Evaluation of the Implementation of the Enhanced Prevention Focused Approach in Quebec and Prince Edward Island for the First Nations Child and Family Services Program

1.2.1 Background and Description

The First Nations Child and Family Services (FNCFS) Program funds FNCFS agencies to provide culturally appropriate child and family services on reserve in a manner reasonably comparable to those available to other provincial residents in similar circumstances within program authorities. To this end, the program funds and promotes the development and expansion of child and family services agencies designed, managed and controlled by First Nations. Since child and family services is an area of provincial jurisdiction, these First Nation agencies receive their mandate and authorities from provincial governments and function in accordance with existing provincial child and family services legislation.

Government funding for child welfare is complex, and involves both bilateral and trilateral agreements between Aboriginal Affairs and Northern Development Canada (AANDC), the 105 First Nations Child and Family Services agencies funded by AANDC, the 10 provinces and Yukon Territory. In areas where First Nations Child and Family Services agencies do not exist, AANDC funds services provided to First Nation^{Footnote 3} children and families on reserve by provincial or territorial organizations or departments.

In 2007, the FNCFS Program began its reform to the EPFA from the previous funding model for all jurisdictions except Ontario and Alberta^{Footnote 4} known as Directive 20-1. Directive 20-1 has been in place since April 1, 1991. It places increased emphasis on early intervention and family supports and funds according to a formula for operations (including limited prevention services) and reimburses for eligible maintenance expenditures, based on actual costs.

The EPFA reorganized the FNCFS Program's funding structure to include three targeted streams of investment – maintenance, operations, and prevention/least disruptive measures – that are eligible for use for Child and Family Service activities, though FNCFS agencies have the ability to move money between the three streams to better meet their needs.

The EPFA represents a refocusing of FNCFS funding towards a more prevention-based approach. Prevention services may include, but are not restricted to, respite care, after-school programs, parent/teen counselling, mediation, in-home supports, mentoring, and family education. Prevention services may also assist in the earlier and safe return of a child to their family. The rationale for this shift is that the implementation of prevention services in the early stages of a child's life often mitigates the need to bring children into care, and thereby supports keeping First Nation families together. This is consistent with provinces that have largely refocused their own Child and Family Service services/system from protection to prevention services.

The EPFA supports:

• Families getting the support and services they need before they reach a crisis;
• Community-based services and the child and family system working together so families receive more appropriate services in a timely manner;
• First Nations children in care benefitting from permanent homes (placements) sooner by, for example, involving families in planning alternative care options;
• Services and supports co-ordinated in the way that best helps the family; and
• Coordination of services – funding for staff/purchase services.

To date, six jurisdictions covering approximately 68 percent of all First Nation children ordinarily living on reserve are currently under the EPFA model^{Footnote 5} and work is underway to move the remaining jurisdictions^{Footnote 6} to the EPFA as soon as possible.

AANDC's FNCFS programming is funded through the following authority: Payments to support Indians, Inuit and Innu for the purpose of supplying public services in social development (support culturally appropriate prevention and protection services for Indian children and families resident on reserve), and is derived from the Department of Indian Affairs and Northern Development Act, R.S.C. 1985, c. I-6, s.4 and subsequent policy proposals.^{Footnote 7} Under AANDC's Program Alignment Architecture, the program falls under the Strategic Outcome ‘The People,' which aims to promote "Individual and family well-being for First Nations and Inuit."

1.2.2 Program Objectives and Expected Outcomes

AANDC funds a suite of social programming, including the First Nations Child and Family Services Program, the Family Violence Prevention Program, the Income Assistance Program, the National Child Benefit Reinvestment Program and the Assisted Living Program. The overall objective of AANDC's social programs is to "provide funding to First Nations administrators to provide on-reserve residents with individual and family supports and services that have been developed and implemented in collaboration with partners in order to contribute to:

• fostering greater self-sufficiency for First Nation individuals and communities;
• improving the quality of life on reserve;
• creating a community environment where incidences of family violence and child abuse are reduced or eliminated; and
• supporting greater participation in the labour market and fully sharing in Canada's economic opportunities."^{Footnote 8}

More specifically, the objective of the FNCFS Program is to ensure the safety and well-being of First Nations children and their families on reserve by supporting culturally appropriate prevention and protection services, in accordance with the legislation and standards of the province or territory of residence. In addition, the incremental investments of the EPFA are expected to help agencies to stay aligned with emerging provincial practices focused on early intervention services.

According to the original program documentation, the immediate outcome expected from EPFA investments was increased access to services that protect children and families at risk at a standard reasonably comparable to non-First Nations communities in similar circumstances. Social workers are expected to be able to strengthen partnerships through horizontal integration with other community services/organizations for better case management (i.e. through case conferencing) to improve service delivery and provide integrated responses to meet the real needs of First Nation children and families. Capacity development support would be provided to smaller agencies that may lack the economies of scale to deliver the full continuum of services.

At the time of data collection for this evaluation, the performance measurement strategy was being revised to improve performance reporting. Currently, the outcomes for the FNCFS Program are captured in the Evergreen Performance Measurement Strategy for Social Development Programs. This Performance Measurement Strategy is meant to reflect the higher level outcomes expected for the current suite of five social development programs funded by AANDC and delivered to First Nation communities. It sets out AANDC's accountability with respect to measuring, managing and reporting on the expected results for the five programs. There are no specific outcomes that apply solely to the FNCFS EPFA, but rather three broader outcomes that apply to the FNCFS Program as well as other applicable AANDC social programs.

The relevant immediate outcome for the FNCFS Program is that "men, women and children in need or at-risk have access and use prevention and protection supports and services." This outcome is attributable to both the Family Violence Prevention Program as well as the FNCFS Program and is described as follows: "Prevention and protection supports and services will be made available to men, women and children on reserve and these supports and services are expected to address a variety of situations. The focus on providing prevention supports and services to those at-risk is in line with the approach taken by most provinces when addressing children at risk and family violence. Prevention supports and services include, for example, respite care, counselling, in-home supports and family education. Protection supports and services include, for example, shelters for women and families, and foster care, institutional care and group home services for children."

