Implementation Evaluation of the Enhanced Prevention Focused Approach in Manitoba for the First Nations Child and Family Services Program

Relevance

The over-representation of First Nations children in care and the overarching factors which contribute to this disparity, such as housing, poverty, substance misuse, lack of mental health services, child abuse and neglect, are the most common parental and community issues facing First Nations communities in Manitoba. Each represents a unique challenge to keeping Aboriginal families and children united and safe, and taken collectively, these factors indicate that there continues to be a demonstrable need for child welfare prevention services in the First Nations communities of Manitoba.

The literature reviewed for this evaluation concludes that the differential response model is most effective if it includes all three tiers of prevention. Review of the business plans and key informant interviews reveal that agencies have undertaken activities, which fit into each tier, whereby heightening the effectiveness of the Enhanced Prevention Focused Approach.

Design and Delivery

The evaluation found that the two main elements included in the design and delivery of the EPFA, which facilitated the achievements of expected outcomes are the EPFA's flexibility and its focus on culturally tailored programming. Flexibility allowed agencies to develop locally relevant programming through community consultation and the participation of elders, ensuring that protection and prevention services were targeted to address the determined needs of each community. Flexibility also allowed for prevention initiatives to reflect the unique cultural character of Manitoba's First Nations, which the literature suggests is instrumental for the achievement and success of prevention programming.

Overall, some of the most common challenges identified in the implementation of the EPFA were the provincial requirements for receiving EPFA funding, which caused large delays in the release of funds for these agencies, while other agencies struggled with the considerable changes happening in Manitoba child welfare at the time of EPFA implementation. Strong professional relationships between AANDC regional office and agencies as well as engaged Boards of Directors demonstrate signs of effective management of the EPFA. There were, however, concerns in this area as to the lack of business capacity supports for agencies.

The evaluation found evidence that some agencies are participating in their own monitoring activities to improve programming, though there remains challenges to integrating reporting at the federal/provincial government levels. Areas for improvement include the improvement of data sharing, streamlining of reporting and providing better feedback to agencies on their performance.

Performance/Effectiveness

The evaluation found that the EPFA has encouraged the expansion of collaborative networks within communities by developing programs and delivering services in partnership. Some of the best examples of constructive engagement include the Circle of Care approach, resource committees and the referral system. Agencies have introduced numerous innovative practices to overcome factors, which can hinder the implementation of family enhancement programming, such as community infrastructure deficits, a lack of public awareness, heavy workloads and time constraints for services. Most agencies report that it is difficult to recruit and retain qualified staff, particularly First Nation staff.

Overall, some of the most common challenges identified for the performance of the EPFA are the ever expanding services that FNCFS agencies are expected to provide, as well as difficulties based on large geographical distances and the costs associated with these. Most agencies report that awareness of and participation in prevention programming has increased in their communities but that it will take time to change community perspectives and the negative stigma surrounding Child and Family Services. Nevertheless, the EPFA has allowed for an increase in access to prevention services, and early indicators point to a reduction of the number of children in care.

Economy/Efficiency

The evaluation found that investing in prevention activities has the potential for substantial societal and economic benefits due to the multiplying costs associated with child maltreatment. Although a number of agencies are employing cost-effective practices, and while the flexibility of the EPFA was identified by key informants as one of its greatest strengths, the rise in maintenance and operation costs in Manitoba has meant that agencies must then take from their prevention dollars and put them into maintenance. Consideration is needed on how to ensure prevention dollars remain under the prevention stream.

Based on these findings, it is recommended that AANDC:

1. Consider increased funding for operational costs for multi-site agencies and travel to remote communities in any revisions to the costing model;
2. Explore how to ensure prevention dollars are being utilized for prevention activities so that agencies are able to develop sustainable prevention programming and explore other areas of activity to support a reduction of children being sent off-reserve;
3. Work with the province and FNCFS organizations to address the issue of managerial capacity and business supports in agencies; and
4. Continue to pursue data sharing opportunities with the Province of Manitoba and streamline reporting for agencies.

1.1 Overview

This Implementation Evaluation of the Enhanced Prevention Focused Approach in Manitoba is part of a multi-year Strategic Evaluation of the Implementation of the Enhanced Prevention Focused Approach (EPFA) for the First Nations Child and Family Services (FNCFS) Program, which began with an implementation evaluation in Alberta in 2009-2010. The purpose of the strategic evaluation is to look at jurisdictions individually two to three years after the approach has been implemented to address issues of relevance, design and delivery, effectiveness and alternatives.

In 2010-2011, a Mid-Term National Review was undertaken to consider the overall relevance of the EPFA, promising practices in prevention programming, as well as to provide some insight on discussions to establish tripartite frameworks to date. Additionally, implementation evaluations have been conducted for Alberta (2009-2010), Nova Scotia and Saskatchewan (2011-2012), and Quebec and Prince Edward Island (2012-13). Further evaluative work will be considered as agreements are reached in remaining jurisdictions.

This report presents the findings and recommendations of the evaluation of the Implementation Evaluation of the Enhanced Prevention Focused Approach in Manitoba for the First Nations Child and Family Services Program. The evaluation examined the process of implementation of the EPFA in Manitoba FNCFS agencies from 2010-11 to 2012-13. Data was collected between November 2013 and March 2014.

1.2 Program Profile

1.3 Manitoba Profile

The FNCFS Program in Manitoba provides funding to mandated FNCFS agencies to deliver, in accordance with provincial legislation, culturally appropriate prevention and protection services to First Nation children and families ordinarily resident on-reserve within AANDC program authorities. The province mandates agencies under the Child and Family Services Act to deliver services. There are four components to the program, including: development (start-up); maintenance; operations; and prevention. The FNCFS agencies receive funding from four sources: (1) the Province; (2) AANDC; (3) the Authorities; and (4) Canada Revenue Agency. There are 17 fully mandated First Nation Child and Family Services agencies in Manitoba (serving 63 First Nation communities), 15 of whom have funding arrangements in place with AANDC. The two agencies that do not receive AANDC funding are: the All Nations Coordinated Response, which is a coordination and referral service operating in the city of Winnipeg and has a mandate to provide services to all Manitobans requiring child and family services, and the Animikii Ozoson Child and Family Services serves families living in Winnipeg who have ties to First Nations in Ontario or choose to receive services from this agency.

