NOGDAWINDAMIN Family and Community Services Agency Response to

NOGDAWINDAMIN Family and Community Services Agency Response to Jordan’s Principle and CHRT Jordan’s Principle Child First - Community Implementation Kerry Francis, Executive Director Sept 26, 2018

Jordan’s Principle Update Water Tower Inn, 360 Great Northern Road, Sault Ste. Marie, ON September 27, 2018 Time Topic Lead 8: 30 Opening Elder in Residence, Dorothy Elie 8: 45 Welcoming Address Executive Director, Kerry Francis 9: 00 Introductions 9: 30 – 10: 30 Presentation of Nogdawindamin’s Executive Director, Kerry Francis involvement with Jordan’s Principle Case Manager, Principle & CHRT Orders Leslie Recollet Director of Finance, Kirk Langdon 10: 30 Break 10: 45 - Noon Breakout Group Discussions Meeting the immediate needs of the children Noon – 1: 00 Lunch 1: 00 – 2: 15 Breakout Groups – continued Community capacity building to meet the long term needs of children 2: 15 Break 2: 30 – 3: 30 Group work presentation to larger group 3: 30 Next Steps 3: 45 Closing Elder in Residence, Dorothy Elie

THE PATH TO DESIGNATION 2008 – Nordik – Community Consultation 2009 – Notice of Intent to pursue designation 2009 – Stage 1 - Designation Feasibility – Assessing Community Interest 2010 – Capacity Review & Feasibility - Final report 2011 - Graduated Development Phase 2011 – Stage 2 - NFCS Community Consultations 2014 – Policy & Procedure Manuals & Documentation Review 2015 – Transition Approval & Implementation of Service Delivery 2016 – Stage 3 - Capacity Development 2016 - Decentralization of Prevention Services to Communities 2016 – Stage 4 - MCYS Pre-Designation Review 2017 – April - File Transfer and Designation Celebration 2017 – Stage 5 - Post-designation Service Delivery & Capacity Maintenance

THEORETICAL THREE YEAR PLAN • Year One: – – – NSFN Population Stabilization of Services - compliance, file transfers, and jurisdiction Organizational Optimization – service expansions, mentorships, training Budget and forecast stabilization – future budgeting & core funding Strategic Plan renewal • Year Two: – Other Aboriginal Population – new service team recruitment and preparation/training – Stabilization of expanded services (ie: CMH, Infant Transition) – Budget normalization and formula revision • Year Three – Metis and Inuit Nation – new service team recruitment and preparation and training

Elders Teachings Cultural Supports Preference is for actions that are geared to Circles, Sweats maintaining family unity Crisis/ Circle of Care Supports Referral while also ensuring child safety. Community Services Family Support Services Seeking n i or in m a Neonatal Caring Services d n i Receipt aw d g of Child/Youth Mental Health o N Service be a Mino Madzwin n i h s Ani Kinship Services Communit Customary Care M y Links ains Alternative Care trea m Treatment Alternative Care Volunteer Services First Nation Circle of Apprehension Care Team Children in Care Full spectrum of wrap-around services. Legal Services Supporting individual pathways to wellness. Intervention Services Supervision Agreement Adoption CONTINUUM OF SERVICES

Transition Year 1: April 1/15 – March 31/16 Requested: Budget: Other Revenues: Prev – Community Based: Total All Sources: $4, 442, 465 $3, 562, 700 CW Shortfall: $ 879, 765 $ 15, 636 $ 2, 005, 243 $ 5, 583, 579 Actual CW Expenditures: Actual Prevention Exp: Total Expenditures: $3, 610, 214 $2, 027, 786 $5, 638, 000 Deficit: $ 54, 421 • Combined Deficit of $54, 421 excluding: – Service deficits (reductions to absorb cost of Prevention Measures) – Deficits incurred by communities - undefined.

Transition Year 2: April 1/16 – March 31/17 Requested: Budget: Other Revenues: Prev – Community Based: Total All Sources: $10, 815, 552 $ 7, 184, 300 $ 60, 617 $ 1, 942, 721 $ 9, 187, 638 Actual CW Expenditures: Actual Prevention Exp: Total Expenditures: $7, 546, 253 $1, 943, 192 $9, 489, 445 Shortfall: $ 3, 631, 252 Deficit: $ 301, 336 • Combined Deficit of $ 301, 336 excluding: – Service deficits (reductions to absorb cost of Prevention Measures) – Deficits incurred by communities - undefined.

