The committee met at 12:03 p.m.

[K. Paddon in the chair.]

K. Paddon (Chair): Good afternoon, everyone. My name is Kelli Paddon. I’m the MLA for Chilliwack-Kent and the Chair of the Select Standing Committee on Children and Youth.

I would like to acknowledge that I am participating in our meeting from my constituency, Chilliwack-Kent, which is located on the traditional territories of the Stó:lō people, specifically the Ts’elxwéyeqw, Pil’alt and Tiyt tribes. I would like to encourage all of you to also consider and reflect on the Indigenous connections to the land where you are all located.

This afternoon the committee will be reviewing two reports from the Representative for Children and Youth. I would like to thank the representative, Dr. Jennifer Charlesworth, and her staff for joining us today as well as guests from Simon Fraser University and Indigenous child and family service agencies.

First, we will be considering the representative’s report A Parent’s Responsibility: Government’s Obligation to Improve the Mental Health Outcomes of Children in Care.

Joining us today are Dr. Jennifer Charlesworth, Representative for Children and Youth; Alan Markwart, executive lead, legislative and special initiatives; Dr. Charlotte Waddell, university professor and director, Children’s Health Policy Centre in the faculty of health services; Dr. Chris­tine Schwartz, adjunct professor, Children’s Health Policy Centre, faculty of health sciences; from Indigenous child and family service agencies, Loretta Stewart, director of practice, Nisg̱a’a Child and Family Services; and Kelley McReynolds, director, Ayás Méńmen Child and Family Services.

[12:05 p.m.]

I appreciate all of you being here. Thank you so much. I’m going to turn it over to Dr. Charlesworth.

Consideration of Representative
for Children and Youth Reports

A Parent’s Responsibility:
Government’s Obligation to Improve
the Mental Health Outcomes
of Children in Care

J. Charlesworth: Beautiful. Good afternoon, everyone. Pleased to be with you once again to share two reports.

Thank you very much, Chair, for introducing all of my colleagues that will be sharing information with you today.

I’d also like to acknowledge that I am joining you from the traditional territories of the W̱SÁNEĆ people. It’s snowy up here on the hill. I’m also just reminded of how important this time, these seasonal changes are and grateful that we’re actually seeing the cool and the moisture on these lands as they soak up the moisture and prepare for a time of dormancy and reflection.

You have very kindly introduced my colleagues that are joining today. We are going to be focusing, first of all, on A Parent’s Responsibility, and I’ll be inviting our colleagues from the Children’s Health Policy Centre to speak in and share some slides with you.

Then we will speak about the report that we did that accompanied that one, and then I’m going to turn it over to Kelley and Loretta — thank you very much for joining us — because I think they’re actually pointing a way into the future, and also it will reflect for all of you the work that we’re going to be doing in collaboration with the Indigenous child and family services agencies in the third of our series on mental health. More on that a little bit later.

After that, we’ll welcome your questions and dialogue with our guests, and then we will move on to our second report of Beyond Compliance.

Karan, you are kindly going to be sharing the slides for us. Thank you. We’ll start now, then.

We’ll come to this one in a moment. But the fact that young people who are in care have higher instances of mental health problems than those who aren’t in care is reflected in both our advocacy calls and in our reviews or investigations. The reportable circumstances are the reports that we receive there.

This is such a crucial issue for children, youth and families in this province. As you know, mental health is, generally, but it’s a main priority for RCY. We decided to take a deeper look at the experience of children in care and their mental health status. We went to the Children’s Health Policy Centre in order to gather additional information and really take a deep-dive look at the literature.

I’m actually a little ahead of myself, Karan. We actually need to pull up the CHPC’s work.

We arranged with the Children’s Health Policy Centre and Christine Schwartz and Charlotte Waddell, and they did some work for us that then we integrated into our reflections, our analysis, of the data that we had available to us. What we wanted to do is to start with Dr. Schwartz and Dr. Waddell sharing their information that sets the stage for an understanding of prevalence, the concerns and the ways in which things could be done that would be helpful. Then we’ll talk a little bit more about the “now what” and “what next.”

I’m going to pass it over to you, Christine. I think you’re guiding us through.

Apologies for my slip, folks. I was getting a little ahead of myself.

C. Schwartz: It’s an honour to be able to share the findings from our report.

As well as being a researcher with the Children’s Health Policy Centre, I’m also a registered psychologist. For the past 20 years, I’ve been providing mental health services to children and youth. As part of this work, I’ve had the privilege of caring for many young people in the foster care system.

I’m going to briefly turn it over to my colleague Charlotte to introduce herself.

C. Waddell: Good morning, everyone. Thank you from me, too, for this invitation.

Jennifer, we really appreciate you including us today.

In addition to the research work that Christine and I do with others at the Children’s Health Policy Centre, I’m a child and adolescent psychiatrist.

[12:10 p.m.]

I also practise providing clinical care to young people who are coping with extraordinary adversities, many of whom have been in foster care. This is a population that we were really grateful for the opportunity to speak about.

Over to you, Christine.

C. Schwartz: I want to acknowledge that both Charlotte and I are on the traditional territories of the Lək̓ʷəŋin̓əŋ-​speaking people.

Given the time we have for the presentation, we wanted to focus on the prevalence of mental disorders among children in the government care system and on doing a little bit of a deeper dive into the background on how we derived the data for this report.

Accurately measuring need is vitally important, because to best meet the mental health needs, policy-makers really need to have an accurate accounting of them. So we set out a really rigorous standard to estimate the prevalence of mental disorders among children in care.

We began searching for meta-analyses that were specifically focused on children in government care that met all of these criteria. Specifically, the review authors had to be very clear about the methods they used, including the children they included, as well as how they conducted their meta-analyses.

The studies had to be conducted in high-income countries to be most relevant to both policy and practice in Canada. As well, the studies had to have a high standard for determining whether or not a child had a mental disorder, so they had to use a reliable method for diagnosing that was compatible with either the Diagnostic and Statistical Manual of Mental Disorders or the international classification of diseases. As well, the review authors had to do an analysis of the quality of each study they included in their review.

We found one meta-analysis that met all of these inclusion criteria. It included more than 3,100 children from France, Germany, Norway, the U.K. and the U.S.

Moving to the next slide, please, looking at what we were able to find. We begin with the prevalence rates for mental disorders among children in the general population in the second column. Then we could compare it to the prevalence rates for children within the care system.

For every single disorder that we were able to find good-quality data on, the rates were substantially higher for children in the care system. The largest difference was for post-traumatic stress disorder, in which children in care had rates that were 40 times higher than the general population of children. Some other disorders also had rates very much higher for children in care, including 15 times higher for conduct disorder and nine times higher for depression.

Next slide, please. The prevalence data provide us with really important information. So do children in B.C.’s care system. This quote, to me, really speaks to a common fear that kids in the care system have about speaking about their own needs, which is really important in understanding how we can better serve kids in this population.

Even though the systematic review we cited did not have any data from children in care in B.C., the good news is we really do have a viable way to better understand the mental health needs for kids in B.C. There is a really good tool to assess mental health needs, which is currently being used in B.C., that could be used more widely in order to get specific data on the mental health needs of children in care in B.C. It’s called the brief child and family phone interview, and it’s really easy to conduct. It can be done in just 30 minutes by interviewing parents, teachers or the kids themselves, depending on their age.

There are, also, two other main points from the report that I wanted to briefly touch on. The first is the importance of providing effective interventions to avoid children coming into care in the first place. Of course, it’s of no surprise that most parents truly want to be able to care for their children and keep them out of the foster care system.

[12:15 p.m.]

I can still remember a time when I began practising as a psychologist. I was working with a mom who was devastated when she was informed that a child protection investigation was underway. I also really distinctly remember her efforts working with me to learn new parenting skills and the absolute relief she experienced when she knew she was going to be able to continue to parent her son. And what I knew from the research was that if she was able to effectively parent her son and keep him in her home in her care, his outcomes were going to be so much better.

I also want to acknowledge B.C. policy-makers for the substantial investments they made in keeping children with their parents by offering the nurse-family partnership, which has tremendous success in preventing maltreatment.

For children who do enter the care system, we have good evidence that we can prevent and treat many mental disorders. In my current practice, I work with many teens in the foster care system. I’ve heard their experience in entering the care system, including one young person’s especially vivid memory of a social worker taking them out of their home as a young child while they watched their father being put in the back of a police car. I’ve seen the connection between the traumas they’ve experienced and the mental health burdens that they continue to carry.

What I also know is that there are many ways we have to help these young people. This includes having effective programs to prevent eight of the 12 most common childhood mental disorders and effective treatments for all 12. This includes the disorders we noted in the earlier slide that kids in care have much higher rates of.