In November 2003, The Child and Family Services Authorities Act was proclaimed, which resulted in the creation of four Authorities in the province: Northern Authority, Southern Authority, General Authority and Métis Authority. These Authorities are responsible for mandating, funding, and monitoring the work of the agencies. The Northern and Southern Authorities were established to oversee the work of First Nation Child and Family Services agencies in Manitoba.

FNCFS agencies operating under the Northern Authority include:

1. Awasis Agency of Northern Manitoba
2. Cree Nation Child and Family Caring Agency
3. Island Lake First Nations Family Services
4. Kinosao Sipi Minisowin Agency
5. Nikan Awasisak Agency Inc.
6. Nisichawayasihk Cree Nation Family and Community Wellness Centre
7. Opaskwayak Cree Nation Child and Family Services.

FNCFS agencies operating under the Southern Authority include:

1. Anishinaabe Child and Family Services
2. Dakota Ojibway Child and Family Services
3. Intertribal Child and Family Services
4. Peguis Child and Family Services
5. Sagkeeng Child and Family Services
6. Sandy Bay Child and Family Services
7. Southeast Child and Family Services
8. West Region Child and Family Services
9. All Nations Coordinated Response
10. Animikii Ozoson Child and Family Services

In July 2010, First Nations in Manitoba, the Province of Manitoba and AANDC entered into a Tripartite Accountability Framework. AANDC also announced $177 million in incremental investments over a period of five years (fiscal years 2010-11 to 2014-15 inclusive) with $42.2 million in ongoing funding to implement the new EPFA to enhance the delivery of protection and prevention services to First Nation children, families and communities in Manitoba. Under this new approach, there is additional funding provided for prevention activities, and is provided in three streams of prevention, operations and maintenance; funding can be moved between streams for the purpose of addressing the needs and circumstances facing individual communities.

The current structure in Manitoba gives all families in the province the right to choose which Authority is most culturally appropriate for them, with limited exceptions. Manitoba is currently the only province in which all families have this option.^{Footnote 2}

2.1 Evaluation Scope and Timing

The scope of the evaluation includes perspectives from AANDC, the Province of Manitoba, as well as FNCFS agencies and First Nation community members in the province. Since a Mid-Term National Review was undertaken in 2010-11 to consider the overall relevance of the EPFA, this evaluation will largely focus on the status of the implementation of the EPFA, particularly design, delivery and any initial impacts on overall program administration and performance in Manitoba.

The purpose of the Strategic Evaluation is to analyze jurisdictions two or three years after the EPFA has been implemented in order to address issues of relevance, design, delivery, performance, efficiency, effectiveness, and alternatives. Once all of the evaluations are complete, a comprehensive comparative analysis of the different EPFA approaches across the provinces will be completed.

This evaluation examines the process of implementation of the EPFA in Manitoba FNCFS agencies from 2010-11 to 2012-13. Data was collected between October 2013 and March 2014, inclusively.

2.2 Evaluation Issues and Questions

In line with the Terms of Reference, the review focused on the following key issues:

Relevance

1. What are the child welfare and prevention needs of First Nations in Manitoba?
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 the Government of Canada in meeting this need?
   
   Design and delivery
   
4. To what extent are the prevention activities logically linked to the production of the expected outputs and results?
5. To what extent has the design and delivery of the EPFA facilitated the achievement of outcomes and its overall effectiveness?
6. Has the approach been implemented as planned? If not, why?
7. Is the management / governance of the EPFA effective or are there improvements that could be made?
8. To what extent are the monitoring and reporting mechanisms of the prevention approach effective in supporting decision making?
   
   Performance and effectiveness
   
9. To what extent has the EPFA influenced the constructive engagement and collaborative networks to improve child welfare?
10. What are the key factors that have facilitated or hindered the process of implementation?
11. To what extent has progress towards intended outcomes been achieved as a result of the implementation of EPFA?
12. Have there been positive or negative unintended outcomes?
    
    Economy / Efficiency
    
13. Is the current approach the most economic and efficient means of achieving the intended objectives?
14. Are there more economic / efficient alternatives for achieving the same outcomes?

2.3 Evaluation Method

2.4 Roles, Responsibilities and Quality Assurance

EPMRB of AANDC's Audit and Evaluation Sector was the project authority and managed the EPFA Manitoba evaluation in line with EPMRB's Engagement Policy and Quality Assurance Process. The Quality Assurance Strategy is applied at all stages of the Department's evaluation and review projects, and includes a full set of standards, measures, guides and templates intended to enhance the quality of EPMRB's work.

As part of the evaluation for FNCFS in Manitoba, an evaluation working group was established to draw on the knowledge and expertise of key stakeholders to ensure that the evaluation products are reliable, useful and defendable to both internal and external stakeholders. The broad mandate of the working group was to provide ongoing advice to EPMRB, particularly with respect to the detailed methodology report, the preliminary findings deck and the draft final report. The working group operated from November 2013 to June 2014 and included members of EPMRB, program staff (Headquarters and Manitoba region), the Province of Manitoba and the Northern and Southern Authorities.

The EPMRB team assigned to this evaluation was involved in each phase of the evaluation, including data collection and analysis, and reporting. Oversight of daily activities was the responsibility of an evaluation manager. The methodology and draft final reports were peer reviewed by EPMRB for quality assurance. EPMRB requested input from the Evaluation, Performance Measurement and Review Committee to review preliminary findings, key findings, and the final report.