Mandated Operations Year 1: April 1/17 – March 31/18 Requested: Budget: Other Revenues: Prev – Community Based: Total All Sources: $18, 811, 268 $ 17, 770, 268 Shortfall: -$ 1, 041, 000 $ 4, 196, 901 (including funded pilots) $ 1, 942, 721 $23, 909, 890 Actual CW Expenditures: Prevention Measures: Actual Prevention Exp: Total Expenditures: $19, 111, 920 $ 3, 304, 904 $ 2, 202, 714 $24, 916, 538 Deficit: -$ 449, 655 • Combined Deficit of -$ 449, 655 excluding: – Service deficits (reductions to absorb cost of Prevention Measures) – Deficits incurred by communities undefined.

Mandated Operations Year 2 – April 1/18 to March 31/19 • Maintenance oriented budget projection – sustaining existing operations: 2018/19 Budget Request: Cash Flow Basis Funding (SEP): Other Projected Revenues: Prev – Community Based: Total Sources: $23, 411, 510 (projected required level) $17, 770, 268 Shortfall: $ -5, 641, 242 $ 5, 000, 118 (existing approvals) $ 1, 942, 721 $24, 713, 107 Proj. CW Expense: $23, 814, 210 Proj. Community-Prevention: $ 1, 942, 721 Proj. Prevention Measures $ 5, 000, 118 (including funded pilots) Total Expenditures: $30, 757, 049 Conditional Deficit: $ -6, 707, 118 • • Ongoing deficits in finance and services are not sustainable. Agency reserves exhausted by innovation to meet expanding needs. Unable to absorb cash flow requirements to finance provincial budget delays. Prevention services at risk without required budgets in place.

Reality Check Data Elevation Surprise • Expected 15 % increase - actual was 39. 74 % - clients/communities more comfortable reaching out and other factors? . • First Nation individual status - not captured by mainstream societies. • Service volumes are minimized under mainstream service/recording. Challenges • Service volume prediction based solely on mainstream statistics - unable to provide full spectrum of service and operational data to reflect agency needs. • Delays in mobilizing agency structure with: • Timing of funding and budget confirmations. • Capacity building to understand monitor volumes. • Case loads exceed benchmarks - compliance challenges. • Subsequent investigations recurring in complex cases. • Urgent and unmet needs emerging.

AGENCY RESPONSE COMMUNITY EXPECTATIONS OF SAFE HARBOUR. • Some budget flexibility – able to move within defined chart of accounts to mobilized services required. • Enhanced Prevention Resources – able to address issues before elevation of cases by outreach and early interventions. • Case volume and data collection on presenting issues in prevention cases allowed analyses for trends/sources/issues and identification of interventions. • Urgent needs identified, documented and service proposals developed. Strengths • Early success under Cultural model - Admission Prevention - assisting families with apprehension being last resort.

Children’s Mental Health Pilot Protection Resource Manager • Children’s Mental Health Pilot – Health Canada $3, 597, 517 to March 2019 – Defined service scope • Open Investigation & Assessment: 69 • Ongoing: 242 (178 Protection, 64 Non-Protection) • Children In Care: 141 (131 In Care and 10 CCSY) • Reality Check 1 - Children’s Mental Wellness Manager 1 - Team Supervisor 6 – Child/Youth Clinicians 4 - Records Clerk • Significant volume of cultural referrals • Psych referral volumes exceed service availability • 2 yr waiting lists for psychiatric services • Adjustment • Elder in Residence and Helper added to assist Elder in Residence and Helper

Children’s Mental Health (cont. ) 1 –Physician • Addendum – Psychiatric Services – $467, 900 to March 2019 – Psychiatrist, Nurse, and Transcriptionist • Reality Check 1 – RN 1 – Transriptionist – Benchmarks exceeded with 156 ongoing files at Q 1 2018 – Pressure to expand service to Children Not In Care and off reserve • Addendum – Expansion of Services – $1, 217, 580 approved – 1 Supervisor, 8 Clinicians, 1 Clerk – 1 Elder in Residence and 1 Helper – 1 Finance Clerk • Reality Check 1 - Team Supervisor 8 – Child/Youth Clinicians 1 - Records Clerk Elder in Residence and Helper – Extensive client information gathering at intake – Bottleneck at screening department – Up to 2 hours/client complete/collect service history & documentation • Addendum – Specialized Clinical Intake – – Internal adjustment in progress 1 Supervisor 4 Clinical Intake Workers Processing up to 40 intakes per week 1 - Supervisor 4 – Clinical Intake Workers