Not only do we have effective interventions that work within a general population; we also have effective interventions designed specifically for kids in care. For example, there are prevention programs that have reduced symptoms of post-traumatic stress disorder, anxiety and substance use.

We also have examples of effective treatment programs for kids in care that have resulted in less substance use, fewer depressive and fewer conduct disorder symptoms.

Turning to the last slide, I just want to acknowledge the funders of our work at the Children’s Health Policy Center.

Thank you so much for your time, and I’ll turn it back over to Jennifer.

J. Charlesworth: Thank you so much, Christine and Charlotte.

As I said, this is an area of significant importance for us. In fact, this is the first in a series of three reports, at least three, that we are planning right now. This is the first one. We’ve collaborated with the Children’s Health Policy on another one that’s pertaining to the mental health needs of children and youth with special needs. The third one will be done in collaboration with the Indigenous child and family service agencies and Indigenous researchers on the unique experiences of mental health for First Nations, Métis, Inuit and urban Indigenous children.

Thank you so much to Christine and Charlotte for continuing to do wonderful collaborative work with us. It’s much appreciated. I want to echo what Christine pointed out — that the robust data for the mental health concerns of children and youth in care does not exist in B.C. Nor does it exist, actually, in Canada. We wrestled with that one. I think it’s very important for you to know that we ultimately do have confidence in the data that’s been brought forward because of the criteria that were set out by CHPC.

We don’t think there’s any reason to believe the prevalence rates are any less here in B.C. than in the U.S. or the U.K., which is where we were learning from. In fact, the rates of mental health disorders amongst B.C.’s children in care may be even higher. I say that because we’re consistently seeing greater complexity in the challenges faced by children in care in our advocacy calls, and our reviews and investigation team gets a good picture of what’s going on for young people in care through our reportable circumstances.

Actually, just before this, we had what we call our monthly initial review, where we go through all of our in-mandate injuries and deaths. There was a staggering number of children, many in care or in extended family or out-of-care options and on the verge of coming into care, who are dealing with mental health crises and not being able to get the kinds of supports they’re so desperately needing.

[12:20 p.m.]

I want to pick up one more thing before going into our materials, so I’ll cue you now, Karan, for bringing our slides up.

The most important thing is prevention. We want good outcomes for children and youth, all children and youth, and I know this committee is particularly concerned about outcomes. Prevention is the most important. If we can prevent a child from coming into care, if we can support that family and wrap around that family and assist them as they’re going through what many families go through, of ups and downs, then that will lead to better outcomes, on average.

Then the next thing is that for some families, where the child must come into care for any variety of or any number of reasons, then doing the early intervention and not waiting until we’re at a crisis point is really, really important — doing that early intervention and the treatment to result in better outcomes. I can tell you from our experience that, too often, with the way in which our system is designed right now, it’s only when things are in deep crisis that there is some measure of service provided, and even that is often too little and too late.

If you wouldn’t mind bringing up the slides for us, Karan.

Okay. Our team conducted an analysis of reports of critical injuries for children in care between April 1, 2018, and December 31, 2021. We looked at these to ascertain the frequency and characteristics of critical injuries where the file records indicate confirmed or suspected mental health diagnoses. We say “suspected” because oftentimes there’s such a delay in getting a diagnosis, or an assessment and diagnosis, that we’re often going on what is presenting in terms of the behaviour.

In that period, there was a total of 4,096 critical injuries. As you can see in the slides, 61 percent of those related to a child or youth who had either a confirmed or suspected mental health diagnosis alone or a confirmed or suspected concurrent mental health and substance use. Basically, we’ve got…. The 1,581 is that there were no mental health concerns that were identified associated with that critical injury or death; 1,200 plus for mental health; and 1,200, almost 1,300, where there were concurrent mental health and substance use, leading to a total of 2,500.

A young person’s legal status under the Child, Family and Community Service Act may vary depending on their situation. So care agreements and youth agreements may be put in place due to the child’s or youth’s mental health challenges that preceded the agreement. These two groups may be more likely to have a history of confirmed or suspected mental health diagnoses. This slide confirms this.

Critically injured children under care agreements are markedly more likely to have a history of mental health challenges, but nonetheless, the rates are very high for all three groups. So you’ve got in care or formerly in care. You’ve got an in-care agreement or a youth agreement. An in-care agreement might be a special needs agreement or a voluntary care agreement — oftentimes families coming and saying: “We can no longer cope because of our child’s circumstances.” Oftentimes they are hopeful that the child will get more care and support by having some sort of a relationship with the Ministry of Children and Families.

Let me give you an example of the kinds of situations we’re seeing. It will help bring the Children’s Health Policy Centre research to life even further.

Our advocates are currently working with a 16-year-old youth who has been out of school for four years due to behavioural and mental health concerns. The youth has experienced suicidal ideation and self-harm and regularly ingests substances and objects. In fact, a recent X-ray showed two batteries and several screws in the youth’s body. They’ve become severely underweight. They have a significant eating disorder, and they’re currently in specialized care in hospital.

However, hospital is not the answer. That is not a place for long-term healing and well-being. But there is no placement for this youth upon discharge, and their parents do not feel able to care for them. They’ve tried very hard, but they simply cannot do it any longer because they’re also worried about the well-being of other children in their home. So that’s a young person that’s on a special needs agreement, but there is no placement.

[12:25 p.m.]

Another example. Our advocates are currently trying to help an Indigenous youth who has been hospitalized in the adult psychiatric ward, again because there’s no adolescent psychiatric unit in their community. Restraints have been extensively used in dealing with this youth, both physical restraints and pharmaceutical constraints, due to his behaviour and his size. His caregiver, who also has a sibling in their care, is moving out of province and has said they can no longer handle this young person. Again, there’s a problem with where to put him upon discharge from hospital, as there’s no current resource set up to meet his needs.

These are examples. I’m not giving you all the details because I want to respect confidentiality and their privacy, but I can assure you that these are examples. These are not outlier examples. These are ones that we see every single month.

We’ve most recently, in this last month, had children as young as eight — we had another one today, nine — who are attempting suicide. Their mental health is extremely fragile. They’re presenting with an alphabet soup of diagnoses, and that’s not uncommon for children even under the age of ten. One really wonders what in the world we are doing when a child of eight or nine is seeing that their life is so challenging and traumatic that they are contemplating ending it. COVID, of course, has also not helped. But we need to pay attention to this.

Now, the lack of formal data collection in B.C. that would enable us to definitively determine rates of mental health concerns for children in care is of great concern, and we need to address that. We’ll speak to that in a recommendation. And we need to understand the mental health needs of First Nations, Métis, Inuit and urban Indigenous children, as there is a significant gap in information here and across Canada.

The evidence in the CHPC report showed that children in care have an approximate one-in-two chance of having a mental health disorder. That’s four times higher than children who have not been in care, on average. And as alarming is that number is, it should not come as a surprise, because the poor mental health outcomes for young people in care have been well documented, including by my office. The need is pressing, especially for First Nations, Métis, Inuit and urban Indigenous children and youth, who are 18 times more likely to be in care than the rest of the child and youth population.

So where are we going here? We need to foster better mental health outcomes. The CHPC study looked at fostering better mental health outcomes for children and youth in care through prevention approaches and treatment approaches. The news here is more positive, because the report identified several scientifically proven programs to prevent child maltreatment that can help avoid bringing children into care — remember that, in the by agreements — as well as programs that are effective in preventing and treating mental health disorders among children who do come into care.

Christine has gone over them, and the report is quite detailed. But they do show that there is a range of good options available to government and policy-makers. Working collaboratively with First Nations, Métis, Inuit and urban Indigenous partners, it’s possible to create culturally specific and culturally safe programs for Indigenous children and youth.

Thus far, however, with respect to mental health prevention and treatment programs, no organized system of targeted trauma-informed and evidence-based mental health intervention services has been fully put in place. There were announcements last week but those are, quite frankly, a drop in the bucket in the grand scheme of things. One would expect…. And that’s for the general population. There’s no specificity towards children in care, and that’s what we’re focusing on today.

As we point out in the introduction of our report, one would expect that a reasonable parent who knows their child has an approximate 50 percent chance of experiencing a serious disorder would ensure that screening resources were put into place to flag problems at the earliest possible time and then to provide appropriate services. But that’s not the case for children in care in B.C. For children in care, MCFD is that parent. None of the research-based programs identified as successful in the CHPC review have been implemented systematically in our prov­ince, and they should be considered.

In a moment, I’m going to turn it over to Loretta and Kelley to speak about some beautiful work that’s been done under the leadership of the Indigenous child and family services agencies. But before I do, I’m just going to, because I think it points the way forward, go through the six recommendations. You’ll see that the Indigenous child and family services agencies figure largely in those.

[12:30 p.m.]