Key indicators for this outcome include: percentage of First Nations men, women and children in need or at-risk, ordinarily resident on reserve, that are using prevention and protection supports and services and rates of ethno-cultural placement matching. The first indicator is meant to determine the extent to which prevention and protection supports and services either on or off reserve, or on another reserve, are available to First Nations ordinarily resident on reserve, and the latter adopts the National Child Welfare Outcomes Indicator Matrix^{Footnote 9}, which states: "Given that placement matching for Aboriginal^{Footnote 10} children is legislated in most jurisdictions, the priority National Child Welfare Outcomes Indicator Matrix measure tracks the proportion of placed Aboriginal children in homes with at least one of the caregivers is Aboriginal."^{Footnote 11}

Intermediate outcomes according to original program documentation were expected to include a more secure family environment, reduced need for the removal of children from parental homes, reduced incidents of abuse, and overall improvement in child well-being. To measure attainment of this goal, more quantifiable outcome data was to be gathered. At the planning phase of this approach, AANDC committed to partner with provinces and First Nations to ensure that First Nations' indicators can be extracted directly from the provincial database.

In the current performance measurement strategy, this intermediate outcome translates to "Men, women and children are safe." This outcome applies to the FNCFS Program and the Family Violence Prevention Program, and is described as follows: "With access to prevention-focused supports and services that are designed, for example, to enable children to remain safely in the family home, to prevent the kinds of situations that give rise to family violence or to prevent elderly people from having to leave their homes, better outcomes are expected for those affected. Providing supports that enable children to stay in the family home safely is expected to result in children that are not only safe but also benefit from a more stable environment. It is also expected that the prevention projects undertaken by First Nation service providers (e.g. training, awareness and conferences) will increase the capacity of First Nation to meet the various needs of their communities and avoid escalation of situations to the point where people need to access protection services. Early intervention or enhanced prevention approaches, as contemplated by prevention services, are expected to reduce the number of families and individuals who reach a crisis state in their personal or family situations. If the issues leading to situations of family violence can be addressed early, such crises may be avoided entirely. Such services are also critical in addressing the issues that led to the crisis in the first place in order to avoid recurring incidents.

Having access to protection supports and services for men, women and children on reserve, such as a shelter, does ensure the immediate safety of those who must leave a violent domestic situation. In addition, having access to various options for a child that must leave the family home (e.g. out of home placements, kinship care) also provides immediate safety as the child is removed from an unsafe situation. The availability of shelters or similar safe locations for men, women and children that provide a haven to escape violent situations or unsafe environments is expected to result in men, women and children that are safer. Once safety is no longer a concern, men and women, for example, are able to step away from their chaotic environment and make choices for themselves through the community prevention programs and services available, thus, creating a more stable environment for themselves and their families."

At the time of this evaluation, performance measures for this outcome included mortality rates, injury rates and recidivism rates. The mortality rates indicator was reflective of the National Child Welfare Outcomes Indicator Matrix indicator "percentage of children who die while in the care of child welfare services," and is meant to assess the overall conditions of safety. The purpose of measuring injury rates was to assess overall safety in the communities and was reflective of the National Child Welfare Outcomes Indicator Matrix indicator "serious injury and death." Finally, recidivism rates were expected to reflect the long-term effectiveness of services, and are also reflective of National Child Welfare Outcomes Indicator Matrix. In the current performance measurement strategy, these indicators have been replaced with a performance indicator on ‘recurrence rates'. This indicator speaks to the long-term effectiveness of services as well as safe environment by measuring the percentage of clients who received prevention and/or protection services and did not require protective services within 12 months of file closure. This indicator applies to all clients, however, for children in care, the National Child Welfare Outcomes Indicator Matrix indicator states "recurrence is the proportion of children who are investigated as a result of a new allegation of abuse or neglect within one year following closure of their child welfare file".

The expected ultimate outcome for the FNCFS Program is to have a more secure and stable family environment for First Nation children ordinarily resident on reserve. This outcome applies to all five of the social programs and is described as follows: "The social supports and services delivered are targeted at at-risk individuals and families that often face multiple barriers and challenges. Addressing the basic and special needs of individuals, ensuring a level of safety for those at risk, and providing supports to enable men and women to get into the paid work force is expected to result in men, women and children who are then in the position to address any additional needs they may have and to take advantage of other opportunities provided by their First Nations communities. When basic needs have been addressed, individuals are able to take the steps necessary to address their other needs, whether through participating in the paid or volunteer workforce or through accessing other programs to address related needs such as housing, education or health."

There are two performance indicators for this outcome that are applicable to the FNCFS programs. The first is: ‘rates of permanency status achieved (Child Specific)'. This is a National Child Welfare Outcomes Indicator Matrix indicator and measures the cumulative days in care until a child is reunified, permanently placed with kin, adopted, emancipated, or placed in a permanent foster home. Permanency status is tracked forward from a child's initial placement for up to 36 months, at which point permanence is not considered to have been achieved. Lasting reunification with family is the primary goal for most children placed in out-of-home care, and a majority of children will return home within less than a year of their initial placement. However, for some children reunification is not possible and stable alternatives such as permanent foster care, kinship care, and adoption must be pursued.

The second indictor is: "percentage of communities using innovative community-driven approaches to program delivery". This indicator measures the contribution of social programming to First Nation communities that are then able to make it possible for First Nation men, women and children to be offered different approaches to being involved within social development within their communities to improve their social well-being. It assesses whether or not alternative approaches to governance or other models improve the health and social outcomes of First Nation men, women and children.

