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1. GOVERNANCE

Introduction

The Ministry of Children and Youth Services’ 2013-2018 Strategic Plan entitled “Growing Together” rests on five foundations, three of which are particularly relevant to their commitment to providing good governance. Foundation 2, “Knowledge and Information Management”, Foundation 3, “System Stewardship and Partnership” and Foundation 4, “Robust Internal Controls and Resource Oversight” articulate the Ministry’s commitments. These include respectively a commitment to an integrated approach to managing and sharing data and information; strong stewardship, leadership and partnership; and robust controls and oversight to ensure the best outcomes for children and youth.

The Child and Family Services Act (CFSA) sets out requirements specific to residential care and licensing of residential care in Ontario. The Youth Criminal Justice Act (YCJA) sets out sentences ordered by the courts, including open or secure custody. Access to residential services for mental health is not legislatively mandated, with the exception of secure treatment programs under Part IV of the CFSA. Children’s Residences (group homes) and residential care (foster homes) are licensed and, in many cases, funded under the authority of the CFSA.

The residential care system for children and youth in Ontario has grown organically. It is a large, complex collection of a diverse mix of service providers, including ministry directly operated, transfer payment operated, private non-profit and for-profit operators. As of January 2016, there were approximately 16,115 residential beds for children and youth across Ontario, approximately 6,000 of which were being utilized by Crown Wards. There were over 600 licences issued by the Ministry to residential service providers including Children’s Residences and Foster Care Agencies (both transfer payment funded and private per diem funded operators). The Ministry invests approximately 1 billion dollars in residential care, approximately one-third of the Ministry’s expenditures (MCYS, nd).

In all sectors, service is highly decentralized and the size of service providers varies widely. Diversity is the primary potential strength of a decentralized approach. In theory, there can be significant benefits to locally developed and delivered services that leverage community resources to meet the specific needs of children and youth. Varying areas of specialization across providers and a mixed funding model that balances the stability of providers funded through annual-base budgets, with the nimbleness of per diem funded providers that can scale to meet demand are also potential strengths. However, from a governance perspective, it is challenging to ensure that there is appropriate oversight and accountability, access, coordination, communication and information sharing at both the system (Ministry) and daily operations (service provider) levels. Strong governance is critical to ensuring that there is a relentless focus on quality and consistent standards of care and accountability. Integrated oversight is necessary to ensure alignment with strategic directions across sectors and for service providers to operate together as a system. Clear access mechanisms, transparency and evidence of service provider strengths, as well as the active participation of young people themselves, are necessary for families, caregivers, Children’s Aid Societies and young people to navigate the complex but potentially rich landscape.

Issues

Oversight

Within the Ministry’s structure, there is no overarching governance mechanism for residential services. Corporately, residential services are overseen as one of many functions within a much broader range of responsibilities in each of three separate Divisions: Policy Development and Program Design, Service Delivery, and Youth Justice Services.

In turn, responsibility for oversight and accountability of residential services is cascaded down at the operational level to five regional offices. In addition, Youth Justice Services has a “Direct Operated Facilities Branch Director” who oversees the six directly operated secure custody/detention facilities. This Director’s responsibilities do not include oversight of the 14 transfer payment (TP) operated secure custody/detention facilities, nor the 41 TP operated open custody facilities (including the 2 open custody facilities being re-profiled to reintegration facilities, and 1 being co­operated with the Ministry of Health and Long-Term Care for addictions treatment). Three of these facilities are for-profit operations.

The transfer payment operations are monitored through the five regional offices. The regional offices are entrusted with the contract management of residential services within their own regions, however, reported that they see themselves as having limited authority over these services, particularly in relation to private per diem funded operations. Regional offices expressed that they had some confidence in the exercise of their authority and visibility into services provided by transfer payment contracted services as a result of Transfer Payment Accountability Agreements. They had less confidence in this respect in relation to private per diem funded operations in the absence of accountability agreements.

The Panel heard from both Ministry personnel and many stakeholders that there is significant variation among regions in practices and in the exercise of oversight provided in relation to residential services for children and youth. In some cases, private per diem funded operators have residences in more than one region, potentially resulting in uncoordinated oversight by multiple regional offices, none of whom have “the big picture”. Communication and information sharing among regional offices was reported to be inconsistent and sometimes also between regional offices and corporate office. Regional offices expressed the view that, in the absence of an integrated corporate governance mechanism for residential services, the exercise of their oversight was not optimal.