3.1 Is there a demonstrable need for prevention in First Nations in Manitoba?

Finding: Several overarching factors for Aboriginals living both on- and off-reserve are listed below, and each represents a unique challenge to keeping Aboriginal families and children united and safe. Taken collectively, these factors indicate that there continues to be a demonstrable need for child welfare prevention services in the First Nations communities of Manitoba.

Overrepresentation of Aboriginal Children in Care in Manitoba: Over the last decade, numbers and rates of Aboriginal children both on- and off-reserve coming into the child welfare system have increased in many jurisdictions across Canada, but especially in Manitoba. Data obtained by the Manitoba Bureau of Statistics confirms that Aboriginal children are overrepresented among children cared for by CFS and the percentage has been steadily rising. In Manitoba, Aboriginal children represent 85 percent of the children in care population, yet are only 25 percent of the total child population.^{Footnote 3} In addition, the rate of Aboriginal out of-home placements is 19 times the rate of non-Aboriginal out-of-home placements in Manitoba.^{Footnote 4}

As of March 2011, there were 9,435 children in care in Manitoba, (6,792 in care under the Northern and Southern Authorities). In 2013, the number increased to 9,940 children in care (7,254 are in care under the Northern and Southern Authorities). Of the 9,940 children in care, 2,659 or 27 percent of children were funded by the federal government.

Historical Trauma: The literature provides ample evidence of the historical traumas undergone by Aboriginal people. The effects of this trauma have widely manifested themselves in the form of addictions, poverty, increased risk of violence and abuse, as well as the community breakdown. The experience of the residential school system is often cited as a leading cause of family difficulties and the breakdown of family relationships.

Throughout the interviews with case study participants, it was revealed that mistrust remains strong and the historical effects of child apprehension still lingers. An interviewee described this mistrust as follows, "When [one young mother] sees us coming, she grabs her children out of the yard and runs to her house as if a tornado is coming, barricading herself from the CFS worker." This demonstrates the lack of trust for the CFS staff, which must be addressed in order to facilitate staff support of families in need. To help address these issues, the prevention programs provide various activities such as youth groups in collaboration with other service providers, resources for poverty-related issues, such as nutrition, utilities costs, and adequate clothing.

Healing is an important factor for families that need prevention services. It was noted in interviews that parents have a more challenging healing process than non-parents given that they must balance carrying the history of trauma with the needs of their children. Crisis occurs as parents try to survive this balancing act but cannot succeed due to the younger generation's own set of socio-cultural and mental health issues, i.e. rebellion and suicidal tendencies.

Child Abuse and Neglect: The most relevant of risk factors for Aboriginal children, as identified by a number of key informants and scholars, is the rate of substantiated neglect.^{Footnote 7} In the 2014 final report of the Manitoban public inquiry into the circumstances surrounding the death of Phoenix Sinclair, Dr. Nico Trocme provided expert advice on the devastating long term impacts of neglect on the development of a child. Testifying to the Commission, Dr. Trocme said: "you compare neglected children to any other type of child – physically abused, sexually abused, children living in poverty, children living in a range of circumstances – neglected children stand out. Any which way you measure them, neglected children are the ones that have the worst outcomes, by far."^{Footnote 8}

Although Aboriginal and non-Aboriginal rates of abuse are nearly equivalent, a number of studies have identified that substantiated cases of neglect are considerably higher in Aboriginal families.^{Footnote 9} As child welfare has traditionally focused on protection, or the immediate threat to a child's well-being, the long-term consequences of chronic neglect on a child's outcomes have often been overlooked. It is precisely such a problem that family enhancement programming and family-focused prevention activities are designed to address, contributing to a reduction in the number of child protection cases over time.

Poverty is commonly associated with child neglect and is one of the most commonly cited reasons for First Nations children coming into care.^{Footnote 10} Although poverty on-reserve is a national problem, in Manitoba, the situation is particularly difficult with 62 percent of status First Nations children living in poverty, according to 2006 census data measured by the Low Income Measure.^{Footnote 11} The 2012 data from the Manitoba Bureau of Statistics, for example, found that Manitoba has one of the highest numbers of people living on income assistance on-reserve in Canada, where 64 percent of Aboriginal mothers expressed having financial difficulties.^{Footnote 12}

In her paper prepared for the Sinclair inquiry, Dr. Alexandra Wright stresses the importance of taking an "ecological approach" to child welfare practice, which recognizes the consequences of ecological factors such as poverty.^{Footnote 13} According to Wright, studies have shown that the majority of poor families do not abuse their children, but poor children are more likely than others to experience maltreatment because poverty exposes their families to greater stress, and their community to fewer supports.^{Footnote 14}

Housing and Overcrowding: The existence of wider structural issues such as poor housing and poverty exacerbate child welfare's ability to offer the full range of services required to help keep children out of the child welfare system. A substantial segment of the documentary evidence points to substandard and/or overcrowded housing as a factor that strongly correlates with child maltreatment and neglect.^{Footnote 15} The lack of available, safe and affordable housing in Manitoba, and in Winnipeg in particular, was repeatedly identified by most expert witnesses to the Phoenix Sinclair Inquiry as a leading risk factor for children.

Substance Misuse and Addictions: There are clear correlations between substance misuse and levels of neglect or maltreatment. Substance misuse is an important factor contributing to the over representation of Aboriginal children in care, alongside other factors such as poverty and poor housing. Eleven of the fifteen FNCFS agencies' Business Plans reviewed discuss issues of substance misuse and addictions. During the 2011 Caring for Our Own Children in Two Generations Forum, the Assembly of Manitoba Chiefs recognized the need of addressing substance misuse in order to strengthen cultural identity and local communities. Given that parents act as role models, empowering and encouraging parents to seek treatment for addiction would have generational benefits.