1.2.3 Program Management, Key Stakeholders and Beneficiaries

AANDC Headquarters establishes on a national basis the program guidelines, the terms and conditions that must be included in each funding arrangement, as well as the policy related to monitoring and compliance activities. The specific role of Headquarters is to:

• Provide, through the regions, funding for recipients to provide services to children and families as authorized by the approved policy and program authorities;
• Lead in the development of FNCFS policy;
• Consider proposals for change coming from regional representatives and First Nations practitioners;
• Provide oversight on program issues related to the FNCFS policy as well as to assist regions and First Nations in finding solutions to problems arising in the regions;
• Provide leadership in collecting data and ensuring that reporting takes place in a timely manner;
• Interpret FNCFS policy and assist regions in providing policy clarification to recipients, provinces and territories; and
• Provide amendments to the National Program Manual as required and to ensure that program policy documentation is consistent with approved policy and program authorities.

With the support of regional staff, the Regional Director General in each region is responsible for implementing and administering the social development programs in accordance with the guidelines outlined in the National Program Manual. This includes, for example:

• assessing the eligibility of recipient applications and eligibility of expenditures;
• entering into financial arrangements with approved recipients in accordance with the transfer payment Terms and Conditions; and
• monitoring, collecting and assessing both the financial and program performance results of individual recipients, and taking appropriate remedial action.

FNCFS falls within provincial/territorial jurisdiction. It is the role of the province or territory to:

• Mandate recipients in accordance with provincial or territorial legislation and standards;
• Regulate recipients in their activities as they relate to the legislation and standards;
• Provide ongoing oversight to recipients and to take action if the requirements are not being met;
• Participate in tripartite activities such as negotiations, dispute resolution and consultations as well as regional tables;
• Apply the legislation and standards for all child and family services equally to all residents of the province or territory on and off reserve;
• Provide information on outcome data to the federal government; and
• Adhere to other roles and responsibilities as determined through agreements, such as the Tripartite Accountability Framework.

FNCFS agencies are responsible for delivering the FNCFS Program in accordance with provincial legislation and standards while adhering to the terms and conditions of their funding agreement. FNCFS service providers include, but are not limited to, First Nations (as represented by chiefs and councils); and their organizations such as tribal councils or agencies (such as Child and Family Service agencies in various communities).

Eligible recipients for FNCFS funding are:

• Councils of Indian Bands recognized by the Minister of AANDC;
• Tribal councils;
• FNCFS agencies or societies duly mandated by the relevant province/territory;
• Provincial/territorial government;
• Other mandated Child and Family Service providers, including provincially mandated agencies/societies; and
• First Nations and First Nations organizations who apply to deliver capacity-building activities, including the development of newly-mandated FNCFS programs.

Beneficiaries of the FNCFS Program include at-risk First Nations children and their families on reserve that require access to prevention/least disruptive measures services and/or child protection services, including child placement out of the parental home.

1.2.4 The EPFA in Quebec^{Footnote 12}

In Quebec, 15 FNCFS agencies funded by AANDC serve 19 First Nations communities, and three youth centres run by the province serve the remaining eight communities. Based on the level of community responsibility for services, various types of agreements are concluded between AANDC, the band councils (agencies) and/or the youth centres to determine the roles and responsibilities of each party. These agreements also specify the level of delegation in on-reserve application of the provincial Youth Protection Act. Delegation is a prerequisite for AANDC service funding.

The Province of Quebec has been providing prevention services for over 25 years to the Quebec population. In October 2006, First Nations, the Government of Quebec and the federal government signed a tripartite agreement creating first-line intervention pilot projects over a three-year period in order to reduce the caseload and child placement in several communities in Quebec.

On June 16, 2007, a policy monitoring meeting approved prevention services within the FNCFS Program for the Quebec communities as a whole. At that time, Quebec had already been implementing some prevention measures. For example, the Ministère de la Santé et des Services sociaux du Québec's Plan stratégique 2005–2010 noted the application of prevention services delivered to at risk youth and their families. The preferred approach involves continuous early intervention, within the community if possible, to prevent the worsening or recurrence of social adaptation problems experienced by youth and their families.

During this same period, Law 125, An Act to amend the Youth Protection Act and other legislative provisions came into effect on July 9, 2007. The Law encourages keeping children with their families or returning them to their families as early as possible. It also establishes specific time limits for foster care placements depending on child's age and the concept of continuity of care, stable relationships and stable living conditions corresponding to the child's needs and age on a permanent basis. In addition, it stipulates that parental involvement must always be favoured and that parents are entitled to health and social services.

In 2009, Quebec First Nations entered into a Tripartite Framework Agreement with AANDC and the provincial government to implement an Enhanced Prevention Focused Approach to deliver child and family services. As part of the EPFA, First Nations Child and Family Services agencies in Quebec received approximately $59.8 million over five years in new funding, in addition to existing Child and Family Services Program funding.

1.2.5 The EPFA in Prince Edward Island

There are two First Nations in Prince Edward Island: Lennox Island and Abegweit. Although Prince Edward Island does not have a delegated First Nations child and family service agency, these two communities have formed the Mi'kmaq Confederacy's of Prince Edward Island. The Mi'kmaq Confederacy of Prince Edward Island is a Tribal Council organization established in 2002 to represent the common interest of the Abegweit and Lennox Island First Nations. The Mi'kmaq Confederacy of Prince Edward Island provides a range of services, including the Mi'kmaq Family Prevention, Respect, Intervention, Development and Education Program (PRIDE). Funded by AANDC, the PRIDE program provides culturally appropriate family and community services to both First Nations in Prince Edward Island.

In line with most other FNCFS operative mandates across the country, the Mi'kmaq Confederacy of Prince Edward Island PRIDE program operates within the provincial mandate of addressing the needs of First Nations communities. The Prince Edward Island Government's mandate for child protection and prevention services falls under the order of their Child Protection Act of May 2003, (originally implemented in 2003 and amended in 2010), which offers services regarding protection, but not for prevention. Nonetheless, it provides guidance on the shared responsibility of individuals within families, the community, and the province, to act to prevent abuse and neglect.