A significant barrier to oversight is the lack of a meaningful way of counting the number of beds available at both a provincial and regional level, with a corollary understanding of the typology of services provided for those beds (see Chapter 5 on Data and Information). Youth Justice Services has data in relation to open and secure custody/ detention residences under their purview, including capacity, counts and utilization rates. The Ministry has indicated that it is working to develop similar consolidated information on the numbers and types of beds and service providers in child welfare residential services and children and youth mental health services by region, and indeed provided the Panel with a 2014 map depicting group and foster homes by region. Building on this inventory will enable the Ministry to begin to plan for the capacity and configuration of services that are required. A supply and demand analysis is required in order to ensure the right distribution of resources. It will also enable the Ministry to move forward in ensuring the right investment of residential resources by sector as the best use of the current excess bed capacity in open custody is assessed (see Chapter 7 on Youth Justice).

Concerns were also expressed that there is a lack of clarity and a shared understanding among all players about accountability. As a result, accountability is sometimes blurred. This is particularly the case in the responsibility for quality of care issues in residential services in the province. The Panel heard from a number of Children’s Aid Societies that they presume the Ministry has accountability for quality of care in group and foster homes through its licensing process, while the Ministry saw the Children’s Aid Societies as accountable for monitoring the quality of care provided by providers with whom they hold contracts.

Children’s Aid Societies expressed some confidence in their ability to assess quality in their society-operated homes (foster and group) and a select number of frequently used resources in their jurisdiction. Less confidence was expressed in having a window into private per diem funded operations and children and youth mental health facilities as they have limited ability to inspect or monitor these residences. CASs report that they believe that licensing is the only leverage the province has with private per diem funded operators. In some cases, generally in larger Children’s Aid Societies, efforts are made to assess quality of care through both a dedicated staff role related to quality assurance and outcomes measurement (though this position does not exclusively work with residential services). The Panel also heard some good examples of several CASs coming together in a shared service model (for example, in the GTA) to try to address program inspections by dividing up the tasks. It was observed that having Ministry licencing inspections as well as CAS inspections is potentially duplicative and efficiencies could be achieved if the Ministry expanded their inspections to assess quality.

In smaller Children’s Aid Societies, we heard that there were insufficient resources to perform this function and they “hope” that the Ministry is ensuring quality through the licencing function. As will be discussed under “Accountability”, this is problematic as the Panel heard overwhelmingly, that quality is not assessed as part of the licencing function.

The Ministry’s oversight function is also affected by the lack of good data and/or the absence of strong analysis of existing data sources. The Panel is pleased to note that performance indicator frameworks have been developed for both the child welfare and youth justice sectors. It is, however, unclear whether the application of these frameworks will sufficiently address the governance and quality of care issues identified during our consultations. Supporting this concern, the Auditor General review (2015) found that despite a clear need to better assess outcomes following child welfare services, the Ministry “does not have sufficient information to monitor the performance of the Child Protection Services Program,” further noting that the data collected for the newly established child welfare performance indicators “is not sufficient to adequately monitor and assess” performance. This is outlined more fully in Chapter 5 of our report on Data and Information.

Service Delivery

More detailed commentary is provided about the issues identified in the delivery of residential services in other sections of this report. The comments in this section are meant to identify overarching issues identified in the Panel’s work from a governance point of view.

In a large, diverse, decentralized system of service delivery it is critical that residential services be well coordinated, with a strong continuum of care, smooth transitions between providers and sectors and good information sharing and communication. Clear, evidence-based information about the expertise, strengths and experience of each operator is important to young people, their families and caregivers, Children’s Aid Societies and placing agencies to match children and youth to the service provider that can best meet their needs. At present, this is the responsibility primarily of placing agencies. Children and youth mental health is in the process of identifying lead agencies across 33 service areas (excluding secure treatment) for the planning and delivery of core services. Placements in Youth Justice custody/detention facilities are court ordered. The level of custody (ie. Open or secure) is determined by the courts. During our consultations, the Panel heard that service provision is often not well coordinated across and within sectors. There is little evidence of a strong continuum of service providers with good communication, information sharing and continuity of care for children and youth transitioning between sectors and providers. Ministry direct operated, transfer payment operated, and private services tend to operate quite separately from one another and generally not as an interconnected system.