Through the Families First Screening, Healthy Child Manitoba screened 83 percent of newborns in 2012 for a number of health risks, and found that 33 percent of Aboriginal mothers consumed alcohol during pregnancy, compared to 10 percent of non-Aboriginal mothers, increasing the risk of a child being born with Fetal Alcohol Spectrum Disorder.^{Footnote 16} Moreover, first time use of tobacco, alcohol and other drugs occur at younger ages in Aboriginal populations, and is a leading factor in teen pregnancy.^{Footnote 17}

Teenage Pregnancies: A 2012 report prepared by the Manitoba Ministry of Aboriginal and Northern Affairs found that 29.8 percent of Aboriginal mothers were teenagers at first birth, compared to three percent of non-Aboriginal mothers, a difference of 26.8 percent.^{Footnote 18} Statistics have shown that Aboriginal children live in larger families with younger parents. Family size and age of parents is important as these can determine family income, and the risks of poverty.

The Early Development Instrument is a tool used to measure a child's readiness for school based on a number of indicators. When Manitoban children were tested for school readiness at age five, results showed that two in every four Aboriginal children were vulnerable when they started school.^{Footnote 19} The finding of the Early Development Instrument study, as presented to the Phoenix Sinclair inquiry, stated that there is broad-based support that the three most significant risk factors for poor academic and social outcomes were children born to teen mothers, families living on income assistance and contact with the child welfare system.

Mental Health: The need for a culturally appropriate continuum of mental health services was identified by the Mental Health Commission of Canada's 2012 Mental Health Strategy.^{Footnote 20} The strategy acknowledged the lack of accessible mental health services for both parent and child on-reserve as a pressing concern. For many geographically isolated communities, for example, mental health services are not available, creating significant barriers to receiving necessary care.^{Footnote 21} Such a service gap contributes to poor outcomes for Aboriginal children as parents struggling with mental health issues are more likely to place their children in vulnerable situations, which can negatively impact the mental health of the child in turn.^{Footnote 22}

According to a number of sources, younger generations of Aboriginal people are at a much higher risk for mental health problems than non-Aboriginal youth.^{Footnote 23} On-reserve Aboriginal Manitobans were hospitalized more than twice as often as non-Aboriginal Manitobans in the 2008-09 fiscal year, and were more likely to report being hospitalized for mental health issues.^{Footnote 24} Experiencing childhood trauma or abuse is a known risk factor for poor mental and emotional health. The consequences associated with adverse childhood experience are often interrelated, as one negative outcome may lead to another.^{Footnote 25}

The need for greater mental health services was a reoccurring theme throughout the interview process. Representatives of both the Southern and Northern Authorities, as well as the All Nations Coordinated Response, which is primarily responsible for intake, described how most comprehensive mental health services are limited to the city of Winnipeg, and that long wait times for care remains a challenge for families. Due to the lack of mental health services in communities, it often falls back on social workers who may not have the necessary training to deal with a wide array of mental wellness concerns.

According to a provincial government key informant, "intermittent First Nations and Inuit Health Branch mental health workers go to community every three weeks. This approach does not accommodate crisis." A number of agencies explained how a mental health crisis requires a regular and sustained presence of mental health workers in community to guarantee that children and families have access to the necessary services to ensure they do not harm themselves or others. This supports the need for strong collaboration with health partners.

Suicide: Suicide is the leading cause of death among Aboriginal people under 44 years old. Among First Nations communities, suicide rates are twice the national average, and suicide occurs five to six times more often among Aboriginal youth than non-Aboriginal youth in Canada.^{Footnote 26} Childhood separation, loss, and family disruption are all identified as having correlation to suicide.^{Footnote 27} Based on data from the 2002-2003 Manitoba First Nations Regional Health Survey for Youth (n=1,125), 19 percent of youth surveyed reported experiencing feelings of suicidality. Results found that a perceived sense of community caring was protective against suicide.^{Footnote 28}

In certain communities in Manitoba, youth suicide levels are a growing concern, and were cited by a number of key informants as a factor which contributed to a stronger focus on child protection in the past. According to one agency, "because we had a lot of losses with young people and so much staff turnover, and prevention is such a big commitment, the energy was just not there." In the Shamattawa First Nation, for example, suicide attempts reached a crisis level in 2002 when a cluster of suicides and attempted suicides propelled then-Chief William Miles to declare a state of emergency. In 2007, 74 children from the community attempted suicide and another 82 reported wanting to try.^{Footnote 29} This accounted for one in four children in the community. The Awasis Agency of Northern Manitoba services this reserve, alongside several of the poorest and most remote communities, which has also experienced high numbers of child suicides.

As Child and Family Services are held accountable if a child commits suicide, significant resources are spent to monitor such cases and this represents a substantial cost driver in terms of service delivery. A key informant of the Awasis CFS stated that: "there is a high level of mental health issues in young kids, which is beyond the scope of CFS. We have a child trying to commit suicide 24/7. If they commit suicide, the agency is liable. But the monitoring/care provided is costing lots of money." Therefore, taking a proactive and preventative approach to mental health crisis could help to reduce the risks of suicidality and the costs associated with such crises over time.

3.2 Can the EPFA be reasonably expected to achieve its stated objectives?

Finding: The flexibility of the EPFA allows for prevention activities to take place on three different levels, which experts claim are necessary for prevention activities to have a positive impact on individuals, families and ultimately communities.

The EPFA is designed to be a more flexible approach to child and family services for First Nations in Manitoba to ensure that more First Nations children and parents get the help they need to prevent the types of crises that lead to intervention and family breakdown.^{Footnote 30} The anticipated result of the EPFA is to have a more secure and stable family environment and improved life outcomes for First Nations children ordinarily resident on-reserve, while following provincial legislation and standards. The EPFA is intended to provide a better framework of protection and prevention services through increased, flexible and targeted funding for prevention services as a new stream of funding.^{Footnote 31}

Evidence suggests that this paradigm shift taking place internationally in child welfare policy towards more preventative measures will reduce the number of children in care in the long term. Within the first few years of the implementation of EPFA, 43 percent of agency business plans have noted a decline in the number of children in care. Although a number of agencies and communities had developed prevention initiatives prior to the introduction of the EPFA, a key informant from Southeast Child and Family Services expressed how: "the agency would not have seen this decline in children entering agency care or more children being reunited with their parents if not for the increased funding that came about because of EPFA."