The Province of Prince Edward Island is responsible for the delivery of mandated child protection services for all children. First Nation child and family services in Prince Edward Island focuses on prevention, early intervention and gauging the children's results to determine the real impact of services on children's lives. In the late 1990s, the Prince Edward Island Director of Child Welfare and Lennox Island First Nation developed a prevention program that emphasized the importance of safeguarding the culture and identity of Aboriginal children. In August 2009, Prince Edward Island's First Nations entered into a partnership with AANDC and the provincial government to implement an Enhanced Prevention Focused Approach to deliver child and family services. The framework agreement will provide $1.7 million in new funding over five years.

Pivotal to the development of the Mi'kmaq Family PRIDE Program is the belief that children, families and communities benefit most from services that are sensitive to and congruent with their cultural beliefs and traditional values. The PRIDE vision is: To provide a holistic and culturally sensitive approach to individual, family and community wellness and risk reduction through prevention services and protection support. The PRIDE's ten objectives are:^{Footnote 13}

1. Promote the sacred value and inherent worth of children;
2. Reinforce the traditional cultural values of caring, sharing and co-operation within the community as a whole to ensure the well-being of children and their families;
3. Respect the dignity and independence of children and adults, and their right to participate in decisions that affect their lives;
4. Assist parents, extended family and community to raise healthy, happy, resilient children;
5. Reinforce the linkage between children who are ordinarily resident on reserve and who are being cared for outside their communities with their Mi'kmaq heritage, advocating and supporting a continued relationship with their immediate and extended family, culture, and community;
6. Promote and reinforce cultural pride in children and youth;
7. Strengthen supportive networks and collaborative decision making within the community, and amongst the community and external service providers;
8. Promote the best interests of children with regard at all times for their safety and well-being;
9. Reinforce the value of parents and parenting, and the role of the community in supporting parents; and
10. Strengthen families and community life.

The Prince Edward Island First Nation prevention system currently in place under the EPFA focuses on individual, family and community well-being and risk reduction through three types of preventive interventions:

1.2.6 Financial Resources under EPFA in Quebec and Prince Edward Island

The EPFA implements three funding streams: maintenance, operations and prevention services.

• Maintenance is budgeted annually based on actual expenditures of the previous year.
• Operations and prevention services funding are based on a cost model developed at regional tripartite tables and are consistent with reasonable comparability to the respective province within AANDC's program authority.
• Funding under the three streams is eligible for movement from one stream to another in order to address needs and circumstances of individual communities.

Table 3 below provides an overview of the amount of EPFA funding in the two provinces (in millions of dollars).

Previous Evaluations

The Implementation Evaluation of the EPFA in Alberta^{Footnote 14} found that the prevention approach is responsive to community needs and that overall it offers a culturally appropriate model for First Nation communities in the province. While the evaluation showed some preliminary evidence of success from implementing the approach, there were jurisdictional challenges, as well as concerns with human resource shortages, salaries, support from government/agency management, community linkages, and geographical isolation.

This report was followed by the Mid-Term National Review in 2010-2011, which examined the overall relevance of the EPFA, promising practices in prevention programming, as well as insights on the development of additional tripartite frameworks. The review reiterated the need for a prevention approach given the over-representation of children in care, common underlying risk factors in First Nation communities and service delivery issues. The report also examined factors that served to help or hinder EPFA framework agreements and best practices in prevention programming.

Finally, the 2013 EPFA Evaluation in Saskatchewan and Nova Scotia confirmed the need for a preventive approach in both jurisdictions. In both provinces, the report found an increase in prevention activities and evidence to suggest that the EPFA was supporting the security and well-being of children and families on reserve. However, the report also indicated that FNCFS agencies were having challenges with human resources, meeting provincial standards and geographic isolation. Performance monitoring and reporting concerns were also raised.

2.2.1 Relevance

The evaluation incorporated findings from previous evaluations of the EPFA to answer some of the questions related to the relevance of the approach. Lines of evidence further examined the relevance of the program in Quebec and Prince Edward Island specifically.

1. What are the child welfare and prevention needs of First Nations in Quebec and Prince Edward Island?
2. Can the EPFA be reasonably expected to achieve its stated objectives?
3. Is there a legitimate, appropriate, and necessary role for the Department and Government of Canada in meeting this need?
   • Are there other programs involved in similar activities and do they share the same objectives?
   • Is there duplication with other programs’ activities?
   • Is the federal role appropriate in the context of other organizations’ roles?

2.2.2 Design and Delivery

The analysis examined the implementation of the approach in each province respectively, how EPFA activities could logically contribute to expected results, how the design and delivery of EPFA contributes to the achievement of outcomes in practice, and factors that facilitated or hindered results.

1. To what extent are the prevention activities logically linked to the production of the expected outputs and results?
2. To what extent has the design and delivery of the EPFA facilitated the achievement of outcomes and its overall effectiveness?
3. Has the approach been implemented as planned? If not, why?
   1. Is the management / governance of the EPFA effective or are there improvements that could be made?
   2. To what extent are the monitoring and reporting mechanisms of the prevention approach effective in supporting decision making?
   3. To what extent has the EPFA influenced the constructive engagement and collaborative networks to improve child welfare?
4. What are the key factors that have facilitated or hindered the achievement of results?

2.2.3 Performance (Effectiveness, efficiency and economy)

The evaluation examined early progress toward intended outcomes, recognizing that the impact of preventative programs often takes many years to measure. The evaluation focussed primarily on immediate and intermediate outcomes. It also examined whether the approach is the most efficient and economic way to achieve outputs and outcomes.

1. To what extent has progress towards intended outcomes been achieved as a result of the EPFA?
2. Have there been positive or negative unintended outcomes? If so, were any actions taken to benefit from or remedy the unintended outcomes?
3. Is the current approach the most economic and efficient means of achieving the intended objectives?
4. Are there more economic / efficient alternatives for achieving the same outcomes?