Now, I do say, too, that the Indigenous Child and Family Services Directors are responsible for services to more than half of Indigenous children in care. It’s also important — we all do this — to recognize some First Nations are not served by Indigenous child and family service agencies. Then some are, of course, engaged in resuming jurisdiction under the federal act or under the recent Bill 38.

The intention of our recommendations is to enhance the knowledge and understanding of mental health concerns, to ensure that systematic action is taken to screen, assess and address these concerns in a timely, trauma-informed and culturally attuned way.

Our first recommendation is that MCFD, the Ministry of Mental Health and Addictions and the Indigenous Child and Family Services Directors co-lead comprehensive research to identify the prevalence of the range of mental health disorders amongst children in care and, thereafter, utilize the disaggregated data to directly inform service planning. We need this data because if you don’t have data, you don’t know where you’re starting, you don’t know the scope of the problem, and you don’t know how best to assess whether progress is being made.

The second recommendation is that MCFD, the Ministry of Mental Health and Addictions and the directors again co-lead the development and implementation of initial mental health screening of all children at risk of admission into care or who have been admitted into care, with periodic screening thereafter. This obviously needs to be done in a trauma-informed and culturally safe and relevant manner and should include the potential development of Indigenous-specific screening instruments over the longer term, again with that disaggregated data being centrally collected and analyzed to inform service planning.

We are also recommending that government and the directors again co-lead the development and implementation of targeted, voluntary assessment services and evidence-based, voluntary mental health programs and services for children in care and children at risk of being brought into care with, again, particular attention to culturally appropriate, trauma-informed services. These plans should be incorporated into the Pathway to Hope.

The fourth recommendation is that the development and implementation of the recommendations that I just mentioned be informed by the Indigenous Child and Family Services Directors’ Culture Is Healing, An Indigenous Child and Youth Mental Wellness Framework. You’re going to have a preview of that in a moment.

We also recommended that MCFD provide capacity-building funding to the directors, to support their ongoing leadership engagement and consultation and to support the implementation of the recommendations. We often ask First Nations, the Indigenous child and family service agencies and many of our community partners to do a tremendous amount of work on our behalf. We don’t acknowledge that’s significant labour and that they are stretched with their primary mandate. So we want to acknowledge the need for capacity-building funding there.

Our final recommendation is that as part of the government’s planned reform of the Child, Family and Community Service Act, MCFD include an amendment to the statutory rights of children in care so it is clear that these children have a right to health care, including mental health care. Without specifically saying mental health care, the ministry has a tendency to interpret health care as meaning only physical health and not inclusive of mental health.

It’s our hope and expectation that government will take these recommendations seriously, and we’ll, of course, monitor their implementation. The good news is that we know that we can do better.

I would like to pass it over to Kelley and to Loretta to speak into their beautiful work with Culture Is Healing. We invited them because this is another opportunity to see that there are things within B.C. that can be grown, supported and amplified. It also foreshadows work that we’ll be doing in collaboration with them, going forward, to better understand the mental health needs of Indigenous kids.

Over to you, Kelley and Loretta.

I think, Loretta, you’re first, right?

L. Stewart: Yes, that’s correct.

Good afternoon. My apologies if I have to clear my throat. My daughter went through the cold, and now mom’s trying to fight it off.

My name is Loretta Stewart. I am Nisg̱a’a, and I am Haisla. I am the director of practice for Nisg̱a’a Child and Family Services.

I live and work on Nisg̱a’a territory, on Nisg̱a’a lands.

I’m happy and honoured to be here with you to share information from the Indigenous Child and Family Services Directors. The information is around Culture Is Healing.

[12:35 p.m.]

Indigenous Child and Family Services Directors continue to witness the profound impacts of the opioid and mental wellness crisis on children, youth and families.

As it was stated in the two reports that were just highlighted, we are seeing a growing number of children coming into care. In the worst cases, children are orphaned as a result of parental involvement in substance misuse. We are also seeing increasing threats to youth mental wellness. Despite this reality, as highlighted by the RCY’s report A Parent’s Responsibility, there is a detrimental gap in the mental wellness services that are meeting the needs for Indigenous children, youth and families.

In addressing this crisis and supporting mental wellness, we as Indigenous child and family services agencies often work with a variety of service providers, including health, emergency response, psychiatric care, overdose prevention. It is recognized that some of these partners may be working through different lenses than the Indigenous child and family services agencies do, and most often, it’s a Western lens or the medical model lens.

We also are aware of the lack of training pertaining to Indigenous knowledge that professionals, such as clinicians, receive within the core curriculum of formal education and professional development. Awareness is limited and fails to be present for ongoing services. For example, I just completed my master’s, within the last three years, for counselling. We only had one particular course that was Indigenous focused, and we only received the course because my cohort agreed to have the course. It was not mandated. It was a choice.

Although it’s the majority of Indigenous people that we see needing the services, there’s very little educational opportunities for clinicians to have a very sound understanding of Indigenous holistic healing. We are experts, and we need to have the ability to share our knowledge throughout all service streams.

Culture Is Healing, An Indigenous Child and Youth Mental Wellness Framework, was developed by Indigenous Child and Family Services Directors to address the need for a new, shared approach across all service streams that intersect with mental wellness. It’s a bundle of three resources, including the framework itself, a poster with reflective questions and a four-page companion document. The framework centers on our four guiding principles of being culturally centered; inclusive and accountable; wellness focused; child, youth and family and community centered.

Our approach is integrating these principles and draws on the First Nations Health Authority’s policy statement of cultural safety and humility that recognizes systemwide change starts with me. For system change, we need practice change, and for practice change, we need individual change. As individuals, we must make conscientious and intentional efforts to ground our work and ourselves in the guiding principles.

The framework provides strategies for change at all three of these interconnected levels of change, individual practice and system change.

Now I’d like to call on my colleague Kelley to introduce herself and to complete our presentation.

K. McReynolds: Thank you, Loretta.

Good afternoon, everyone. I’m Kelley McReynolds, Yataltenat. [Sḵwx̱wú7mesh was spoken.] I’m the director of child and family services for the Squamish Nation, for Ayás Méńmen.

I’m coming to you from the village of Eslha7n Sḵwx̱wú7mesh Úxwumixw.

[12:40 p.m.]

I’d like to start off by just expressing my gratitude to the RCY for the work that has been done and the knowledge brought forward in the reports, I think, and for acknowledging the Indigenous directors and for us having a key role in providing better outcomes for child and youth mental health. It’s holistic care. That’s what’s healing. That’s what’s part of the healing journey where we can be stronger and really beat as one.

What I see in this new report is what we as Indigenous Child and Family Service Directors have known for generations. We know that the current approach really is not working for Indigenous children, youth and families. The inadequacies and the gaps that we see in child and youth mental health — it’s absolutely heartbreaking and devastating.

There’s a lack of relevant mental health care and the understanding of Indigenous youth. There’s a lack of taking the time to build the relationship and the understanding that’s needed for this holistic planning and implementation for good mental health supports and services, especially when there is mental health and addictions combined. What I’ve been seeing, really, is this lack of relational practice and no real appropriate plans.

I wanted to add a little bit here to some of the examples that Jennifer had shared earlier, just knowing these are things that we in our Indigenous communities deal with, unfortunately, far too often.

We did have a youth in care who was admitted to one of the youth concurrent disorder centers. The youth had been in care out of province for most of their life, struggling with mental health, undiagnosed and misunderstood traumas. This youth had just recently returned home to our community at age 18. We, as family and community, have been wrapping around this youth to connect them to family, to community, to culture and to systems of support. This youth was admitted into the centre to really get a deeper understanding of sort of diagnosis, medication management and medically managed detox.

The time unfolded with lots of frustrations dealing with the child and youth mental health systems. The centre really focused a lot more on inadequacies or disruptive behaviour. The centre was really reluctant to work with us to build that understanding of this youth’s story. I was constantly questioning how could they build this individualized treatment plan if they were not taking the time to understand the youth’s needs and the goals and, really, this youth’s life story.

The centre remained reluctant to work with us. They focused on a discharge. I will say a discharge with no real plan to really have sustainable supports for this youth moving into the future. I literally begged them to work with us to have a plan for the youth and to help them understand the Indigenous world view and to understand the histories and traumas that were connected to this and many youth.

Unfortunately, the youth was discharged the next day. They really had no place to go and be fully supported. They went to a shelter. Sadly, they died within 24 hours. The youth was found outside at a dumpster across from the shelter.

This was not how the youth’s story should have ended. Unfortunately, these stories are just too many — too many — and they become the truths of the systemic harms and the lack of appropriate supports and services that are put in for Indigenous children, youth and families.

It is the mental wellness practice and system changes that are needed now. They’re needed to support the Indigenous youths and families in their journey to reclaiming wellness. They need for all of us to collectively come back to a place where all nations and communities are thriving. We need a place for safe and appropriate healing spaces. Culture is healing. In part, that means that it’s a place where children can be brought up in our own ways.