3.3 Is there a legitimate, appropriate, and necessary role for the Department and the Government of Canada in meeting this need?

Finding: The federal government has a role to play in child welfare on-reserve with regards to funding, program management, accountability, and capacity development, in addition to supporting the spirit of reconciliation.

To contextualize both the need and appropriate role of AANDC in Manitoba, it is important to understand the experience and laws surrounding the Aboriginal populations in the province. The history in Manitoba, as well as other jurisdictions, is well documented starting in 1951 with Section 88 of the Indian Act enabling provincial child welfare jurisdictional access on-reserve. In 1966, Indian Affairs and Northern Development Canada completed the Hawthorn Report, an in-depth survey detailing all aspects of life for Canada's Aboriginal peoples living on-reserves. In respect to child welfare services, the report found that "the situation varies from unsatisfactory to appalling."^{Footnote 36} The findings from this report would be echoed in other future significant reports, including the Kimelman Report, and the Aboriginal Justice Inquiry, which devoted an entire chapter of findings to the disparities in the child welfare system in Manitoba.

In 1966, the federal government and the Government of Manitoba entered into an agreement that provided for the existing Children's Aid Societies of central, eastern and western Manitoba to deliver child welfare services to 14 bands in southern Manitoba. Three-quarters of the bands (primarily northern) were not covered by this arrangement and, as such, continued to receive some services from the provincial Department of Indian Affairs. However, at this time, provincial child welfare authorities would intervene only in emergency or "life and death" situations.^{Footnote 37}

By the 1960s, the federal government could not deny that Aboriginal peoples were facing serious socio-economic barriers such as greater poverty, higher infant mortality, and lower life expectancy and levels of education rates than non-indigenous Canadians.^{Footnote 38} Practices of regularly facilitating out-of-province and international adoptions of First Nations children-in-care stopped in 1982, but it is known that such practices have supported historical legacy effects, which all case study agencies report observing to this day.

Associate Chief Judge Edwin Kimelman's report concludes that control of child welfare for Aboriginal children needs to rest in the hands of Aboriginal child welfare agencies.^{Footnote 39} In 1991, another report was tabled under the Aboriginal Justice Inquiry; by 1999, the Manitoba government fast-tracked CFS issues for Aboriginal peoples by signing an agreement, which established a Child and Family Services Protocol. This agreement established a common process for creating a province-wide mandate for First Nations and Métis to jointly restructure the existing child welfare system through legislation and other transformation processes. By 2003, the Child and Family Services Authorities Act proclaimed the establishment of four authorities in Manitoba (Northern, Southern, Métis and General Authorities).^{Footnote 40}

The need for federal investments in child welfare in Manitoba continues to flow from the Government's responsibility to fund services for First Nation children and families living on-reserve, in accordance with FNCFS Program authorities. The EPFA is highly consistent with departmental and Government of Canada priorities, and the federal government continues to have a role to play in child welfare on-reserve with regards to funding, program management and accountability, as well as capacity development. In addition, some key informants noted that in light of the 2008 Apology for the residential school system, which resulted in a generational loss of family linkages and cultural continuity, improving the life outcomes of Aboriginal children and families was consistent with the spirit of reconciliation.

4.1 To what extent has the design and delivery of the EPFA facilitated the achievement of outcomes and its overall effectiveness?

Finding: The two main elements that are helping to facilitate the achievement of expected outcomes are the EPFA's flexibility and its focus on culturally tailored programming.

Flexibility: One of the biggest strengths of the EPFA as stated by almost all key informant interviewees is the flexibility that it provides agencies to determine their programming. As service delivery resulting from direct community consultations has been linked to positive outcomes, it is important that agencies have the ability to design prevention programming to meet their community's particular needs. Flexibility has also given agencies the chance to focus on building personal rapport with clients. Sandy Bay Child and Family Services, for example, adapted their referral system based on the client's relationship and level of comfort with the staff member. The referral is then sent directly to that staff member as opposed to being processed through general intake. By encouraging this bond between the case worker and the client, a level of comfort is established. Several informants noted how parents are more likely to reach out to the case worker who has an intimate understanding of their family's file when needing support. This is in line with the program's objective of supporting agencies in offering services co-ordinated in the way that best helps the family, while doing so in a timely manner.^{Footnote 41}

The flexibility of the approach also allows agencies to effectively deliver EPFA supports and services on high risk days, which a key informant of Southeast CFS described as: "days in the community when welfare and child tax payments are made, resulting in the widespread abuse of alcohol throughout the community." High risk days are particularly challenging in the remote communities of Manitoba, according to this same informant: "in the remote communities one of the concerns that we have is that when there's a payday, we tend to have a lot more activities related to addiction and family violence. So we want staff to be more active during those times."

Some examples of how agencies have addressed high risk days include increasing the number of staff in community, helping parents make responsible plans in advance for child care, organizing alcohol-free community activities. Nisichawayasihk Cree Nation CFS described how activities on these days are an approach to remedy neglect: "children are in care mainly because of neglect. Three weeks out of the month parents are great. That one week, they hire a babysitter, the babysitter is tired of waiting for the parents to come home, and the babysitter calls CFS after 1.5 days to come and get the kids. We rarely have neglect cases now."