Document Review

A comprehensive document review was conducted as part of the Mid-Term National Review of EPFA in 2010-11. For this evaluation, additional documents related specifically to the EPFA in Quebec and Prince Edward Island were reviewed. These included policy and program documents, business plans, recent audits, reviews, and evaluation reports. Documents were read and analyzed based on the evaluation questions and themes.

Literature Review

A review of domestic and international literature was undertaken to examine the need for FNCFS (particularly prevention services for First Nations in Quebec and Prince Edward Island). Specifically, the literature review examined prevention theory, risk factors that necessitate the EPFA, and best practices. Documents were read and analyzed and an account of supporting themes and insights were noted. Findings from the literature review were triangulated with the information retrieved from other lines of evidence.

Key Informant Interviews

Thirty-two interviews were conducted with key program stakeholders to gain an understanding of the perceptions and opinions of individuals who have had a significant role or experience related to EPFA. Interviews were crucial to understanding the implementation of the program in communities and the early achievement of results. Interviewees included the following interview groups: AANDC FNCFS officials (four); FNCFS agency directors and staff (21); and provincial representatives (seven).

Interviews were semi-structured and conducted in-person or by telephone. Detailed notes were taken during the interviews. They were transcribed and analyzed according to research themes. The confidentiality of interviewees was maintained throughout the evaluation.

Case Studies

Case studies were conducted to gather community-level data on the implementation and performance of the EPFA in Quebec and Prince Edward Island. Three case studies were completed (two in Quebec and one in Prince Edward Island). The case studies focused on the FNCFS agencies and the communities that they serve. A total of four communities were visited. In Prince Edward Island, the Lennox Island and Scotchfort communities (one of Abegweit First Nations three reserves) were visited; and in Quebec, the Mashteuiatsh and Gesgapegiag communities were visited. These case studies were conducted to:

1. Provide an in-depth look at implementation and performance.
2. Examine program outcomes in communities along with the factors that have facilitated or hindered program success.
3. Identify promising practices and lessons learned from front-line workers and community members (and potentially from children and families involved with the services).

Case studies did not examine the performance of the specific agency. Instead, they examined agencies as part of the larger implementation of the program.

EPMRB contracted Johnston Research Inc., an independent, Aboriginal-owned and experienced firm, to conduct the case studies. Johnston Research Inc.staff, accompanied and supported by EPMRB staff, visited communities to conduct interviews, observe the community and facilities, and conduct focus groups.

Finally, two site visits were conducted in Quebec (Wendake and Kitigan Zibi) to conduct interviews and site observations, and to obtain documents from two additional FNCFS agencies.

Surveys

Surveys were administered to agency directors and front-line FNCFS agency staff in Quebec. The surveys were not administered in Prince Edward Island, given that all First Nation communities in Prince Edward Island are served by Mi’kmaq Confederacy of Prince Edward Island and were covered extensively in the case studies. The surveys were used as a quantitative line of evidence to validate findings of other qualitative methods. They were distributed to 15 agencies and were competed by14 staff members from nine of the agencies. It is noted that given the total sample and response, the surveys could not be used for any statistical inference. Rather, they provided more in-depth information from multiple sources in each agency.

The survey examined respondents’ opinions on the implementation of the EPFA, observations at the community-level on the impact of transitioning towards an enhanced prevention focused approach, feedback on partnership building and the development of a continuum of care, as well as notes on promising practices and lessons learned.

2.3.1 Considerations, strengths and limitations

Determining factors

Certain key determining factors point to the fact that the need for prevention activities is more profound amongst First Nations. A comprehensive review of the literature on child and family abuse concludes that there is an ongoing need for culturally relevant prevention services for First Nations in Quebec and Prince Edward Island. Key risk factors (with various causes) that contribute to the crucial need for the EPFA among First Nation communities are linked together by the literature, and include emotional, behavioral, family and social problems, which can be divided into four factors: (1) individual; (2) family; (3) social; and (4) background factors.

Individual factors: these are psychobiological in nature (e.g. depression, mental illness and anxiety), and have a decisive influence on an individual's behaviour.

Family factors: refer to detrimental cultural and family circumstances. It includes family breakdown, improper parental behaviour towards children, and the risk that children, particularly boys, will replicate their parents' behaviour. Interviewees mentioned that the intergenerational impacts of residential school have limited their people's ability to learn parental and community skills and responsibilities through their cultural as well as the usual socialization processes.

Social factors: include socioeconomic determinants such as poverty, lack of education, limited employment opportunities, the poor state of housing and sanitation facilities, and poor water quality, all of which affect many Aboriginal people. In 2001, more than half (52.1 percent) lived in poverty, and according to interviewees, living in such conditions incessantly contributes to a feeling of helplessness and hopelessness. Documents reviewed show that in Canada, 40 percent of Aboriginal children are presently living in poverty, compared to 17 percent for the rest of Canada. For example, a review of literature from D. Macdonald & Daniel Wilson (2013) shows that poverty in itself is nothing; however, it carries a heavy symbolic load in our capitalist world. In the case of the EPFA, poverty translates into a lack of resources, power, voice and access to services and raises the need for an ongoing maintenance of the EPFA, if its outcomes are to be realized.

Table 4 shows that the Aboriginal and Registered Indian populations have weaker participation rates in the economy compared to the non-Aboriginal population and, that unemployment rates are more than double for Registered Indians compared to the non-Aboriginal population (with the exception of Registered Indians off reserve in Prince Edward Island, due to small numbers).

With respect to education, Table 5 shows the Educational Attainment for the 25-64 age cohort. The non-Aboriginal population, and off- reserve Registered Indians, are more likely to have a post-secondary education than Registered Indians on reserve.

Table 6 shows that in both Quebec and Prince Edward Island, Registered or Treaty Indians on reserve have lower median incomes than other population groups in Quebec and Prince Edward Island. In Prince Edward Island, Registered or Treaty Indians on reserve have a median income of $20,000 compared to $27,600 for Registered or Treaty Indians off reserve, and $34,400 for non-Aboriginal people in Prince Edward Island. In both comparisons, those living on reserve have lower incomes than other population groups in Prince Edward Island. In Quebec, the situation is similar, as Registered or Treaty Indians on reserve have a median income of $23,900 compared to $30,000 for those living off reserve, and the gap widens further when compared to non-Aboriginal people in Quebec who have a median income of $35,300.