[Sḵwxwú7mesh was spoken.]

That means to be brought up in our own way, with family, belonging, honesty, hope and identity, through learning and growing on their own lands and closer to traditional healing — a place where children and youth and families can feel embraced by the safety and love and protection

[12:45 p.m.]

A Parent’s Responsibility speaks to these needs. It speaks to the needed changes through calling for MCFD in collaboration with the Indigenous Child and Family Services Directors to develop a new child and youth mental health approach by co-leading comprehensive research, developing and implementing policies and processes for mental health screening, co-development and implementing plans for assessment services and mental health services for children.

Again, we’re very grateful for our partners at the RCY for recognizing the experience and knowledge that the Indigenous Child and Family Service Directors and staff can bring to this work from our position in providing culturally based child and family services for over 120 First Nations communities as well as Métis and urban populations through B.C. for over 30 years. This experience has positioned us to expertly inform the approaches to wellness that are rooted in Indigenous values and beliefs.

Our framework culture is that healing can be an enabler to operationalizing these recommendations. Through partnership and coming together and taking a new shared approach, we can change the trajectory of Indigenous child, family and community mental wellness.

This is the pathway forward for our children and youth, healing together for healthier families for generations. Paddling together is essential response to this mental health crisis, so now is the time for us to act.

Huy chexw a.

J. Charlesworth: Thank you, Loretta and Kelley — really appreciate it.

What you have before you, committee members, is that we’ve got a good understanding of prevalence of the risks. We’ve got ideas about and proven ways of making a difference, taking a look at Western and Indigenous perspectives and wrapping around our children to make them healthy and well.

We would welcome your questions. Over to you, Chair.

K. Paddon (Chair): All right. Thank you so much, and thank you for all of the work, not only into the report but the presentation today.

I’ll now look to members for any questions, if you want to…. There we go. All right.

S. Chant: Thank you very much for the presentations this morning — as always, very compelling. For those of us that look for them, lots and lots of background to support and to pretty much lay out a good way forward if we can figure out how to get the momentum going.

Mine is probably a very simple question, and I apologize for not knowing this, but I should. Tell me a little bit more about what a youth agreement is. Like, what does that look like, please?

J. Charlesworth: Well, Kelley and Loretta and Alan all know this even better than I do, but basically, why don’t I just give the bare bones?

It’s something that’s provided for under the Child, Family and Community Service Act, and a youth agreement would be sorted out with the young person. It’s typically for older youth for whom there is not a section 13 protection concern per se. But, nonetheless, the child’s current circumstances are such that, you know, it’s not possible for them to live with family or they don’t feel safe and they want to move forward. It’s a negotiation with the young person that would enable them to receive some financial supports, with certain conditions, that would allow them to typically live independently away from their family supports.

I am going to look over to Kelley and Loretta, who prob­ably use youth agreements on a regular basis. Would you like to add in, either of you?

L. Stewart: I would just add that it is youth driven. They have to have a level of capacity that shows that they can have some independence, and it’s not monitored as much or as fulsome as a child in care, so that’s why we need to ensure that they do have a level of capacity to do a certain number of things independently.

S. Chant: Chair, can I have a follow-up?

K. Paddon (Chair): Yes. Go ahead.

[12:50 p.m.]

S. Chant: If I’m understanding correctly, can a child in care who becomes a youth move into a youth agreement, or is it only for kids that have gotten this far as best they can and that have not been in care previously?

J. Charlesworth: I’m again going to look to the practitioners — Kelley, Alan, Loretta.

A. Markwart: Well, typically, with a child in care, they would stay in continuing care, and they would move into independent living, which would be a kind of equivalent to a youth agreement. A youth agreement is intended for 16- to 19-year-olds who have not previously been in continuing care.

S. Chant: Thank you so much. I’ve got it.

H. Yao: I actually have three questions. I definitely will ask one at a time, and if no one else puts up their hands, I’ll want to continue with my other questions.

The first question is to Dr. Jennifer Charlesworth. With the recent Bill 38, how do you see, in this report, the government-and-parent interplay with the recent Indigenous Self-Government in Child and Family Service agreement? Do you mind maybe shedding some light on that for us?

J. Charlesworth: Absolutely. Again, I’m going to cue you, Kelley and Loretta, because this is something that’s going to be very significant to you.

I’ll speak about one aspect of it and then turn it over to them. Bill 38, as I’m sure you all are well aware, creates the opportunity, within B.C., under the provincial legislation, for nations and Indigenous governing bodies to move forward around resumption of jurisdiction, and it complements the federal legislation.

There are a couple of things that I’d like to say about this report that we’re talking about, around children in care and mental health status, and the work that is being done in communities all across this province to resume jurisdiction or to bring more of their traditional laws and practices to bear in order to support children.

One of the challenges, frankly, Henry, is that we don’t have great data. I feel for our colleagues in the communities, in the Indigenous governing bodies and in Indigenous child and family service agencies because we don’t have that disaggregated data, and you don’t have a strong sense of what the circumstances are for children. What is going on for them, and how do you plan appropriately for them? That’s one of the reasons why, in many of our reports, we speak to the importance of data, the collection and understanding of children’s needs and being able to make that available to our colleagues so they can plan accordingly.

I think that the recommendations from this report will actually support the movement that is taking place in communities with Indigenous agencies. That’s one way to look at it: all of these are stepping stones or opportunities.

The other thing that’s really important — this is what Loretta, Kelley, Charlotte and Christine are speaking to — is to make sure that we have the best knowledge possible on what is effective, what results in better outcomes, and bringing Western and Indigenous perspectives to bear, to wrap around children. It shouldn’t just be: “Well, whatever.” It should be something that has some foundation to it — a historical understanding of well-being — just having a really good understanding of what is impactful for children’s well-being. I think those are the ways in which Bill 38 and this report actually complement one another.

I’m going to look to my colleagues for comments there. You’re much closer to it, Kelley.

K. McReynolds: Yes, I agree. Bill 38 certainly does support the Indigenous rights to jurisdiction, which is very promising and great to hear. But it needs to remain very strong in the language of the Indigenous people — to have Indigenous law prevalent and upheld.

[12:55 p.m.]

That really is around what we’re talking about as “our children, our way” — to be able to bring up our children in our own ways and honouring our ancestral way of life, so as not to be interfered with by any other laws that are out there. I think that’s what I would add to it.

L. Stewart: What I would add is that although there’s Bill 38 and jurisdiction and movement forward to our inherent rights, we still need services. We still need to ensure our services are being provided to children in care and Indigenous children, youth and families, and we still need those services to meet our Indigenous people where they’re at, where they’re trauma-informed and culturally appropriate. A truly trauma-informed practice means you have the ability and the capacity to work with our children, youth and families where they’re at and providing them with the adequate supports, services and resources that they need to move forward.

You know, the report focused on children in care. You think about children in care and the trauma that they have faced, but for a lot of our Indigenous families, we’re working really hard with them to ensure that they’re not coming into care. They still have faced those traumas, and they still need that level of support. They still need the western practice and cultural knowledge to come together to wrap the services around them. So it needs to move together in a good way. That’s what I would like to add.

K. Paddon (Chair): Henry, I’ll go ahead and let you ask your next question.

H. Yao: My second question, actually, is for Christine, and maybe even Kelley and Loretta can jump in as well.

We understand that research and meta-analysis was drawn from both the U.K. and the United States. Obviously, we also understand that correlation does not equal causation. One other thing, I think, from listening to a lot of Dr. Charlesworth’s report, once we have been educated: westernized diagnoses often fail in cultural understanding, such as misdiagnosing autism as FASD, because of racism and other issues.

I’m wondering. If we are looking forward to collecting data, and we want to truly be able to break away from a lot of potential cultural-racism bias, how would you recommend that we engage in this data collection in a way that can truly reflect British Columbians’ circumstances? If you don’t mind me saying this — and I hate to say it: the U.K. and the United States, definitely, in this aspect, are not reflective of us. I would love to have a more detailed or more in-depth understanding, if we’re going to be collecting this data.

C. Schwartz: Thank you for that important question. You’re absolutely right. Diagnoses need to be made carefully and cautiously so that they acknowledge and recognize differences in how symptoms of disorder may present, based on culture. I think that’s part of the reason that we set the high standards we do, about looking for rigour and making the diagnoses.

It’s not only using standards of classification that inherently, within them, recognize that there are cultural differences…. So the ICD is used internationally. The DSM is used more in Canada and the U.S. Then at the level beyond that, the interview, when that’s given, is making sure that the interviewer is aware of cultural differences and asks questions in appropriate ways for that.

