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Jurisdictional Review

The Panel conducted a review of publicly available information about the governance models utilized by several other jurisdictions nationally and internationally. Jurisdictions within and outside of Canada were examined, including British Columbia, Alberta, Quebec, Saskatchewan, Manitoba, Nova Scotia, Newfoundland, New Brunswick, California, New York, Wisconsin, the United Kingdom, Israel, and Australia. The review included both a comprehensive literature search as well as consultations with key informants from various jurisdictions. Overall, we did not find an alternative governance model for which there was clear and compelling evidence that it ought to be implemented in Ontario. Many jurisdictions appear to be grappling with the difficult question of how to best govern and oversee residential services for children and youth, and ensure that residential service providers are delivering effective and high-quality services for young people. Some best and promising practices were nevertheless identified from the inter-jurisdictional review, which have informed some of the Panel’s recommendations. For example, centralization of standards and placement information appear to allow for greater oversight on the system of services, and framing standards and evaluations from the perspective of children and youth appears to support quality assurance in a meaningful way.

The Panel also explored Ontario exemplars including the Long Term Care (Ministry of Health and Long Term Care) and Child Care (Ministry of Education) sectors. These local exemplars serve vulnerable populations in a residential or care setting similar to residential services for children and youth, and are perceived to have modern governance structures and regulatory frameworks in place. Both sectors have legislatively-enabled practices that the Panel considers to be best practices and which have influenced the recommendations of the Panel related to governance.

The Panel also reviewed many previous reports on residential services in Ontario over the past decade and found remarkably consistent findings to our own. The Bay Report (2006), The Blueprint for Fundamental Change (2013), and We Are Your Sons and Daughters (2007) all presented recommendations along the themes of Oversight, Accountability, Service Delivery, and Funding based on identification of issues very similar to those noted by the Panel. All of these reports put forth general recommendations about strengthening oversight and accountability within the Ministry. Specific recommendations around enhanced licensing through unannounced inspections and progressive enforcement strategies, greater consistency in application of standards, and, a focus on quality within an accountability framework were found in all.

On the themes of oversight and accountability, The Bay Report (2006) recommended that the Ministry establish a more consistent approach to governance and accountability and that it should consider undertaking a review of all tools currently in use to determine how they could be strengthened by clarifying accountability, expectations and reporting requirements. It recommended a review of licensing, contracting arrangements and financial reporting. The Bay Report (2006) went on to recommend that licensing be developed into a more effective tool to better provide for quality services in residential settings. It indicated that this could include developing progressive enforcement strategies, incentives for quality, and greater powers in granting and removing a license. Other interim progressive measures such as more effective use of random inspections could also be implemented.

The Blueprint for Fundamental Change (2013) echoed these recommendations, calling for the Ministry to improve oversight to ensure that children and youth have consistent, high quality care within a clear licensing and accountability framework. It urged the Ministry to consider additional methods of oversight such as unannounced inspections. The Report on the CFSA Review (2015a) also provided recommendations related to oversight and accountability, including greater consistency in application of standards, regardless of geography, and a more robust system of inspections and enforcement including more frequent and unannounced visits. It also proposed that OPRs be subject to significantly more rigorous oversight, inspection, assessment and/or review.

In addition to licensing-related recommendations, previous reports also spoke to the need for a public website to provide information about residential services as key to improving oversight and accountability. The Bay Report (2006) suggested that a publicly available inventory of residential services be established as the basis for a central bed registry for each community area. The report indicated that this would facilitate a more integrated approach to service planning, and support placement decisions. The Report on the CFSA Review (2015a) also recommended public reporting on quality, safety, compliance and other performance measures to foster clearer and more transparent performance expectations.

Various reports also made recommendations around how to include quality into oversight and accountability frameworks and mechanisms, however, no consistent approach is found among the reports. The Bay Report (2006) focuses its recommendations on the early stages of assigning roles and responsibilities for quality between the Ministry and service providers, suggesting that a key role for the Ministry could be the development of standards of care, quality indicators, and outcomes. We Are Your Sons and Daughters (2007) tackles quality from an operational perspective, recommending the establishment of a regulatory body to develop and enforce standards of care with a focus on quality for all residential settings. And The Report on the CFSA Review (2015a) seeds the notion of continuous quality improvement rather than continuing to focus on minimum standards.

Finally, previous reports have given some attention to funding considerations related to residential services. No report makes a recommendation around a new funding model. Both The Bay Report (2006) and The Report on the CFSA Review (2015a) however do note the inconsistencies in both the approach to and the impact of per diem rate setting across regions, and strongly suggest that there be a review. Both reports also suggest looking at anchoring per diems to an evaluation metric such as need, or performance.