Background factors: includes historical elements that have an impact on Aboriginal peoples' lives, for instance, the fact that Aboriginal people were dispossessed of their lands, lost control of their living conditions, saw their beliefs and spirituality extinguished, fell victim to racial discrimination, and found their social and political institutions weakened. All these background factors have seriously damaged their confidence and contribute to their predisposition to suicide, self-harm and other forms of self-destruction (Royal Commission, 1995).

These factors are far from isolated, and when combined with one another, they influence individual behaviours. Minde and Minde (1995) show that psychosocial problems observed among Native American children and adolescents in terms of social and school adjustment are the product of interaction between socioeconomic status and environmental conditions, on the one hand, and socio-cultural and historical characteristics specific to each community, on the other.

The literature is corroborated by key informants who noted that residential schools and their consequences, not only played a role in cultural breakdown, but also undermined family life, destroyed parenting skills, and were the setting for widespread neglect and abuse that was experienced or at least witnessed by generations of children. Key informants noted that without federal funding for such prevention programs, whether in Quebec or Prince Edward Island, they would be unable to receive the level of services now considered essential.

In the same vein, Beauvais (1996) and Machamer & Gruber (1998) show that the interconnection between poverty and idleness on reserves, parenting and inadequate family interactions contribute to the risk of alcohol and drug abuse, lack of motivation and early drop-out among Native American adolescents. Poverty, isolation on reserves and lack of motivation are also considered to be powerful predictors for identifying the causality of suicide among Aboriginal adolescents and young adults (Bagley, Wood & Khumar, 1990).

Some risk factors, such as poverty and alcoholism among parents increase the probability of a negative reaction. The risk may be personal or family-based or occur in a broader environment. Vulnerability to a negative reaction increases exponentially with each additional risk factor. This is referred to as the "stacking" of risk factors. Interviewees and case study participants were overwhelmingly concerned with these risk factors, emphasizing overcrowding and substandard housing, mental health issues, addictions, historical traumas, lack of social supports, differing needs from the mainstream, as well as ongoing funding and service delivery issues. For Moodie, R. and Jenkins, R. (2005), who surveyed the opinions of a number of mental health experts, a major investment must be made going forward to promote mental health and prevent mental illness in order to put a stop to the ever-increasing costs of curative treatments for mental illness and the associated physical health problems.

The strong correlation between socio-economic status and children's academic performance is well established. The literature also shows that there is a correlation between the level of education as a risk factor and child poverty by ethnic group. Rudy Pohl's Poverty in Canada notes that young parents, most particularly young single mothers, are more vulnerable and face challenges related to education and employment that can lead to poverty (Pohl, Rudy. (2002). Poverty in Canada. Street level consulting and counseling). However, with respect to children living in poverty, theirs is a demand that is much greater and which require extra support for them to live and to fulfil their potential. It is a well established fact that children living in poverty are more vulnerable than any other section of society and it is equally well known that poverty is linked to various physical, social and economic disadvantages that occur later in life.

Interestingly in Canada, both Government and business are concerned or preoccupied with workforce replacement and shortages in skilled labour while at the same time, studies reiterate that amongst Canada's population, the youngest and fastest growing demographic in the country are Aboriginal people, but they are those caught in the throes of poverty.

As illustrated in Figure 1, the median age (the midpoint where half the population is above and the other half below) is significantly lower for Registered Indians on reserve, compared to their non-Aboriginal counterparts. In Canada, there is a 16 year gap between non-Aboriginal males when compared to males who are Registered Indians on reserve, and a 17 year gap between women. That gap increases to almost 18 years between males who are non-Aboriginal in Prince Edward Island and males that are Registered Indians on-reserve in Prince Edward Island, and a gap of close to 19 years for women. In Quebec, the gap is 17 for males and 16.4 for females.

Figure 1 Source: Statistics Canada, 2011 NHS, AANDC Special Tabulations

Text alternative for Figure 1

This figure is a bar graph of the median ages of both Non-Aboriginal and Registered Indian, On Reserve. The figure source is listed as "Statistics Canada, 2011 NHS, AANDC Special Tabulations. The numbers on the side of the graph increase in 5 year increments, from 0 to 50. The graph contains four clusters of bars, one each for "Male Non-Aboriginal", "Female Non-Aboriginal", "Male Registered Indian, On Reserve" and "Female Registered Indian, On Reserve". Each cluster contains 3 bars: a blue bar signifying Canadian median ages, a red bar signifying PEI median ages, and a green bar signifying Quebec median ages (these colour-coding is explained by a legend at the bottom of the graph).

For the "Male Non-Aboriginal" cluster, the median Canadian age appears to be approximately 40, the PEI median age appears to be approximately 42, and the Quebec median age appears to be approximately 40.

For the "Female Non-Aboriginal" cluster, the median Canadian age appears to be approximately 41, the PEI median age appears to be approximately 43, and the Quebec median age appears to be approximately 42.

For the "Male Registered Indian, On Reserve" cluster, the median Canadian age appears to be approximately 23, the PEI median age appears to be approximately 24, and the Quebec median age appears to be approximately 23.

For the "Female Registered Indian, On Reserve" cluster, the median Canadian age appears to be approximately 25, the PEI median age appears to be approximately 24, and the Quebec median age appears to be approximately 26.

The child poverty rate remains at 1989 levels, the year of the all-party House of Commons resolution to end child poverty. In that year, federal and provincial governments committed to eliminate child poverty by the year 2000 but this is not the case, with Canada ranking 25^th among the 30 countries that comprise the Organization for Economic Co-operation and Development, a body that tracks child poverty rates internationally. In the case of Aboriginal children, data from the 2006 census (Statistics Canada study) show that the average child poverty rate for all children in Canada is 17 percent, while the average child poverty rate for all the indigenous children is at 40 percent.