Varying degrees of quality in service delivery were evident and a lack of tools and processes exist to assess the quality of individual service providers and the system overall. There are a lack of consistent standards for quality of service and an absence of common key indicators of quality within and across child welfare, children and youth mental health and to a lesser extent, youth justice.

There is unclear differentiation among service providers in the child welfare and children and youth mental health sectors, with many providers advising that they provide “treatment” without any clear definition of treatment. The designation of “treatment” and “specialized” foster homes and, where applicable, group homes, does not always correspond to a meaningful distinction in service provision. Assertions by service providers about their areas of strength are not assessed and validated by the Ministry.

In general, reintegration supports for children and youth leaving residential care and transitioning back to families and/ or communities were often identified as lacking or insufficient. The Panel heard from families in children and youth mental health that residential treatment services are offered with varying degrees of connectivity to non-residential clinical and community supports. While their child is in care, they often feel well supported but when their young person returns home, the withdrawal of support is distressing. Supports for youth transitioning from CAS care to independence were often identified as inadequate. In youth justice, the Panel heard that more reintegration resources are required to support youth and to sustain any gains made in custody.

Accountability

The licensing requirements to which all service providers in the residential services sector are held are contained in legislation, in regulation, and in policy. These set out the minimum requirements to be met by licensed providers of residential care to obtain and retain a license, authority for the Ministry to take action on non-compliance/ un-met standards, and are supported through inspection, enforcement and compliance activities by the Ministry. Requirements are largely the same for all licensed residential programs serving children and youth, across the child welfare, mental health and youth justice sectors. Youth justice has standards in addition to the legislative and regulatory requirements required by all residential programs. (MCYS, nd)

Part IX of the CFSA speaks to the licensing of children’s residential programs which is the primary accountability mechanism applied by the ministry to licensed residential services. Currently, there are two types of licenses issued by the Ministry: 1) license to operate a children’s residence (group homes), which may be operated by either staff (staff work in shifts to care for 3 or more children not of common parentage) or by live-in parent(s) (live-in parents provide care to 5 or more children not of common parentage); 2) license to provide residential care (foster care agency) to 3 or more children not of common parentage. Licenses are issued for residential services that are delivered by either a transfer payment agency directly funded by the Ministry or by a private per diem funded operator. Initially, an applicant is entitled to be issued a license if they apply for a license in accordance with the CFSA and its regulations and pay the prescribed fee, subject to any terms and conditions imposed by the ministry Director. Subsequent compliance and continuance of license is determined through an annual licensing inspection for TPAs and OPRs, and a compliance review for Directly Operated Facilities. A letter of compliance rather than a license is issued to Child and Parent Resource Institute and the YJ facilities that are directly operated by MCYS.

Concerns were raised throughout the consultations, and are echoed by the Panel, that a growing number of residential placements are unlicensed as a result of a legislative gap in the definition of licenses. Please see the section in this chapter pertaining to the Panel’s recommendations on the CFSA.

Five Ministry regional offices across the province monitor compliance with the CFSA. Most licensing activities are regionally based, including requirements for information and reporting, and new staff orientation and training. Although all regions use common software, each region maintains its own database. Questions about the interpretation and application of standards are submitted and responded to regionally by the corporate Clearinghouse. Questions and answers are not aggregated and disseminated to all regions for the collective benefit of licensing staff. The MCYS (2007), Improving Child and Youth Residential Services in Ontario: An Action Plan, in response to the Bay Report Children and Youth Residential Services Review (2006) identified the creation of centralized tools and training to promote common understanding and expectations around licensing across the province, but the Panel found limited evidence that this has occurred.

Licensing staff at the regional offices conduct annual licensing inspections which focus on a physical inspection of the residence, a review of policies and procedures of the licensee, file reviews, and interviews amongst a sample of staff (including foster parents) and residents. Licensees are given advanced notice of the annual inspection. The result of the inspection is a renewal of license with or without terms and conditions (which may provide time to comply), refusal to renew license, revocation of license, or suspension of license. The Panel was advised that the licensing inspection report is the property of the licensee, and that any visits to the residence by a licensing specialist outside the annual inspection period requires a program supervisor to enter the residence unless permission is granted by the service provider.

