in the act, so that’s the language that we went with. And I think it does emphasize what the powers under the act to restrict the freedom of these children…. We did have lots of conversation about it, so I love the question.

J. Charlesworth: Yes. In fact, we’ve been taking a look at the language that’s in use in many different ways within the RCY and how it is that we use language in a way that speaks to what’s actually happening — “detained” is a good example of that; that’s the language in use — and also, in terms of how we represent children and their stories, that we aren’t replicating that harmful or that punitive language.

A good example of that is, “Well, they were disengaged or resistant to service,” and rather than that, saying: “Well, if a young person’s choosing not to participate in the service, then we haven’t given them a good value proposition. We haven’t figured out how best to meet their needs.” So not blaming the child but taking a look at what the system is doing to meet the child wherever they’re at. We’re very mindful.

I think it’s going to be really interesting as we move forward, especially around mental health and substance use, how we continue to change the language so that we aren’t stigmatizing and shaming people for the things that they’re dealing with.

H. Yao: I do have a question for our committee leader. Jinny, is there any chance our committee can actually go visit the Maples centre so we can actually see firsthand what it looks like?

J. Sims (Chair): I would say that with COVID right now, that may not be the best course of action. But let’s put it on the list of things for us to discuss.

H. Yao: Much appreciated. Thank you so much, Jinny.

J. Charlesworth: May I just add one thing, just as an offering? Some of the young people that were involved in this work are very happy to come and meet with you. It would be virtually, obviously.

We thought, just because we’re getting to know one another, we didn’t want to do that. But we have on occasion supported young people to come and share their information and their insights, and I can tell you, they’re incredibly generous with their insights and ideas.

That might be something that we can do within a virtual environment — bring these young people to share experiences and have that conversation with you about how things could be better.

J. Sims (Chair): Thank you. With all the head nodding that went on during that comment, I would say that’s a task ahead for us.

I have a number of people on the list still. We haven’t forgotten you.

J. Rice: I can appreciate that this report is written in the perspective of the children or youth that are subject to the act, but why is it that there has been an increase? I can’t remember…. You said a 160-some percent increase in the use in the last ten years or the last year since you have data.

What is the perspective of the health authorities or the people that are using the act? I don’t want to say “the other side,” but I’m just curious what the other side thinks, for lack of a better way of framing that.

J. Charlesworth: I’m going to look to Jordan or Carly on this one, because we certainly did…. There were service providers that were part of the data collection, so you might have some more to offer on those interviews.

Over to you, Carly.

C. Hyman: Sure. I can try to answer. I mean, we actually didn’t examine the reason for the increase. One of our recommendations is that government do just that. I would just be speculating here, but we’re concerned that the increase might be a result of a system of voluntary supports and services that aren’t meeting the needs of young people, resulting in more children and youth having mental health crises and requiring involuntary care.

I certainly think, and the service providers shared the perspective, that the opioid crisis is contributing to the increase. I think the complexity of young people with co-occurring mental health and substance use challenges is likely contributing.

Those are just a couple of initial thoughts. But as I said, we did recommend…. That’s the first recommendation that’s included in this report — that government examine the reason for the increase.

J. Rice: Can I have a follow-up?

J. Sims (Chair): Okay, Jen.

[11:55 a.m.]

J. Rice: Do you think there’s geographical data, I guess you could say? Like, are rural and remote communities or communities that pretty obviously don’t have mental health supports using the Mental Health Act because they have no alternative? Is that a recommendation in there? Sorry if that was. I didn’t read all the reports. I just want you to know I tried my best.

J. Charlesworth: Thank you for that.

Jordan, do you want to comment on that?

J. Watters: I think it might be actually more of a Dorothy question — with our data expert.

J. Charlesworth: I should have introduced Dorothy Easton, who has joined us as well. She is one of the members of the reviews and investigations team and a data expert.

Dorothy, would you like to offer anything in there?

D. Easton: Hi. We did analyze some of the data by health authority. We didn’t analyze the increase by health authority, but we didn’t see a huge disproportionate number by the population size and the number of youth that were involuntary. We’re hoping to look at the data a little bit more on that. I can’t answer that just from what we presented in the report, but the proportional numbers didn’t seem off terribly.

J. Charlesworth: Thanks, Dorothy.

J. Sims (Chair): Thank you very much.

Now, I do have a number of people on the list still. I’m also very respectful of the time element, because we’re getting…. Well, I think we’re almost at our adjournment time, so I’m seeking some guidance. If everybody is available — because I don’t want to exclude anybody — then we could extend our meeting by 15 minutes. But even if one person is not available, then I’m going to suggest that we carry on with the questions, with the speakers list, at the meeting tomorrow.

If you are not available, raise your hand, please. Okay, with that in mind, what I’m going to be saying — now making a decision — is that we will put the people who did not get to ask their questions today on the speakers list, and we will answer those questions tomorrow. This will definitely give Jen extra time to read the report, if not for the first time, for the second time.

Once again, Jennifer, to you and your whole team, thank you for the work you do in this area. It’s very important work. It’s work that requires heart and mind, and I really get a feeling for that when any of you talk, so thank you.

I’m going to be looking for a mover to adjourn the meeting.

I see Fin Donnelly has moved that we adjourn, seconded by Jen.

Motion approved.

The committee adjourned at 11:58 a.m.