EMERGENT NEEDS – APPREHENSIONS AT BIRTH • Defining Needs – – Baby Lucious Neonatal Service Hub 21 caregivers currently dealing with NAS infants 8 high risk pregnancies for immediate service Complex Needs Committee NAS increasing in concert with opioid crisis 4 NAS births 2017/18, 3 apprehensions - no prior service Director of Services • Neonatal Caring Services Program - Pilot – – Health Canada Pilot - $469, 719 to March 2019 Outreach with high risk pregnancies Wellness planning – pre, peri and post natal 6 months Service navigation, mentoring, cultural services, respite Child Wellness Service Manager Clinical Assistant • Reality Check – Case load and projections exceeding benchmarks at – Target group outreach hampered - mobility required – Shortage of appropriate transition housing and supports • Addendum 2 - Outreach Workers – Furnishings and start-up costs supported by DISC - $50, 000 – Two outreach Workers added – Two furnished emergency transition housing units added

ADMISSION PREVENTION NEEDS – OFF RESERVE • Mainstream Model Deficient – – – Decentralized Prevention Services provide service in the community 65% of population (@ 15, 430) is off reserve with significant needs Mainstream confirms providing a basic (read barely adequate) service Service data reflects services to 263 families with 202 being off-reserve Significant potential to influence service outcomes through earlier intervention • Admission Prevention Pilot – Off-Reserve – 15 month pilot project $1, 267, 367 to March 2019 – in-home supports, life skills, service navigation – Access coordination - volunteer supports & cultural services • Reality Check – Benchmarks exceeded within 3 months and growing – Significant cultural service and support referrals • Addendum – Additional Workers added to absorb case load Protection Resource Manager Specialized Services Supervisor Family Wellbeing Coordinator 5 - Family Wellbeing Workers 8 – Additional Family Wellbeing Workers

JORDAN’S PRINCIPLE SERVICE SCAN • Defining – Inherited case loads - significant volume of unmet needs in all service areas. – Need to shift the modality of service to proactive prevention. • Action Plan Developed. Staff assigned to test the waters: – Planning Committee – ED, DOF, DOS, Special Projects. – 2 Staff & coordination costs eligible as Prevention Measures. – Orderly approach to deliver high needs priorities and gauge service demand. • Phase 1 – Children In Care - 149 Children in Care completed • Phase 2 – Children Not in Care - Projecting 300+ children – 30% complete • Phase 3 - Community-based Children – in collaboration with communities

Child: Needs Identification - Case Samples SBB Age / DOB: 9 yrs old May/10/2008 Status: Yes – Sagamok Anishnawbek Needs Identification: Child identified with Neurofellomatous/Cerebral Palsy, complex global delays, feeding tube, visual impairment, seizure disorder and challenges with brain processing Request History: NIHB, Health Canada, CFS (INAC) No local or regional or provincial program support funding Current Request: Reimbursement for Two Arjo voyager Duo Lift Renovations to child’s bedroom & bathroom Service Professionals Speech Therapist Physiotherapist making Ophthalmologist Pharmacist recommendations Physician Social Worker Traditional Healer Surgeon Chief & Council Support Product of Service Description: 1. Refurbishing Wheelchair $ 1, 003. 00 Feb 02, 2018 2. Home Renovations $18, 401. 68 2016 3. Paediatric Bathing System $ 3, 546. 40 Mar 13, 2018 Total Final Cost: $ 22, 951. 08 – Reimbursable Payment to NFCS

Needs Identification - Case Samples Child: AN Age / DOB: 4 yrs old Jan/23/2014 Status: Eligible – In progress Atikameksheng Anishnawbek Needs Identification: Child identified Behavioural; physical aggression Developmental delay, Speech & Language Delay Request History: NIHB, Health Canada, CFS (INAC) No local or regional or provincial program support funding Current Request: Reimbursement for Specialized Rate OPR – Behaviours 1 block of speech therapy (placed back on waitlist) Service Professionals making recommendations Speech Pathologist Social Worker Daycare SUP Chief & Council Support Physician Paediatrician Traditional Healer Product of Service Description: 1. OPR Specialized Rate $15, 306. 20 Mar 05, 2018 2. Speech Therapy $ 640. 00 Apr 27, 2018 Total Final Cost: $ 15, 946. 20 – Reimbursable Payment to NFCS