Culturally Tailored Programming: Literary evidence suggests that Aboriginal involvement in the design and delivery of prevention services, as mentioned above, offers increased cultural connectedness for some participants, and can positively contribute to cultural strengthening within communities.^{Footnote 42} The Assembly of Manitoba Chiefs argues that a strong cultural identity is necessary for healthier First Nations communities. An improved child and family services, they state, must involve Elders, listening to youth, supporting and encouraging parental responsibility, involving attentive leadership that provides cultural council in order to strengthen identity and feelings of Indigenous pride and self-worth.^{Footnote 43}

The Medicine Wheel Model is an example of how agencies have developed services that integrate First Nations' world views and values, as well as family and community structures into a coordinated frontline approach that is focused largely on prevention. The Medicine Wheel model provides for a comprehensive and holistic approach to the complex issues of First Nations child welfare and incorporates concepts such as the Circle of Care, Mino Yah I Dah, protection circles, prevention programs that promote First Nations way of life, staff evaluations utilizing a Medicine Wheel Model, elders, leadership and restoring of First Nations languages. In total, eight of the fifteen business plans reviewed spoke directly of this model and/or the importance of a holistic approach to child welfare services.

A culturally relevant approach was also linked to greater engagement from community members, as clients were more comfortable accessing services in a familiar environment, according to a number of key informants. A representative of one agency noted: "cultural programming is quite popular in terms of people wanting to participate in it; reinstating their cultural identity is key to improving outcomes."

4.2 To what extent are the activities logically linked to the production of the expected outputs and results?

Finding: The activities undertaken by the agencies are in line to achieve better results for children and families. Additionally, AANDC has made changes to its reporting structure in order to better report on performance.

FNCFS activities are intended to help build partnerships, gather and share information, develop programs and manage funding agreements, as well as to deliver social supports and services in partnership. This section will explore how the activities undertaken either at the agency level or federal level are logically linked to each of these expected results.

4.3 Has the approach been implemented as planned and in an effective way? If not, why?

Finding 1: Concerns from some agencies around the requirements for receiving EPFA funding caused large delays in the release of funds for these agencies, while other agencies struggled with the considerable changes happening in Manitoba child welfare at the time of EPFA implementation.

At the onset of EPFA, agencies had to meet specific federal and provincial requirements before the funding could be released. Namely, agencies had to develop a Business Plan outlining their goals, objectives and expected activities, as well as transfer all case work information into the province's Child and Family Services Information System electronic reporting system, and reimburse the Canada Revenue Agency's children special allowance payment to the province. Put together, these requirements caused a delay in implementation, with one agency taking over a year and a half to resolve their issues. Certain agencies held reservations regarding these requirements, namely the condition that all information be logged into the Child and Family Services Information System, as some respondents felt that the level of detail required by the system was invasive.

These administrative delays were mentioned by a number of key informants as challenges to overcome in the planning stage of the EPFA. Moreover, having to write a succinct and detailed business plan, often for the first time, was cited as a challenge by some agencies. This led a number of agencies to hire consultants to assist them in fulfilling this requirement, with little or no in-house capacity built in this area.

Key informants also discussed how the timing around provincial devolution and the new federal funding model happened very close together, that a number of agencies grappled with planning with this rapid change. A representative from one of the agencies commented on how: "there has been lots of change in child welfare in Manitoba. When the differential response came in, it became almost overwhelming to get all the things done that needed to get done. There were lots of people in our communities who did not know how to put information into Child and Family Services Information System. It all came too fast at once. For those first couple of years, it was just crazy."

Finding 2: Recruiting and retaining qualified staff remains a challenge for most agencies, though through targeted partnerships, they are finding ways to build a full complement of staff.

Early results indicate that the flexibility of the EPFA has allowed agencies to hire on family enhancement staff dedicated exclusively to prevention activities. Other early indicators, such as the reduction of numbers of children in care, speak to the effectiveness of many agencies' implementation of EPFA. A prevention model, however, takes time to implement, with initial and ongoing outreach and partnership activities being critical to its success. One of the ongoing challenges that remains is the issue of hiring and retaining qualified prevention staff, with 50 percent of agencies citing this as a barrier, particularly in northern agencies.

In order to address this concern, some agencies have partnered with post-secondary institutions to develop the abilities of their current staff and to recruit new staff. Nisichawayasihk Cree Nation CFS, for example, implemented a training program with a focus on prevention by developing community based certificate, diploma and bachelors level training programs. Dakota Ojibway CFS also worked with Yellowquill College in Winnipeg to develop a two year FNCFS Diploma Program, entitled the "Work and Learn Program," while Awasis has coordinated with the University of Manitoba to offer a Bachelor of Social Work cohort program. Also, Southeast CFS developed an Entry Level Family Enhancement Worker Training Project providing work experience opportunities for staff in local communities as a recruitment strategy to establish an Aboriginal staff base for EPFA service delivery.

4.4 Is the management and governance of the EPFA effective?

Finding: Strong professional relationships between the AANDC regional office and agencies as well as engaged Boards of Directors demonstrate signs of effective management of the EPFA. Some concerns in this area are the role of the Authorities as well as the lack of business capacity supports for agencies.

The importance of communication between partners was raised as a key factor for effective management of the EPFA. Most agencies interviewed reported having a great relationship with the AANDC regional office in Manitoba. According to a number of sources, the continuity of certain key players in that office has contributed to an understanding of each of the party's roles and challenges. Some examples include one agency describing how the regional office was helpful in sorting out cash flow problems with the province, and others commenting on how the regional office has always been helpful and open to answering questions or any concerns.

In addition, an important managerial and governance structure for agencies continues to be an engaged and consistent Board of Directors. By establishing the broad policies, objectives and overarching vision of the agency, as well as reviewing agency reports, board members can oversee the performance of operations, and offer accountability to stakeholders and the public. Chief and Council members often sit on the Board of Directors, which can help to ensure that cultural continuity stays at the heart of family enhancement services in the community. Although certain agencies cited the potential dangers of political interference, generally speaking, functioning and reliable boards were seen as a vital component for proper management and direction. A review of all four case studies' board of director structures revealed no concerns by the agencies, and in fact, they were viewed quite favourably.