The reason we set this high standard is that if you’re not careful in measuring, you can have the numbers go both ways. They can be overestimated; they can be underestimated. Because of the systematic review we did — it included data from, actually, six different countries; there was also France in there — in some ways that gives us more confidence in the data. It’s not just all from the U.S.

[1:00 p.m.]

What we also know is that differences in fundamental access to health services can also affect disorder rates, if kids don’t have those basic needs met. Indeed, there can be errors in the data, but because we searched for such high-quality data, it gives us confidence in it. The measure we’re suggesting for more widespread use in B.C. also gives us that confidence.

I’m also going to turn it over to my colleague Charlotte in case she has anything she wants to add to that.

C. Waddell: Henry, thank you for your question, which I, too, think is incredibly important.

Just to say a word about a strong agreement — Jennifer, you’ve articulated this, and Kelley, you did too — we need B.C.-based data. We’re always unhappy when we do our research process and we can’t identify good British Columbia studies. It happens all too frequently.

One of the things you’ve talked about, Jennifer and Alan, in your report very much is focusing on the need for data on B.C. kids, made-in-B.C. data.

The one suggestion we have that is quite easy to implement and that B.C. is, in fact, already using is this 30-​minute telephone interview, or it could be a Zoom interview, called a brief family and child phone interview. It goes through a set of mental health questions, and it can be done…. You can talk with kids themselves. You can talk with parents. You can talk with caregivers, teachers, clinicians — anybody surrounding that young person.

It feeds into what has been a really nicely constructed set of approaches to analyze the data and compare to Can­adian norms, if you will. It’s based on very large data sets based in Canada from epidemiological work that has been done on Canadian populations, reflecting our diversity.

Does it reflect the diversity perfectly? No. But it’s a lot better than looking to other countries all the time.

Christine and I strongly support doing something to really take a step to collect better B.C. data. It’s overdue.

J. Rice: I love the data conversation. I was looking up…. I was trying to find some statistics, and then I got sucked down one of your other RCY reports, Jennifer.

I guess my question is…. When you were…. I missed this in the beginning, so I’m sorry if you have to repeat yourselves. You talked about the countries that were used as comparisons, and I didn’t catch them all. I know Dr. Charlotte Waddell just spoke about France. Were we compared with other nations or communities that have such a high Indigenous population like ours? I’m sorry if you said that already.

J. Charlesworth: I’m going to put it over to Christine and Charlotte to answer that one in terms of the countries and the comparators. Then we’ll speak in after that.

C. Schwartz: The countries that were included in the meta-analyses were the U.S., the U.K., Norway, Germany and France. In terms of the representation of Indigenous youth, they would not be comparable to Canada, for at least four of the five countries.

J. Rice: That’s interesting. I just have one last comment, if you don’t mind.

The other day, I was flying to Rupert and my flight got diverted, and I flew Terrace and that got diverted. Then I finally got on a flight to Terrace and I met…. Normally I work or tune out with Netflix, but I struck up a conversation with this really interesting woman. We talked the whole flight, and the flight flew by for me.

I believe that was you, Loretta, if I’m not mistaken.

L. Stewart: Yes. That’s correct. That was me.

[1:05 p.m.]

J. Rice: Anyways, I wanted to share with you how much I enjoyed our conversation, and of course I learned so much about our child welfare system on that flight, as it is, but more so today. I just wanted to say thanks for that.

L. Stewart: Good to see you. Thank you.

J. Charlesworth: I love that.

If I can just pick up on your very important point, Jennifer, of: is this data comparable? We struggled with that. We worked with Charlotte and Christine, and Alan, I should say, was the author of the RCY report. So Alan was right on top of this.

We felt it was still important to bring things forward, recognizing that as a limitation. It’s important for you to know that there’s that limitation, that we don’t have the B.C. data, that we don’t have the Canadian data and that we don’t have the Indigenous experience well represented in it. Hence the importance of working really closely with Indigenous Child and Family Services and other Nations, and with putting some effort and energy towards this so that we have a better understanding. You can’t plan if you don’t know.

This is really critical for us. So we felt it was important to bring it forward. We have confidence in the information as presented there, but as Alan has quite rightly said, it probably indicates that we have under-reporting, or we have a higher prevalence, in other words, given the diversity and the complexity in B.C.’s circumstances. Thank you for that question.

J. Rice: Madam Chair, if you wouldn’t mind.

I would agree totally with what you said. That’s where my mind went. I was trying to think of what a good comparison would be. I don’t know enough about the world or global…. I don’t know, but the easier one that came to mind was that New Zealand would be interesting, where it has such a high Indigenous population but also has a high settler population as well.

It’s not that I’m telling you how to do your work. You guys are the pros and the experts. I am not, but I just do find it really interesting. That’s exactly where my mind went — just the under…. Not even being a true reflection — not to use a terrible word — of just how severe the situation is or how much more we need to know. So I hear you. I’ve heard that from all of you in all of your presentations. I’ll leave it at that.

A. Markwart: If I could offer just a degree of speculation around that, the prevalence in Charlotte’s and Christine’s report around PTSD was 4 percent, which was 40 times higher than in the general population. I would think, and I agree it’s speculative, that it may well be substantially higher among the Indigenous child welfare population, as an example.

F. Donnelly: Thank you to everyone for your presentations.

Jennifer, I was hesitant to ask this question, but I am very curious about it. I totally agree with your emphasis on prevention. Would you recommend, or could you or would you avoid recommending, a focus on budgets, as a policy, for instance, to focus a percentage on prevention versus reaction or crisis?

J. Charlesworth: In the sense of the mental health budget, per se?

F. Donnelly: Yeah. Any budget that has to deal with a shift towards — to get to that prevention. In my parliamentary secretary role on conservation, it’s often such an important realization. We know we have to focus more on prevention, and it’s actually cheaper in the long run. But with regard to children and youth, it’s a little bit different. That was my hesitance about asking this question. But, you know, like if [audio interrupted].

[1:10 p.m.]

K. Paddon (Chair): I’m glad to see Hansard back with us so that this is all on record.

Dr. Charlesworth, if you could repeat your response, that would be fantastic.

[1:15 p.m.]

J. Charlesworth: Well, Fin, it’s an excellent question. It’s probably…. The question that we’ve wrestled with for decades, really, is: what’s the balance between prevention, early intervention, crisis intervention, treatment — that kind of thing?

I would say I think it is important that we consciously and proactively invest in the prevention. But I’d be reluctant to say, “Oh, well, 10 percent of the mental health budget,” for example, “needs to go to prevention,” because we need to take a look at this in a broader context — children in the context of their families, in the context of their community, their nation and our society.

As I was mentioning earlier, Gemma and Jennifer Dreyer, who are with us today, are in fact working on what we call keeping families safely together, which is, fundamentally, about how it is you support families and build the capacity of the families, especially when they’ve got little ones, so that there’s less in-care intervention and that they’re able to raise their children up and have mental experience and mental wellness.

I think we have to look at it in the context of not just mental health but what the other things are that we can do that create the opportunities for higher mental wellness, which is really what Kelley and Loretta and the team that’s worked on Culture Is Healing are all about, and Alan.

A. Markwart: Well, it depends on which hat I’m wearing. In principle, with the RCY hat, of course I would agree with dedicating money to prevention. As a former ADM with MCFD, I was responsible for child and youth mental health services and a range of other programs. I can tell you, it’s very hard to do, in practice. Within a sphere of very limited resources and overwhelming needs, can you choose to ignore the urgent needs that are before you for the sake of others?

I can say that, going forward, there is a pathway forward. I think moving money and resources to prevention in the face of limited resources to begin with would be extremely difficult. But a portion of resources, going forward, could and perhaps should be dedicated to prevention. You can either do that as a proportion of the budget or a specific program initiative, such as nurse-family partnership, which is a good example of that.

If that were to be done, I couldn’t emphasize enough that there needs to be accountability around those expenditures to ensure that those resources indeed do go to the kinds of targets that you’re intending. Otherwise, they’ll get lost and drawn up and used for other purposes.

Those are my comments.

K. Paddon (Chair): I see Dr. Waddell.

Do you have something to add here?

C. Waddell: Yeah, I just wonder if I could add a couple of quick things to what you’ve said, Jennifer and Alan.

Fin, thank you so much for this question about prevention. Christine and I and others at our centre, too, struggle with the same questions of: how do we help people really embrace the idea of intervening far earlier, when we can do so much good and can prevent problems that are avoidable, quite frankly, and prevent children from having to experience avoidable adversities?

One proviso we always recommend is to make sure, if you were to target budgets, that the money goes towards things that are effective — programs that are proven.

Alan, I think that may be what you meant by “accountable.”

Don’t just put the money out loosely, which, of course, you never would, but really demand considerable evidence of effectiveness, including cultural safety evidence and evidence from Indigenous communities.