Needs Identification - Case Samples Child: Sibling group – KTBP Age / DOB: 2 yrs & 4 yrs Mar/26/2014 Nov/03/2015 Status: Yes Needs Identification: Child identified with a diagnosis Autism – Gross Motor Supporting Access w/Grandmother – Safety measures Request History: CFS (INAC) No local or regional or provincial program support funding Current Request: Grandmother’s request – Build a fence in her backyard, sandbox, & swing set. Supporting identity, family reunification Service Professionals making recommendations Paediatrician Social Worker Chief & Council Support (Band Rep) Elder in Residence Product of Service Description: 1. Material & labour fence $ 1, 800. 00 Apr 27, 2018 2. Sandbox $ 340. 00 Apr 27, 2018 3. Swing set $ 450. 00 Apr 27, 2018 Total Final Cost: $ 2, 590. 00 – Reimbursable Payment to NFCS

Submission Standards • Clinical/Medical/Physical Needs – Readily identified needs with clinical/professional diagnoses/opinions – Clear link between provider of opinion/diagnoses and identified need • Need/Service Gap Documentation and Supporting Evidence – Service navigation - identify solution – local, regional, provincial, federal – Document specific barrier(s) to access – program gap or no funding or wait list or not qualified or distances etc – Specific gaps are of interest for local capacity/program development • Recreation and social needs – – – – Higher standard of justification argument required Substantive Equality Criteria engaged (see handout) Clear articulation of context / circumstances giving rise to the need Opinion/recommendation from third party on their letterhead Social worker, priest, teacher, OT – best knows needs of the child Articulate as a recommendation and link to the needs of the child Recommendation must be within scope of practice of provider

Service Flow START HERE Service or item related to a specific child or specific group of children? Next slide No Yes Unsure Submit details to chrtjp@nog. ca to determine if already budgeted Is the item/service already included as part of our budget? No Immediate needs details to chrtjp@nog. ca or meet with Sup/CW/Case Mgr. Prepare Jordan’s Principle Submission Name of Child Status or application for status required Supporting documentation - professional opinion (a professional can be a doctor, therapist, social worker, etc. ) - item/service is required Yes Item is related to JP but not claimable. Refer to Finance Policies for regular approval process

Service Flow (cont. ) Item/service not related to a specific child or group of children? Is it for Agency to support: • Prevention Measures • Intake and Investigation • Legal Services • Building Repair/Renovation No Refer to Finance Policies for regular approval process Yes Is item/service already included as part of existing budget? Yes Unsure No Submit detail to chrtjp@nog. ca to determine Full detail and support info to chrtjp@nog. ca for CHRT pre-approval submission. Item is related to CHRT but not claimable. Refer to existing Policies for regular approval process Information required for CHRT Identify area – Prevention, Intake/Investigation, Legal, Building Repair/Reno Name of Staff Member, Position Supporting documents - salaries, budgets, invoices, quotes and receipts Rationale - why required, how it enhances service, how admissions are prevented

Service Collaboration • Case development meeting – Supervision Meeting - Team Supervisor, CW & Case Manager • CW gathers normal course documentation/client data/support info • Case Manager prepares complex case documentation (external quotes, research service/product solutions, external agency/community collaboration etc) • Team Supervisor oversight to meet ongoing deadlines for submissions • Implementation of approved cases – Team Sup/CW/Case Manager collaboration • CW implements normal course solutions (program/service referrals, purchases) • Case Manager implements complex solutions (external admission processes, major purchase, contract services etc) • Normal course policy adherence around expenditure authorizations • DISC proposal $ 469, 718. 55 – approved - awaiting funds. – Program Manager and 8 Case Manager positions – Embedded within the service delivery – Child In Care, Admission Prevention and Alternative Care Worker collaboration essential

Jordan’s Principle Program Planning Committee Executive Director of Services (East) Director of Services (Central) Director of Services (West) Director of Finance Special Projects Manager Program Manager – L. Recollet East Team • Sudbury to Blind River • 201 children (82 CIC & 119 Ongoing) • larger spread/travel requirement but mostly concentrated in Sudbury Case Manager – D. Burla Case Manager – S. Blackmore Case Manager – Vacant Executive Assistant Cultural Services Supervisor Program Controller (TBD) West Team • Sault to Iron Bridge • 259 children (70 CIC & 189 Ongoing) • Lower travel - increased case load Case Manager – L. Ojeebah Case Manager – P. Roach Case Manager – S. Irving Case Manager - VACANT Case Manager – Culture - W. Wesley

Tracking and Payment Processing Nogdawindamin submits application to: ontariojordansprincipledejordanlontario @hc-sc. gc. ca Once Approved: Monthly approval batch of put to a Contribution Agreement. Batch detail info sent to HUB (payment branch) and Nog for payment and reconciliation. HC- ON- xxxx # assigned to file. Jordan's Principle review / response: 3 options: 1 - more info required 2 - escalated to National Review 3 - Approved Email sent to Nog to inform whether more info is required, escalated to HQ, or approved.