In a unique way, the very recent (October 6-15, 2013) visit by James Anaya, the United Nations fact-finder and special rapporteur on indigenous rights who came to take stock of the plight of Aboriginal Peoples in Canada reinforces the continued need of the EPFA. In a telephone interview, the law professor conceded "The idea is to get a first-hand view of the situation of Aboriginal Peoples in Canada by hearing directly from as many as I can." Adding that "Canada consistently ranks among the top of countries in respect to human development standards, and yet amidst this wealth and prosperity, Aboriginal people live in conditions akin to those in countries that rank much lower and in which poverty abounds." He also noted: "One community I visited has suffered a suicide (once) every six weeks since the start of this year."

"Despite positive steps, the daunting challenge remains," he said. "From all I've learned, I can only conclude that Canada faces a crisis when it comes to the situation of indigenous peoples." He also talked about the residential school period in Canada and how it continues to "cast a long shadow of despair on indigenous communities," urging the federal government to extend the mandate of the Truth and Reconciliation Committee "as long as necessary," because "Many of the dire social and economic problems faced by Aboriginal people are directly linked to that experience," as he wrapped up his mission. His visit is the latest in a series of visits by United Nations special rapporteurs on indigenous rights whose findings have been similar to Anaya's.

Overall, the EPFA meets an ongoing, pressing need to help lower the risk factors underlying the psychosocial problems observed in Aboriginal communities. These social problems are sources of social destabilization and stunted economic development. Prevention, therefore, becomes an approach adapted to the current situation faced by Aboriginal communities. The need to implement a prevention focused approach was supported by all stakeholders who were interviewed in both provinces (Quebec and Prince Edward Island). According to them, First Nations have always made it loud and clear that prevention in Aboriginal communities is the only way to counteract the prevalent risk factors. Moreover, some noted that they had used a preventive approach prior to the Government of Canada assuming responsibility for this initiative.

Given their experience and the available evidence, the affirmation of the continued need of the EPFA by key informants is critical The ongoing need for this type of programming is underscored by the continuing existence of First Nation children who are experiencing neglect and abuse across Canada and the observation that without designated funding, communities would not be able to provide a range of prevention services.

Aboriginal Affairs and Northern Development Canada and Health Canada Initiative

Jordan's Principle - This is a shared AANDC/Health Canada initiative based on the case of Jordan River Anderson, a First Nation child born with a rare neuromuscular disorder who required hospitalization from birth. The provincial and federal governments could not agree on who was financially responsible for Jordan's care in a medical foster home. Both governments were attempting to find a resolution; however, Jordan's condition deteriorated and he passed away in hospital before a resolution was reached. On December 12, 2007, the House of Commons unanimously supported a Private Member's motion (M-296) stating that "the government should immediately adopt a child first principle, based on Jordan's Principle, to resolve jurisdictional disputes involving the care of First Nations children." AANDC and Health Canada are working with provinces and First Nations to implement Jordan's Principle. Federal and provincial contacts and processes are in place for each province to address any cases that are brought forward.

Health Canada and the Public Health Agency of Canada

Health Canada partners with AANDC (i.e. FNCFS) in order to institute a coordinated and collaborative approach to child welfare, including the needs of vulnerable children on reserve. Some of the programs where collaboration is assured include:

1. Non-Insured Health Benefits Program: provides health benefits not covered by provincial or territorial health care, to registered Indians living on and off reserve and Inuit living anywhere in Canada. The Non-Insured Health Benefits covers the cost of pharmaceuticals, dental services, vision services, medical transportation, medical supplies and equipment, and crisis intervention mental health counseling. In 2009-10, total expenditures for Non-Insured Health Benefits was $989.1 million.
2. Aboriginal Head Start on reserve: Since 1997, Aboriginal Head Start is intended to deliver Early Childhood Development programs that include locally-designed and controlled early-intervention strategies that foster a positive sense of self and a desire for learning in First Nations preschool youngsters. Aboriginal Head Start programming encompasses: education; health promotion; culture and language; nutrition; social support; and parental/family involvement. Aboriginal Head Start is highly complementary to the goals of a prevention approach to child welfare.
3. The Fetal Alcohol Spectrum Disorder Program: addresses health problems that are associated with alcohol use by mothers during pregnancy and its main purpose is to reduce the number of babies born with Fetal Alcohol Spectrum Disorder and to support children who are diagnosed with Fetal Alcohol Spectrum Disorder and their families to improve their quality of life. In targeting present or future parents at risk, this program is also complementary to child welfare programming.
4. The Canada Prenatal Nutrition Program: is a community development approach (not specific to Aboriginal mothers). The goal of the Canada Prenatal Nutrition Program-First Nations and Inuit Component is to improve maternal and infant nutritional health for pregnant First Nations and Inuit women, mothers of infants, and infants up to 12 months of age who live on reserve or in Inuit communities, particularly those identified as high risk.
5. Maternal Child Health Program: it supports pregnant First Nations women and families with infants and young children, who live on reserve, to reach their fullest developmental and lifetime potential. It is accessible to all pregnant women and new parents, with long-term support for those families who require additional services.
6. The Brighter Futures Program: promotes community-based and culturally appropriate approaches for healthy child development in First Nations and Inuit communities. The program is aimed at addressing child development for children 0-6 within the context of family and community; the ultimate goal is a healthy family and community context in which children can grow. One of its components, parenting skills, aims to promote culturally sensitive parenting skills. Some of its activities include parenting workshops, parental training programs and support groups for parents and fits well with the FNCFS mandate.
7. The Community Action Program for Children: a health promotion program funded by the Public Health Agency of Canada, in partnership with the provinces and territories, it targets all children (0-6) who are deemed to be at risk, not specifically Aboriginal children. Community Action Program for Children places importance on collaboration and partnerships and is big on community capacity building. Community Action Program for Children targets low income families, children being cared for by teenage parents, those with developmental delays or other behavioral problems, and those who are subjected to abuse and neglect.