On nurse-family partnership, Alan, that’s a good example, because it didn’t come about through earmarking 10 percent, for example. It came about through a multi-ministry, multi–health authority, multi-million-dollar set of commitments.

That program is an example of…. We’ve just finished the randomized control trial evaluating it, so there’s the accountability. We’ve got success. It goes into the homes of girls and young women who are pregnant for the first time and experiencing significant socioeconomic disadvantage, and it just gives them intensive supports.

The goal is — and Christine, you mentioned this — to keep kids and parents together and to support that young mother to be the best possible parent she can be.

[1:20 p.m.]

The data from the U.S. on nurse-family partnership has long shown, and this is where it gets complicated thinking about earmarking budgets, that over ten years or more, if you account for services that were not needed over multiple public sectors, the nurse-family partnership more than pays for itself. In fact, it generates income.

Those kids don’t need foster care. They never come into foster care. They don’t need special education. There’s less use of the health care system because there are things like fewer injuries. So many, many different benefits that accrue.

You have to look at it in a pan-governmental way, in a sense, and look at it over an adequate amount of time. So we’re tracking those data for the nurse-family partnership trial in B.C.

I’ll add one final thing, back to the comments about the representation of Indigenous populations in the research. In our nurse-family partnership trial…. My current data suggest that about 6 percent of the population in B.C. is Indigenous. Our trial has…. One-quarter of the participants…. Twenty-five percent of the mothers are Indigenous, and more than one-third of the children are Indigenous.

What we’ve shown is that NFP is feasible with populations. This group of people volunteered. They signed up. They wanted this program, along with anything else they could get, to really improve their child’s chances.

We have a nice foundation to build on, and we have a number of Indigenous communities reaching out to say: “We want to tailor the program. We want to enhance the cultural suitability, and so forth.” That’s another level of accountability to me, Alan, looking at…. Can it serve Indigenous children and mothers well also?

I would say, Fin, your question is incredibly important. If we don’t earmark it — prevention, I mean — it won’t ever happen. I would also say…. This is maybe my last comment. Don’t take it away from treatment. Add to children’s budgets overall. Don’t take away from kids. Give them more.

K. Paddon (Chair): Thank you for that.

We have two more questions and only a couple more minutes for this topic.

Susie, I’ll ask you to go ahead.

S. Chant: Okay. I’ve got some shotgun questions here real quick. Is the brief child home interview mandated into the care system at the moment, or it just happens when it happens? So we don’t…. I’m seeing shaking heads, so that’s my answer. Great. Thank you.

Does the information from that go to CIHI? That’s the Canadian Institute for Health Information. No, it does not. Thank you.

I’m on board with Jennifer and somebody else in terms of New Zealand. Just out of curiosity, I think we should look at New Zealand and see what they’ve got. In the past, I’ve worked with some other stuff related to the standing up of the First Nations Health Authority. We were getting a lot of people from New Zealand coming to help because there was zero data at the time. They were helping us, at least, remember to look at something. So that’s that.

With the RN-family partnership, when was it implemented? Thank you.

J. Charlesworth: Charlotte, I will turn to you for the nurse-family partnership.

C. Waddell: Yep. Quick answer. It started in 2013.

K. Paddon (Chair): All right. That was the fastest shotgun question period ever. That’s fantastic.

We have time, Henry, for your last question.

H. Yao: Thank you so much for the opportunity.

I do have a question about the chart you initially showed, Dr. Jennifer Charlesworth. You said there was no mental health and mental health with substance…. Bear with me if my question doesn’t make any sense. Are you suggesting there are no youth in care who are using substances and who are showing signs of mental health concerns? Or do you think mental health is directly associated with all substance usage in the youth in foster care?

J. Charlesworth: Okay. I’m going to look to Alan on this one.

Basically, as I understand it, we’ve got…. There would also be another bar, if you will, that would just have substance use, but because we were focusing on mental health, mental health showing up in some way…. That’s why we had the concurrent and the mental health alone.

Am I right, Alan?

[1:25 p.m.]

A. Markwart: Exactly. That’s exactly right. Also, you have to bear in mind that this is the full range of ages, from zero to 19. For the most part, say, children under 12 would not have substance use problems.

K. Paddon (Chair): Thank you so much. This has been a great discussion.

We’re going to move on to the next item on the agenda. I just want to thank all of our guests who came today to be able to make sure that we could dig in and understand this report in the best way.

Thank you for coming and for sharing your expertise and your insight and wisdom and stories.

We’re now going to hear from the representative regarding the information report Beyond Compliance: Ensuring Quality in Care Planning. For this conversation, we have, again, Dr. Charlesworth, Representative for Children and Youth; Jennifer Dreyer, executive director, systemic advo­cacy and First Nation, Métis and Inuit research; Gemma Martin, research officer, systemic advocacy and First Nation, Métis and Inuit research.

Thank you for being here. I will leave it to you, Dr. Charlesworth.

Beyond Compliance:
Ensuring Quality in Care Planning

J. Charlesworth: Great, thank you.

Cue you, Karan, for slides. Perfect. You got it. Thank you so much.

Just in case Charlotte, Christine, Loretta and Kelley drop off, thank you so much for spending time with us and sharing. It’s very exciting to continue the collaborations that we have with these wonderful partners. We look forward to bringing this committee further work in the area of mental health with our guests today. So thank you very much. Hands up to you for your work in the world.

Shifting, we will now talk about Beyond Compliance: Ensuring Quality in Care Planning. We actually released this on April 26. We’ve had it on the agenda before, but we’ve had such robust conversations on other reports that it’s taken us a little while to get to this one.

Thanks for your patience on that. Thank you to the staff for their patience.

The care planning review project was actually initiated by my predecessor, Bernard Richard. The initial goal was to review care plans and the process of care planning for children and youth in government care from the perspective of assessing quality and to develop audit instruments that could be adopted by MCFD. So it was a different kind of a journey that we went on with this one.

It was actually initiated following the release of Indigenous Resilience, Connectedness and Reunification: From Root Causes to Root Solutions, A Report on Indigenous Child Welfare in British Columbia in 2016. That’s sometimes referred to as the Grand Chief Ed John report. Actually, in that report, it proposed that the representative conduct annual reviews of care plans for Indigenous children in the care of government. We’ve had a long interest in care plans and care planning, and we wanted to go beyond the compliance type of reporting.

What has happened, typically, for the benefit of the members of this committee, is…. There are audits done as in: is a care plan on file, or is a care plan not on file? That’s one way of measuring things, but it’s actually a pretty crude measure. What’s the quality of that care plan? Has it actually been done in such a way with the people who know about that child? Is it paying attention to the child’s hopes, dreams and aspirations or the things that they’re struggling with, their goals? So we wanted to go beyond compliance and get into quality.

Our data, actually, from reports on critical injuries and deaths and through our advocacy, suggest that oftentimes the quality of care planning is an issue. Just to give you an example from this morning’s review, there were many reportables where the last time a care plan had been done was in 2020 or in 2021. So the standards that are in place are not being followed.

Then when we go into those care plans, as we did in a couple of situations…. We were talking about a couple of situations this morning. There’s really very little in the care plan that is focused on that child. Sometimes we see what we call cookie-cutter or cut-and-paste kinds of care plans that don’t actually reflect the child and the child’s needs.

So what did we do? We examined MCFD practice related to cultural planning for Indigenous children and youth, planning for youth transitioning into adulthood and permanency planning for all children and youth. Now we call it belonging planning for all children and youth. So those three areas.

[1:30 p.m.]

The team used a mixed-methods approach to do this and developed a series of data collection tools, special purpose designed, to examine the quality of both the care plan documents and the care planning process for children and youth in care.

We also did a literature review. We did scans of policies and practices in other jurisdictions. We analyzed MCFD care planning policies in their documents. Then we had internal and external advisory committees.

We did a pilot study, during which the team tested the different tools — survey instruments, interviews, audits, etc. Then the team audited, doing very in-depth reviews of 163 care plans representing 66 child service files. What we are taking a look at is: is there change over time? So we might have looked at two or three care plans for a specific child.

The team also collected qualitative and quantitative data, using surveys with social workers, team leaders and foster care givers. There were 143 foster parents and 318 social workers that contributed survey responses. These were very lengthy surveys, lots of open-ended questions.

Then they went and did interviews. They created an opportunity for anybody who had done a survey to undertake an interview. They did nine interviews, in-depth interviews, with foster parents; 53 with social workers; and 16 with team leaders.

They also worked with the McCreary Centre Society to get youth input on their experience of care planning.

Then McCreary did a focus group in a series of one-on-one interviews, so another 16 youth in the focus group and 20 one-on-one interviews with young people. Our team also did an additional eight interviews with young people after connecting with some of our community partners.