Reality Check As of 24 Sep 18 - 90% of scans result in identified needs.

Reality Check – Individual Needs/Submissions At Sept 24/18 • • • Multiple complex needs being picked up that were previously muted. Crises averted (sex trafficking, homelessness, youth addictions treatment). Significant work to conduct outreach, document, submit, and execute solutions.

Community Capacity Enhancement Ensuring the full implementation and meaning of Jordan’s Principle • Parallel streams - immediate service vs capacity development – Prevention Enhancement • Case Manager required up front – Address high risk and urgent needs in collaboration with Prevention Team – Intake, service navigation, gap documentation and submissions – Service Enhancements • Community-based Team or Task Force – Critical oversight and guidance for Jordan’s Principle community review. – Assess resources, facilities, programs and services – meeting all needs – Recommendations for improvements, additions, renovations services • QA Resources – Quality Assurance Specialists – attached to ongoing services/programs – Data collection, reporting standards, outcomes analyses to inform planning – QA Specialist – lead support for Task Force – coordination, analyses, reporting • Additional Case Manager/Service Navigator/Coordinator roles – Depending on level of need and complexity of service arrangements • Engagement/Coordination – Facilitator/Educator providing overarching communications strategy/tactics

A Few Key Insights From National Summit • Jordan’s Principle - NO SUNSET – will continue full implementation • DSIC staffing increased to address backlogs/timelines. • National Jordan’s Principle Coordinators Network will be formed. • Manitoba - Child First Initiative is regarded as being “best in class”. – complete information modules for community based implementation. – Needs and service gap identification has been used as a springboard. – Training programs and targeted educational initiatives launched. – Active strategies for growing and replacing external clinical services. – Mental Health, Speech & Language, Occupational Therapy and more through collaborative education and training partnership initiated regionally and locally based on identified needs. – Prevention strategies revised and realigned based on observed service gaps and articulated community needs.

Community Implementation Plan • Setting Priorities – Community determines own needs and reporting structures. – How many bodies, what roles, what training and supports, what office spaces and primary role is for each. – Orientation/training on process/forms/supporting docs. – Policies/procedures and internal collaboration and workflow. – Coordinate with Prevention Teams – exhaust local resources first, then regional, then Provincial, then Federal. – Interagency service maps – who is servicing what/whom? Overlaps? – Who will collect the data and in what form(s) to get at underlying issues that will in turn inform prevention and health strategies?

• • • Pre-Lunch Breakout Session Immediate Service Is your FN accessing or intending to Jordan’s Principle Consider your prevention volumes – how many positions required – how best organized/supervised – is data providing intelligence and feedback as to efficacy Will you need to add or expand resources to deliver or enhance services with either additional Prevention resources or dedication Case Manager/Service Navigator role Where on your org chart would this role fit – reporting to whom – draw your own Finance/Admin – is a resource needed to track claims, incur expenses, track & execute spending, reconcile payments, provide reporting Best Practices: Chief/Council • Service users report that Prevention Services should not be reporting to or directed by Band Rep Services as Band Reps are engaged separately when and if protection concerns arise. Band Manager/CAO • Jordan’s Principle Case Manager and Service Navigation is ideally attached to Health/Wellness with direct ties to Primary Health Services, Mental Health/Addictions, Clinical Services and Education/Recreation/Social programs. Finance/Admin Controller Health/Wellness Enhanced Prevention & Family Wellbeing Case Management / Service Navigation Band Rep Services

After Lunch Breakout Session Capacity Development • Does FN require have or require dedicated resources for data collection, program efficacy reporting, and analysis for planning and policy functions • Does FN have or need dedicated resources for education & awareness, communications, ongoing engagement efforts • Is FN currently tracking/coordinating external clinical and support services and growing capacity to address these needs with local resources • Is FN ready for and interested in a broader initiative for comprehensive review facilities, programs and services and recommend improvements and additions required to ensure the full implementation and meaning of Jordan’s Principle – or presently looking to address existing gaps • What would that look like – draw you own picture – here’s ours!

This is a handout

This is a handout