Justice Canada

1. The Aboriginal Justice Strategy: having funded over a hundred community-based projects in Aboriginal communities across Canada, it is a national strategy under Justice Canada and has been operational since 1991. The aim is to create greater community control of justice processes (community healing and prevention approach in child welfare), reduce victimization, crime and incarceration and raise awareness within the mainstream justice system of the cultural needs of Aboriginal peoples as they interact with the justice system. Many of these projects take a crime prevention approach that would benefit families at risk of child maltreatment and domestic violence.
2. National Anti-Drug Strategy: is a Justice Canada led horizontal strategy (partnership with 11 other federal partners) and targets reduction, production and distribution of illicit drugs. A Prevention Action Plan element (overseen by Health Canada) targets youth and implements community-based interventions. As child maltreatment and neglect are often linked to addictions, this program is another collaborator with FNCFS in prevention efforts and is described in areas in key legislation that are relevant to National Anti-Drug Strategy's activities (e.g. Youth Criminal Justice Act; Criminal Code of Canada; Canada Health Act).

Human Resources and Skills Development Canada

1. First Nations and Inuit Child Care Initiative: is a component of the Aboriginal Skills and Employment Training Strategy that provides child care services for First Nations and Inuit children whose parents are starting a new job or participating in a training program. The First Nations and Inuit Child Care Initiative is a $50-million program that has supported over 8,500 childcare spaces in 486 First Nations and Inuit communities across Canada. Aboriginal Agreement holders create programs based on their community needs (mostly pre-school spaces); some are after-school programs.
2. Aboriginal Human Resources Development Strategy: provides job-training opportunities for Aboriginal people (on and off reserve). It is complementary to child welfare by facilitating the achievement of secure employment for parents, improving life circumstances of the family and lessening the stresses of poverty. As poverty is one of the major contributing factors to child maltreatment, reducing poverty has the potential to improve child welfare.

Regarding roles and responsibilities, the importance of federal departments and provincial/territorial engagement and support when negotiating meaningful EPFA agreements in Aboriginal communities cannot be ignored. These partners, as well as First Nation communities have an important role to play under the EPFA. As such, these community-based programs, which take an early intervention/prevention approach to child welfare, from prenatal to teenage years, are sometimes cost-shared with other funding partners. While aiming to support and help create healthy families in healthy communities, they are delivered in a way that reflects the culture and values of the communities in which they are situated. However, most interviewees have noted that a central mechanism or responsible party for coordinating these efforts, such as the FNCFS EPFA is needed.

All interviewees agreed that there is a need for a strengthened interface between federal, provincial/territorial and First Nations partners by increasing the number of regional tripartite Tables on First Nations Child and Family Services working in partnership with each other (e.g. Health Canada, Human Resources and Social Development Canada) to develop single-window service delivery options with respect to early childhood development.

Program Delivery Challenges

The EPFA funding models for Quebec and Prince Edward Island were developed collaboratively with First Nations and provincial representatives, and are intended to reflect federal funding commitments that meet or exceed provincial funding for comparable funding elements. According to key informant interviews and the case studies, the multi-year funding provides for job and service security as well as some flexibility in how spending is allocated. However, the maintenance portion of the funding in the five-year agreement is based on costs from previous years and there is no mechanism to revise the costing model to accommodate additional financial pressures. Consequently, there is a risk that the models will become outdated, particularly with respect to salary increases, provincial changes to their service delivery models, and provincial cost pressures.

AANDC does allow, in exceptional circumstances, requests for additional maintenance funding. The uncertainty of whether or not the additional funding request will be approved can create stress for agency management. In Prince Edward Island, it was reported that funding concerns have led PRIDE to carefully plan expenditures and manage the flow of funding within the specific funding categories. Over the last five years, PRIDE has made only one request for extra funds, which was approved by AANDC.

In Quebec, the following program design challenges were articulated by respondents who participated in the case studies and site visits: need for consistent and better scheduled programs; improved system of communication between protection and prevention services; and the current limitations of in-home service provision.

It was mentioned that there was a need to have more consistent programs, that is not to say there was not enough programming, but rather that the timing of the sessions was sometimes inappropriate. The need to provide the programs in different timeslots to accommodate more clients was important since most clients have no means of travelling off the reserve for services. In one community, parents wanted to see more programming, even if a fee had to be charged (suggesting a monthly fee of twenty dollars), as they explained that there was nothing else happening for their children to participate in. Multiple respondents suggest that weekend services were needed.

Both prevention and protection staff and management in Gesgapegiag First Nation noted that there should be an improved system for communication between protection and prevention services. In the Mashteuiatsh First Nation, there was also a clear lesson learned in that protection and prevention services are best suited as separate entities (e.g., located in separate buildings so that parents are not confused on where the line is drawn); however, ensuring the two are well connected is imperative. In the Mashteuiatsh First Nation, the protection services were including EPFA services as part of family case conferences in order to better support families. In the Mashteuiatsh First Nation, the observation was made that in-home services were lacking and that it would be beneficial for a psycho-educational program like the EPFA to provide parental educational experiences in the home.

In both Quebec and Prince Edward Island, a program delivery challenge was also expressed due to limited office space, and lodging for employees in geographic isolated communities, which makes it challenging to provide additional programming and in some cases stable and consistent programming. The agencies work around this issue by collaborating with other service providers such as schools and by renting office space. For example, the PRIDE Program rents office space in Lennox Island from the Lennox Island Health Center. Programming is carried out on site or at the local elementary school. During the site visit at Scotchfort reserve (Abegweit First Nation) construction of the new Abegweit First Nation Community and Family Resource Center (funded by Atlantic Canada Opportunities Agency, Island Community Fund and Abegweit First Nation) was nearing completion. The PRIDE Program offices for Abegweit First Nation will be located in this new building.