The Panel consulted extensively with respect to the licencing, licencing renewal and inspection function, receiving feedback from licencing specialists, program supervisors, regional directors, service providers, Children’s Aid Societies, placing agencies and young people. Overwhelmingly, concerns were raised relative to the licencing function and little confidence was expressed that it can be relied upon to ensure that a high standard of services are being provided in residential services. Licencing tools were described as having significant limitations by those who use them and as being inadequate to capture important information.

The absence of measures with respect to quality of care was identified by many as a significant shortcoming of the inspection process. In some cases, Ministry staff reported that they attempt to “be creative” in including concerns about quality as part of the inspection process. Other feedback indicated that on an ad hoc basis in one region, Ministry staff were introducing a quality checklist separate from the licencing checklist in order to address their concerns. The view was expressed that it is critical to assess quality of care in order to have confidence in the provision of care to vulnerable young people, however, we heard repeatedly that Ministry staff do not see themselves as having a mandate for assessing quality of care.

The Panel also heard that there are legislative limitations in the CFSA which act as barriers to licencing specialists conducting unannounced inspections of residences, thereby diminishing the value of the inspections. The Ministry is aware of this issue and will be considering it as part of the policy work underway stemming from the CFSA review.

The Panel also heard that there is a lack of communication and transparency with respect to sharing the results of licencing inspections and monitoring of homes. We were advised that the completed licencing checklist and supporting notes and documents often do not get shared with placing agencies. Some CASs indicated that they are only told whether the licence is renewed without any qualitative information. We also heard that while individual CASs may be aware of investigations or licensing conditions specific to a provider in their area, there are no provincial protocols with respect to continuing to place young people in these homes. Practices with respect to what gets shared with placing agencies appear to be variable across regions. There is no central ministry website with links to licences and reports.

Many people we spoke with indicated that there is a lack of transparency generally about concerns pertaining to residential operators and cited legal issues as impediments. Even between CASs, we were advised that reports and documented concerns about a home or operator are not shared, apparently due to concerns about breaches of privacy or the threat of civil liability. We were also advised that these concerns contribute to a reluctance to act with respect to bad operators and a very high threshold being required to take action. Licensing staff felt that it is extremely difficult for the Director under the Act to revoke a license, at times necessitating actions through means other than the licensing requirements of the CFSA and its regulations.

Accreditation has been recommended in previous reviews of the residential services system in Ontario as a way to evaluate, improve, and ensure quality. At present, accreditation is neither a mandatory requirement nor regular practice among residential service providers. Some private per diem operators and children and youth mental health centres are accredited and others are not. The Panel conducted a review of all publicly available information about accreditation models in Canada, as well as a literature review on the effectiveness of accreditation as a quality mechanism, and found that there is no clear evidence of the impact of accreditation on the quality of care delivered by service providers.

Funding

The Ministry funds some residential services directly, others through transfer payment, and some are funded indirectly by placing agencies such as Children’s Aid Societies through contracts with private per diem funded operators.

According to Ministry statistics provided to the Panel, approximately 80 percent of all beds are funded through transfer payment agencies (TPA), the majority of which are foster beds operated by Children’s Aid Societies (CASs). Approximately 17 percent of all beds are purchased on a per diem basis and the majority of these beds serve young people in the child welfare sector. In addition, some beds operated by children and youth mental health centres can also be purchased on a per diem basis, typically by CASs. The remainder of beds are operated and funded directly by Youth Justice Services (six secure custody/detention centres) and the Child and Parent Resource Centre (CPRI, a mental health assessment and intervention facility).

In 2013/14 a new child welfare funding model was introduced by the Ministry to support a significant transformation of Ontario’s child welfare system (MCYS, nd). The model allocates funding from a fixed child welfare operating envelope to all CASs based on each CAS’s share of socio-economic (measures of need) and volume-based (measures of service) factors. The new model is being implemented over a five-year period and CASs are required to submit and operate within a balanced budget plan. The model was developed in response to continually escalating expenditures based on historical child protection spending despite declining caseloads and is intended to better align funding to the needs of children and youth, families and communities. The total approved CAS budget allocation was $1.481 B in 2015-16 and has been essentially flatlined since 2013-14 when the new model was implemented. The Ministry indicates that it will continue to identify the best data sources available for socio-economic factors and may make changes to the data sources in future years. In addition, the ministry will undertake a review of the funding model prior to the end of the five-year implementation period (2017-18).