The difficulty was that the pandemic got in the way of some of our youth engagement, so the numbers of the young people that we engaged were not as high as we had hoped. All this to say that it was quite a robust methodology. We found some interesting things through this. Basically, the fundamental finding is that youth, social workers and foster care givers weren’t satisfied with the care planning process, but for different reasons.

I just want to take a moment. There was a big aha for me that I’ll share. We’d focused so much on care plans as a product, as something that’s defined. What we learned was how important it was that care planning took place. The process was more important than the product in many situations, because if the process doesn’t include family, significant others, the young person’s voice, if possible, if it’s not really taking a look at the child in their context and understanding what the possibilities are, what the risks are, what the opportunities are to support this young person, then the plan will not be as strong as it could be. So the planning became very important. Hence, what we talked about is ensuring quality in care planning.

Next slide, please. This is what we found as challenges from the youth perspective. Fundamentally, youth felt left out, as if their voices didn’t matter. They said that their social workers were too often unavailable. Communication was lacking. Transition planning was insufficient or nonexistent, and cultural planning was inconsistent and sometimes inappropriate — a pan-Indigenous approach, rather than connecting them to their culture.

They also cited social worker turnover as an issue and the lack of time their social workers had. As we often find with young people, they’re very generous. They often say: “You know, I know my worker was really busy. I know that it’s really tough work and whatnot, but this is how I felt.”

Since we undertook this work, there has, of course, been some really important work around transitions and aging into adulthood. So it will be very interesting for us to compare the notes that we had through the care planning work with what the young people say, for example, about transition planning. That, of course, gets challenged because the turnover and the caseloads and the workers’ stress has actually escalated significantly. So that was what the young people said.

What did the foster care givers say? They felt that their input wasn’t always valued. We hear this a lot through our advocacy work. They felt that they were underutilized, often not included in the care planning process. They had limited opportunities.

[1:35 p.m.]

They, too, said social workers are overworked, and it’s hard for them to even access social workers or to be able to share the information that they think is important for the care planning process.

They also talked about the inconsistency in cultural training and planning and that they, too, were struggling. They often weren’t supported to be able to do the work that was necessary to fulfil the plans, even if they were there.

There were inconsistencies in the quality of care planning for children and youth with complex needs. They felt — and we see it as well — that care planning starts to really fall down the more complex the needs of the child are.

What did we find from social workers and team leaders? Workload kind of mirrors what we were hearing before. They felt under-resourced and overwhelmed with the work. They felt that they weren’t able to practise good care planning, even when they knew what had to be done and when they wanted to do it. They cited organizational barriers such as the volume of paperwork required as well as challenges with the integrated case management, or ICM system. They talked about the problem of staff recruitment and retention and the impact on young people when their social workers change.

They also said their own cultural training was insufficient and/or that they weren’t able to access colleagues — for example, Roots or Family Finders workers or others — that could assist them in preparing good cultural plans. Even when training was available to them, they didn’t have the time to take them, and workload surpassed their ability to participate in their ongoing learning. They cited the limited number of community supports, a problem that’s amplified, particularly in the smaller communities.

Before I go on…. I should have mentioned this before. Our work here was entirely focused on MCFD. This was a decision made before I came, but we didn’t do this work with the Indigenous child and family service agencies. It would be very interesting for us to work with them with respect to their care planning process, particularly around the cultural plans. There’s lots to learn from sharing information.

Through all of the different work that we did, we identified six main dimensions of quality care planning. We discuss those at length in the report. Basically, they are….

Have the child participate in the process, support the participation of the child, and collaborate with the child’s parents, family and community.

If we want to talk about prevention, there’s another dimension on that, the child within the context of their community and their family.

The third dimension was to ensure that care planning supports the continuity of relationships for the child. This goes back to the belonging and relational belonging.

Nurture the child’s identity and sense of self. This goes back to belonging again.

Apply an expanded understanding of permanency that brings in that concept of belonging.

Plan early for supported transitions into adulthood. That planning should begin at 15, 16 years of age for a child that’s going to be aging into adulthood from care.

Those are the dimensions that came up through the research that we did and the literature as well. So we know what the dimensions are.

We also decided that we wanted to take a look at bright spots. So we have some examples of bright spots where good practice is already happening.

We included, as well, in our report an example of a complete care planning process that successfully included all of these six dimensions, the intention being to say: “This is possible. It’s amongst you now, and it results in better outcomes for kids.” In fact, in the example, it definitely resulted in a very positive outcome for the young person.

We thought it was important to show this. We recognize it’s hard for a whole variety of reasons: the organizational barriers, the workload, etc. We also wanted people to be brought into this notion of when it happens and makes a difference in a child’s life. What can we do, individually and systemically, that will enhance the likelihood of good care planning with young people so that we have better outcomes? You can also see we were able to make a strong connection back to Skye’s story and belonging.

[1:40 p.m.]

We did not make recommendations in this report. Really, we’ve said the things that needed to be said, particularly in Skye’s Legacy.

We also felt that our relationship with the ministry is, of course, extremely important, and they are doing some good work in this area already. They’re trying to improve the care planning process. So we wanted to make sure that they had our best information that they can incorporate into that.

We suggested that they take a look at their care planning and case management standards and our policies, practice guidelines and training materials with the goal of aligning those materials with the dimensions of belonging. So it was really what we might call a soft release or a soft-touch report. It doesn’t have the recommendations, and it’s really to try and bolster the work that’s going on in the ministry.

The other thing that we were very clear with the ministry about is that they have to go beyond auditing for compliance and reflect a deeper understanding of quality. We shared with them all of the tools that we had that we thought might be useful. We also told them about the tools that we didn’t find particularly useful. We just said: “Look, we tried this. You don’t have to replicate it. This isn’t particularly helpful, but here are the things that we think are important.”

We’re hoping this report will catalyze discussion and action about the barriers and challenges to ensuring quality care plans and care planning. Of course, our ultimate goal is to enhance young people’s experience of connection and belonging during and as a result of their in-care experience, and to improve outcomes.

So that’s a light touch on a very extensive piece of work. I’m joined by Jennifer Dreyer and Gemma Martin, who brought this one home. Gemma came in, joined the RCY, and we dumped all of this on her lap — and a lot of data. So Gemma and the team in systemic advocacy did a remarkable job to bring this one home.

Back to you, Chair.

K. Paddon (Chair): Thank you so much for that. I really liked the key dimensions graphic that was in that report. I think it’s on page 23, if anybody else wants to see it. That was on that last slide. It’s a fantastic graphic. As someone who has done different kinds of individualized planning…. That’s a great graphic. I’m just going to say that.

I’m going to go first, and then I’ll hand it over to Mike. I’m really interested in hearing, hopefully, from Indigenous child and family service agencies regarding the care planning and cultural planning and how this looks for them, specifically even organizations that maybe are doing things in a very different way.

There’s a lot of potential for us to see if the problems are being reproduced in these different environments or if there’s opportunity for improvement. That can be some shared learning there, with different approaches. I’m very interested in that. I hope that we see something or hear about that from agencies in the future, especially in light of this report. That’s not really a question. It’s just kind of a plug for the graphic and information to come.

I will pass it along to Mike for his question, unless you have any comments on my comment.

J. Charlesworth: Sorry. Before Mike speaks in, I just want to invite Jennifer Dreyer, because one of the things that she’s done in her career is work in one of the Indigenous child and family service agencies, in the urban agencies.

Jen, would you like to offer in something there?

J. Dreyer: Sure. I think that would be such a fascinating look, to dive into what Indigenous child and family service agencies are doing. Part of the reason why, early on, the project team had to decide not to include care plans from Indigenous child and family service agencies is just the diversity that’s out there. There’s a lot of progress being made towards the relational practice that’s called for in this report within Indigenous child and family service agencies. They’re doing care planning in a very different way. So it’s definitely something we can look more into.

I just want to acknowledge that beautiful graphic. I’m glad that Gemma is here, because we also have little ones that sneak into the camera during our day, Henry.

One of our little ones, Penny, Gemma’s daughter, was the one who gave us the inspiration for how that visual came, because it really goes back to Skye’s story, where that belonging circle goes around and that the heart and the love have to be in the centre of all of the planning work that we do for our little people.

[1:45 p.m.]

K. Paddon (Chair): Go ahead, Mike. And then, Karin, did you have a question after?

K. Kirkpatrick: Yeah, sorry. I have a comment, but I’ll wait until after the…. I thought, Kelli, you’d be worried about me because I haven’t said anything yet.

M. Bernier (Deputy Chair): I’ll jump in. I was almost worried about Karin for a minute, too, there, but I won’t be now, knowing.

Welcome and thanks, everybody. One of the things…. I know it’s more of a ministry issue, but what I want to flag here, especially reading this report, too, is really around some of the ministry struggles in burnout that they’re facing right now.