Forty-two percent of agencies expressed having a strong working relationship with Chief and Council, and how this relationship facilitated their work in communities. However, a few executive directors for agencies spoke of the impact of the community election cycle, and how when a new chief is elected, at times, the corporate memory is lost and new initiatives must be re-approved, causing delays. Intertribal Child and Family Services, for example, states in their business plan that the agency must always "be mindful of upcoming elections both provincially and locally as the outcomes may impact the agency."

The management of EPFA funding is assigned to the executive directors, as funding flows directly to the agencies from AANDC. That said, the Business Plans that outline the activities the agencies intend to undertake as a result of the EPFA funding are reviewed by AANDC, the Province and the Authorities on an annual basis. The Authorities have noted that they would like to have the opportunity to provide more input around what activities their agencies undertake in order to increase efficiencies. However, since the Authorities are provincially funded, some agencies appeared quite weary of increased involvement by the Authorities at this time.

Finally, the majority of key informants spoke about strong social work practices in their agencies, and how dedicated social workers are to improving the lives of First Nations children in Manitoba. Evidence collected through interviews would suggest, however, that there is a need for enhanced business capacity at the agency level, in terms of defining how to allocate funding, assistance and training on developing business plans, proposals and reports, and to increase performance measurement. In this sense, executive directors could benefit from greater managerial and business capacity supports.

4.5 To what extent are the monitoring and reporting mechanisms of the prevention approach effective in supporting decision making?

Finding: There is evidence that some agencies are participating in their own monitoring activities to improve programming, though there remains challenges to integrating reporting at the federal/provincial government levels.

Although a causal connection between children-in-care data and the impact of specific programming was not typically made in the Business Plans, over a third of agencies mentioned a commitment to program evaluation and/or performance measurement. There were some encouraging practices in the development/ implementation of monitoring prevention programming effectiveness. Examples include: surveying clients after programming, identifying systemic trends demonstrated in agency file data to identify the types of partnerships needed to better meet the needs of clients, and establishing financial databases to track Child Tax Benefit dollars and their allocation to prevention services for children.

There are important differences between the federal and provincial funding methodologies, and certain agencies described how the requirements assigned in the way provincial and federal funding can be confusing. For example, in terms of travel, the province's funding is based on a per kilometer rate, while the federal funding for travel is based on the number of staff. Also, reporting requirements are different for provincial and federal files, with criteria to report being more elevated for provincial family enhancement files than federal files. As these two reporting requirements are not streamlined, both the Province of Manitoba and AANDC have committed to developing a data sharing program in order to harmonize information, as both levels of government expressed how this has been a barrier to a more fluid communication between partners.

Currently, confidentiality concerns make it difficult to share information that may help in reducing the reporting burden. The sharing of this information has political implications, which have been a challenge as recently as May 2014, when the Assembly of Manitoba Chiefs publicly declared that the province does not have the jurisdictional authority to collect, or share this information. Nevertheless, the creation of a centralized system that tracks all children receiving services was a key recommendation of the Phoenix Sinclair inquiry.

The new funding model required all Authorities to maintain a quality assurance program, and each agency to hire a quality assurance specialist. However, quality assurance is difficult to measure both from an AANDC and provincial perspective, as there is a lack of capacity both at AANDC Headquarters and Manitoba regional office to conduct proper quality assurance reviews. Provincial quality assurance tools for the Authorities have also not been fully implemented, due to a lack of resources.^{Footnote 45} Testifying to the Sinclair inquiry, the Southern and Northern Authority argued that funding allocations for quality assurance at the agencies should take into account a range of relevant factors, including agency size, geographic area and caseload.^{Footnote 46}

5.1 To what extent has the EPFA influenced the constructive engagement and collaborative networks to improve child welfare?

Finding: The EPFA has encouraged the expansion of collaborative networks within communities by developing programs and delivering services in partnership. Some of the best examples of constructive engagement include the Circle of Care approach, resource committees and the referral system.

The Circle of Care Approach: Forty-two percent of agency business plans indicate having adopted an integrated approach to performing case management known as a Circle of Care. A Circle of Care is a consensus model that is respectful of the experience and expertise that all members bring to the process. It is a process for coordinating multisystem services around child-centered shared service goals, and a method of developing individualized 24/7 service plans for children with complex needs and their families that involves all caregivers in sharing information, expertise and resources.^{Footnote 47} One key informant described the model as an approach which: "brings collaterals to the table to better service the family. We use it when there are too many fires happening in a family. We invite the school if there are school issues. If there are addiction issues, we involve the medicine lodge. It is a way to ensure that clients only have to tell their story once to service providers." Through such coordinated resource planning, the family is constructively engaged in all steps of their case development; enhancing their feelings of accountability and responsibility to one another.

Nisichawayasihk Cree Nation Family and Community Wellness Services, for example, provides offices within its Wellness Centre for Family Enhancement staff and management. Nisichawayasihk Cree Nation Family and Community Wellness Services takes a whole-community approach to prevention, with many of its 85 workers assuming a prevention approach. Since the prevention program has been implemented, almost all cases which come in as referrals or calls are diverted to the prevention program.

As an alternative to straight case management, a Circle of Care process is initiated to bring in collateral service providers. The family, including extended family members, are involved in discussions to devise a Plan of Care, which will engage several services providers. These service providers work to support the referred family through resource allocation and service supports. The plans include strategies for families that provide access to collateral service providers so that they may monitor and support families.

The Director of Family Enhancement approves the agreement, as does, on occasion, the parent. These service providers typically include: counselling; maternal child health; Head Start; school; Royal Canadian Mounted Police, and public health. Family Enhancement clients have priority service access at many of the Wellness Centre programs, including family counseling and individual adult and child therapies.