The Panel recognizes the significant effort culminating in the design and implementation of the current child welfare funding model, which provides flexibility to Children’s Aid Societies to allocate resources for residential beds.

In practice, the Panel observed through our consultations a general trend for CASs to discontinue the operation of their own group homes in favour of purchasing group home beds from private per diem funded operators. Despite feedback that CASs often viewed their own group homes as more effective, we heard that internal group care is more expensive, leading to the practice of purchasing external, less expensive beds. By contrast, but also driven by financial considerations, CASs advised us that placement in internal foster care is the most common practice, even though external foster care, which is more expensive, was often seen as most effective for young people.

Through our consultations, the Panel heard many concerns about the rate setting methodology as well as the rate review process. We observed that there are significant inconsistencies with respect to per diem rates across all sectors but particularly group homes in the child welfare sector. Stakeholders noted that compensation and infrastructure are excluded from the rate review process, resulting in poorly compensated staff in group homes and an inability to fund infrastructure requirements. There is no provision to address inflationary increases as inflation is not accepted as a criterion for adjusting a per diem rate. Incentives exist to create new programs, whether there is a compelling reason to do so or not, in order to trigger a rate review.

In child welfare and children and youth mental health, funding is inconsistent and there is little confidence that higher per diems for “treatment” are actually delivering a value-added and necessary service. It is not possible to validate the need for the higher per diems nor the services provided, given the lack of clearly defined outcomes and performance indicators. There is also no means by which to independently validate self-identified areas of expertise in most cases.

In the absence of clear standards for quality of care, the Panel observed that there is little financial accountability and no financial incentives or disincentives for operators to deliver high quality care.

The Panel frequently heard concerns about the use of Special Rate Agreements (SRAs), which typically involve funding for 1:1 staffing. It is intended that SRAs be used to provide funding above the approved per diem rate to address exceptional circumstances requiring additional support and supervision of young people with high needs. Often, Children’s Aid Societies and the Ministry have insufficient visibility into SRAs to ensure accountability for these expensive arrangements.

The Panel heard from stakeholders about the misuse of SRAs, including their continuation for excessive periods of time and instances of group homes using multiple SRAs to compensate for inadequate per diems. Vigilance and rigour in monitoring the use of SRAs is required in order to avoid significant costs being accrued to CASs. Where CASs have assigned staff to provide this oversight, the Panel was encouraged to hear that significant cost avoidance was achieved.

As referenced previously, the Ministry does not yet have a central bed registry corporately, regionally or by community. It is noted that the Toronto Region is piloting the Centralized Access to Residential Services (CARS), which seeks to create a central bed registry in the Toronto region. With the exception of Youth Justice, supply and demand is not well understood. The availability of this data across sectors would support a better and more integrated approach to service planning and funding. Given the low counts and significant excess capacity in youth justice secure and open custody, there is a significant and time-sensitive opportunity to optimize resources in the residential services sector by ensuring the right number of beds by type in the right locations.

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.

Panel Recommendations for Legislative Amendments to the CFSA

As the Panel worked through identifying issues and formulating its recommendations pertaining to governance, quality and continuity of care, human resources, data, and voice, the need for legislative reform to remove barriers, provide enablements, and clarify or modernize language became clear. The Panel’s perspectives on legislative reform will complement The Report on the CFSA Review (2015a) process completed by the Ministry, and the resultant recommendations for consideration in the policy work currently underway. Many of the Panel’s views are consistent with the themes that emerged from The Report on the CFSA Review (2015a).

The Panel is interested in changes to the Act that would strengthen the Ministry’s authority to exercise oversight of residential services. Licensing is a major category that could be strengthened through legislative reform. Overall, the Panel believes that any child in out-of-home care must only reside in a licensed home. The two categories of licenses currently provided for within the CFSA do not capture emerging models of care that involve 2 or fewer young people. A new category of license that would provide for a customized license for unique service concepts that fall outside of the two existing categories would ensure that all care contexts are licensed. Additional aspects that would strengthen the impact of the licensing process include enabling unannounced inspections at any time by a broad range of designates, and meaningful consequences for non-compliance through progressive consequences, potentially beginning with administrative monetary penalties of graduating levels, and ending with broader criteria for the removal of a license. Transparency of inspection results through the public availability of status/reports is also recommended.