This will be more of an acknowledgment than it will be a question, Dr. Charlesworth, unless you can comment on this. I just want to give some local examples. Rural British Columbia struggles already when it comes to finding — I don’t want to say dedicated staff; that’s not the right word — the right people to be able to fill the roles that we need in rural B.C. I did some research today before our meeting just to put it in perspective. I have a community like Chetwynd that, according to the ministry, is supposed to have four staff there, and there’s one. Tumbler Ridge doesn’t have any. Dawson Creek, where I live, which is the hub, only has a few.

There are huge vacancies. But the one, for me, is the turnover. We have one person who has served 32 years who has just put in that now she’s retiring. The next-longest-serving person, I believe, is 18 months because of the turnover that we have. I want to flag that. I know it’s not something you don’t know, but I think we need to be talking about this. We, in our offices as MLAs, even outside of this committee, hear of the struggles on the ground that families, caregivers and our youth are really facing around trying to have that stability within their workers and within the offices.

Nothing compounds that more than our staff being burned out, leaving or not even being able to recruit the staff to begin with. So I think it’s something that we need to be talking about more often and making sure we highlight the fact that we need to be recruiting.

I know lots of health professions have this issue, but we’re talking about our children here, our youth, and we need to be able to figure out a way to fill this gap, otherwise we’re just going to see more people leaving as they struggle with trying to keep up with the workload. I just wanted to highlight that.

J. Charlesworth: If I may, Chair, I would like to respond.

Thank you so much, Mike, for that. I think it’s such a critically important person. As you hear from the young people, they want to have relationships in their life. When that gets fractured over and over again, and then they feel…. That creates unbelonging over time.

Just for the committee’s benefit, one of the reasons we didn’t do recommendations was because we didn’t want to put salt in the wound, frankly. The system is struggling mightily right now, and what we wanted to do is say: “Look, these are important elements. How can we support this work going forward? What are the things that might be useful in terms of the planning? What are those organizational barriers, those annoyances that are getting in the way of the staff being able to do their work?”

That was one of the reasons we didn’t need to…. It’s obvious. Of course every child should have a care plan. That’s why it’s in policy. The reality is that it’s not happening, for a variety of reasons, so how are we going to do that? One thing that I am contemplating doing is a special piece of work on staffing, recruitment and retention, because that is a huge, huge problem.

As you say, Mike, you’ve got Chetwynd with one, Tumbler Ridge with zero. We’ve got nine offices, at least, last count that I knew of, that have zero staff. We’ve got a dozen offices that have less than 50 percent capacity, many offices that have no one that’s delegated under the authority of the Child, Family and Community Service Act. That becomes a vicious cycle.

It is an area that’s critically important. I think that we need to increase the number of spots in our post-secondary institutions. We need to think creatively, particularly in small communities. How do you grow…? For the people that are already connected to their community, how do we get in there and support them to get their credentials and the ability? They’re already invested in their community.

[1:50 p.m.]

When I first started, I was headed up to your part of the province, Mike, but I wasn’t going to stay there, because I’m a coastal person. Better to grow those relationships within community and support folks close to their homes. I think it’s a really important point. I just want to say that we’re on it and trying to figure out what the contribution is that the RCY could make to this vitally important issue. Thank you for raising that.

M. Bernier (Deputy Chair): The only thing I’ll add is that I’m a coastal person. I moved up here, and I stayed, so it can be done.

K. Kirkpatrick: Thank you to the RCY and to all of your team. As a critic for MCFD, I hear from parents and from foster parents on a daily basis. It’s almost overwhelming, so I do not know how you and your office, Dr. Charlesworth, do the work that you do. Some days I actually feel a bit defeated, so listening to the presentations today and the importance of intervention on mental health and addictions issues….

I know that social workers now — and this is reflective of what Mike Bernier just said — are overwhelmed. They are tired, and they can’t recruit, and there are not enough people. Even to do the work that they’re supposed to be doing today is impossible, and there’s burnout. Again, just everything that Mike just said.

I can imagine that for you and your staff, there must be a level of frustration that you feel in terms of all of these amazing reports that you put time into and the recommendations you make. Whether MCFD wants to undertake these recommendations or not, the capacity for them to do so is just something that I am so worried about. I’m calling different offices every day. I’m finding that there are people who have left and there’s nobody in charge of something. Then, Dr. Charlesworth, I thank you, because you’re often a person that I can then call saying, “What can I do?” and you’ll send me somewhere else.

It really was an appreciation and thanks to you and your team, and just sharing this frustration I have that there really need to be more resources, I believe, put into MCFD — more resources in recruiting and training and retaining those social workers who have such large caseloads and do such good work and want to do such good work.

I just wanted to end by saying that and just to thank you so much for all the work you do. I struggle with the calls I get, and I can’t imagine the cases that you work with and how distressing they are. Yet you stay and you do the hard work, so thank you.

K. Paddon (Chair): Any comments on that? Or I’ll move onto the next question.

J. Charlesworth: Thank you.

S. Chant: Thank you so much. Lots and lots of stuff. Nurse by trade. Care planning has been part of my life — beaten into me in university; beaten out of me in practice. It took a long time for me to figure out that care planning has to be working together, not working instead of, and that if you don’t care plan with the person the care plan is about, plus whatever resources you’re hoping to use, plus whoever is supposed to implement it and make sure it happens, it’s a useless document.

Interested in knowing, and this may not be answerable at this time, in terms of care planning within the training environment, as people come out, what that training looks like in terms of the training itself, what kind of documentation is expected and if it’s electronic yet, because that, too, is a question of interest to me for two purposes. One, for possibly making it easier, although I’ve seen electronic care planning making life much harder. And two, from the premises of data collection and understanding.

I guess my question overall is the care planning that is done in and around kids in care. Having been a foster parent, also…. I don’t know that I ever saw evidence of care planning — like, ever. I was the care planner, and it was exclusive of the social workers. I needed it to be done, and that’s how I got mine done. Let’s put it that way.

[1:55 p.m.]

I guess my question is: first of all, is there electronic care planning happening? Second of all, is it shareable with all the people that need to be involved in the care plan process? Is it a fluid document?

So that’s me. Thank you.

J. Charlesworth: Great. I’m going to turn that over to Jennifer Dreyer, with one quick comment before.

For 12 years, I taught child and youth care at the University of Victoria as a sessional and wrote two books, actually, on care planning. One of the things I will say is we…. I can’t speak to social work, but certainly in child and youth care, which is where many staff come from, there was very little attention paid to the mechanics of care planning. It’s definitely an area that needs to be developed there.

Typically what happens is people come into the ministry, and then there’s sort of the policy and the procedures that are outlined there at that point. But I think it’s such an important point. How do we prepare people to do planning, to understand what planning is actually about? Then we can get to filling in the boxes and whatnot.

But I’m going to pass it over to Jennifer Dreyer.

J. Dreyer: Thanks for your question, Susie. I so appreciate that description of planning being taught to you and then unlearned when you go out to the field. That was my same experience.

I think what we heard from so many was that the care planning process within ICM, the integrated case managing system — the documentation and administrative burden of care planning actually interrupts the relational practice that we’re calling for in this report.

This is not a new issue that our office has spoken to. One of the first reports that I became familiar with when I went to MCFD was The Thin Front Line, which talked about the weight of the administrative burden of documentation and how that interrupts the delivery of services — in that case, specific to child safety. We heard the same thing from these social workers that we interviewed, as well as the caregivers themselves.

Some exciting work has come out of The Thin Front Line. It has definitely taken some time, but through that was the recommendation to update the internal predictive workload models, which showed exactly what you’re saying: there are not enough hours in a social workers’ day to complete the work expectations for them. We can say that with great confidence. So there has been work within the ministry to try to reduce the administrative burden of care planning, but it’s slow coming.

One of the exciting pieces of work that came from that was the mobility project, where they actually had tablets. This is going to seem like: “Oh, of course they should have had that all of these years.” They’re piloting the opportunity for social workers to take tablets, to sit with families and young people and document it right there rather than having to go back and type it all up there afterwards.

They’re definitely looking for opportunities, but really, a big piece of this work that we learned is that those care plans, those boxes, do not reflect the relational practice and the dimensions of belonging as we’ve come to understand them. So even if we fill that system with more and more staff, they’re still doing cumbersome administrative work in terms of improving the quality of outcomes for children.

K. Paddon (Chair): Thank you so much for that.

We have reached the limit of our time. I know some people have to be in other places, magically, through the world of Zoom.

I just want to thank you, Members, and thank you to the representative and all the staff for joining us this afternoon. I really appreciate the time it takes not only to put the work together but then to come and spoon-feed it and answer our questions. I really do appreciate it. It’s very valuable.

Seeing no further business, I would entertain a motion to adjourn.

Motion approved.

The committee adjourned at 1:59 p.m.