Public reporting is another category that could be legislatively enabled. Requiring an independent study assessing the quality of care, continuity of care and outcomes of children and youth in out-of-home care at a defined period of time (e.g. Every 5 years) to be presented to the Legislature by the Minister of Children and Youth Services would provide an external complement to internal oversight mechanisms. In addition, requiring the public posting of service provider performance through license status, licensing inspection reports or other measurement data would also improve the oversight of the sector. These recommendations are consistent with The Report on the CFSA Review (2015a) theme of increasing transparency and accountability.

The Panel recommends changes to the Act that would enhance the quality and continuity of care provided in out-of-home care. Legislative enablements to ensure that all staff that care for vulnerable children (full-time, part-time, and designated one-to-one staff in group care as well as to workers assigned to foster homes or family-based care) are qualified to do so through a combination of pre-service and in-service criteria are key to the Panel, as are provisions for tracking young people throughout their journey in residential care (including across sectors) and into independence. The Report on the CFSA Review (2015a) also cited issues related to transitions and continuity of care and information sharing in its report.

Also consistent with The Report on the CFSA Review (2015a) participants, the Panel is concerned about some of the language contained within the Act. The Review identified a need to modernize the language in the Act, including the “removal of language from the CFSA that is viewed as archaic, confusing or stigmatizing. The language in the legislation should be amended to be more common, current, respectful, strengths-based, and child- and youth-focused.” The Panel would suggest that the use of the term Crown Ward and Society Ward are prime examples of language that is pejorative and in need of modernization.

The Panel also recommends that the Ministry consider capping occupancy at 8 residents in group care, children and youth mental health, and open custody/detention and units within secure custody/detention centres. While we did not identify evidence in the literature, our observations and feedback from stakeholders suggested that the establishment of effective relationships with children and youth is best accomplished in smaller settings.

Implications for Recommendations

The Panel has considered the feedback from our consultations in the area of governance, including issues of oversight, service delivery, accountability and funding. We have also taken into consideration similar findings from reports over the past decade and the best and promising practices identified through our inter-jurisdictional review as well as right here in Ontario.

We have not identified an alternative model for which there is such clear and compelling evidence of its superiority that we believe Ontario should consider implementing it. We are also mindful of the differences between the Ontario system of residential services for children and youth and others and the difficulty in imposing a model from another jurisdiction. One would have to carefully consider the breadth of the province’s geography, the numbers of young people served across sectors, and the long history of a large, mixed public-private, decentralized service delivery system before proposing the destabilizing effects of a complete disruption of the current system.

Having said that, there is an urgent need to address the existing challenges in the current model of residential service delivery in Ontario. The Ministry must be equipped to provide the overarching, integrated oversight for its large and complex residential services system. It must ensure that it can compel, receive and analyze all of the information and data it requires and that it can be assured that high quality of care is consistently being provided to the many vulnerable young people it is responsible for in this province. The Ministry must ensure that there is transparency of information, strong accountability in the provision of services and that the everyday lives of children and youth in residential care are positive.

While the Panel considered various models of governance, including arms-length options, we are convinced that the authority and oversight of residential services must rest directly with the Ministry. The longstanding issues and challenges that we heard about can only be addressed, in our view, through clear Ministry leadership. We recognize that the Ministry is the steward of the system and it has shared responsibilities in many respects with its partners (parents, caregivers, agencies, Children’s Aid Societies, service providers, associations). Nevertheless, the strong, systemic, integrated oversight function must reside within the Ministry. Building and stabilizing this internal capacity within the Ministry should be a high priority and should reside within the Ministry for a substantial period of time prior to considering an outsourced or third party model.

The Panel envisions that a new, centralized Quality of Residential Care structure within the Ministry would provide integrated oversight of the quality of all residential services for children and youth, including child welfare, youth justice and children and youth mental health. The new structure would act as an integrating mechanism across sectors to avoid siloing, raise standards for quality of care, create consistency and support a continuous quality improvement culture in residential care. The new Quality of Residential Care Branch/Division would be situated in such a way that it reported jointly to the two operational Assistant Deputy Ministers in order to create an integrated means by which the divisions could work more seamlessly on the oversight of quality in residential services.