In addition, Nisichawayasihk Cree Nation Family and Community Services has been able to undertake additional collaboration processes, such as establishing a One-File Case Management system for the entire First Nation. Through the Circle of Care process, CFS clients would be exposed to a number of service providers, but all service providers would refer to this single client family utilizing a one-file number. This approach would enable tracking of that family throughout the Nisichawayasihk Cree Nation Family and Community Services system. Further, the agency is currently examining the means for identifying a single-reporting system on family and client outcomes in order to eliminate confusion caused by the double-counting of clients from one service provider to another.

Community Resource Committees/Child Welfare Committees: Twenty-eight percent of agencies have implemented Community Resource Committees, which bring together community partners to problem-solve child welfare challenges and establish practices that overcome resource constraints to ensure children can safely stay in the community. Many key informants spoke about how the establishment of these committees has been a positive development, yet, some agencies mentioned how the new Privacy Act enacted in the province has stunted the collaborative momentum of the committees because of new restrictions on sharing information with key community collaterals.

Referrals: As outlined in their business plans, 50 percent of agencies actively refer their clients to other services to assist families with their particular needs. For example, many agencies often refer their clients to benefits arising from their services, such as those programs which are offered through the Waa Pina Kosiis Miiki Waahp (Snowbird Lodge), a well-established, provincially funded family resource center for First Nations. The support of National Native Alcohol and Drug Abuse Program workers were also mentioned as another example of joint service delivery. Importantly, even in cases where partnerships were not fully developed, those agencies recognized the need for establishing partnerships to meet their goal of providing the most effective and efficient service for families. Half of the FNCFS business plans highlight a lack of access to resources in communities that support prevention, though many of these same agencies discussed how word of mouth from clients involved with family enhancement programming and other community level discussions have raised awareness of services offered and has led to constructive engagements with new community members.

5.2 What are the key factors that have facilitated or hindered the implementation of the EPFA?

Finding: Agencies have introduced numerous innovative practices to overcome factors, which can hinder the implementation of family enhancement programming, such as community infrastructure, a lack of public awareness, heavy workloads and time constraints for services.

Community Infrastructure: A 2006 external review of the Child and Family Services System in Manitoba entitled Strengthen the Commitment reported on the difficult realities of service delivery in isolated communities suffering from "staggering social and physical infrastructure deficits."^{Footnote 48} Representatives from both the Northern and Southern Authorities also described how the lack of physical infrastructure on-reserve can limit which kind of family enhancement activities can be offered to members.

Limited office space for staff was identified as an important obstacle to the implementation of the EPFA, but agencies have explored space sharing partnerships with other resources in the community, such as the Band Council or the local schools to overcome this challenge. Sandy Bay Child and Family Services, for example, described how placing a family enhancement worker in the school was seen as an opportunity to be positively involved in the welfare of children with prime opportunities to work collaboratively with other service providers. A representative of Sandy Bay CFS expressed how having a social worker in the school: "allows the agency to work with teachers and parents to ensure each child's physical, social, emotional and educational needs are being met. It creates a cooperative environment where the agency can work with other social service providers, as well as doctors, behaviourists and psychiatrists, to coordinate the need of the child. Being in the school also gives the agency the opportunity to help children before they become involved in child the welfare system."

Public Awareness: Addressing the negative stigma of Child and Family Services caused by the residential school system and the 60's scoop was identified throughout the literature as a significant barrier to families engaging with CFS in meaningful ways.^{Footnote 49} These feelings persist even when the entire agency staff is Aboriginal, researchers found.^{Footnote 50} Due to the fact that family enhancement programming under federal jurisdiction is voluntary, unlike child protection, improving the relationship between the agencies and members is imperative to community participation and improved outcomes for First Nations children.

Several key informants spoke to the need for community-level awareness of the recent paradigm shift in child welfare as a precursor to EPFA achieving its stated objectives. To assist with spreading the word in community, 57 percent of agencies used the media to advertise their programming, 47 percent of agencies developed brochures, and 36 percent of communities developed community consultation workshops.

EPFA funding has allowed agencies to hire staff specific to prevention work. This has helped distinguish mandates of the protection and prevention stream to provide more clarity in roles and make steps towards regaining confidence in FNCFS agencies. Prevention allows family enhancement staff to build trust with clients and present a refreshed approach to child welfare by helping parents build healthier relationships in order to keep families together.

Workload: Workload demands paired with limited staffing support have impacted social workers' ability to manage case loads effectively. According to Commissioner Hughes in the Phoenix Sinclair inquiry report: "I heard throughout the inquiry that the new differential response model offers potential for better outcomes for children and economic saving down the road, but that family enhancement services in particular require investment of resources and a commitment of time by social workers, if that potential is to be achieved. This means that workers must not be burdened with unreasonable workloads." Although the EPFA afforded the agencies with dedicated prevention staff workers designed to have fewer cases than protection workers in order to have a more involved approach, 50 percent of agencies cited high caseloads as a significant problem cutting into the time a worker can dedicate to any one file.

Other agencies have noted the negative impact of a lack of support staff to assist in reporting, impacting social workers' abilities to adequately address the needs of all of the families in their caseload. According to one key informant: "the biggest thing that we find with family enhancement is that there is an overwhelming amount of paper work that goes with it." Agencies overall have cited that demanding workloads lead to staff burnout and inevitably issues with staff retention.

Time Limitations: The effectiveness of certain EPFA initiatives can be limited in agencies that apply the provincial 90 day time limits on prevention files to federally-funded clients. Interviews consistently noted that social workers would begin to make progress with the family and then have to either close the file or transfer to protection before the full effects of the EPFA programming had been realized. The effect has been such that clients who are able to see the benefit of prevention services were often left feeling betrayed by the agency. Time limits on case files also does not take into account the reality of long waiting lists for limited community resources, with one interview stating that the waiting list for addictions treatment programs can long exceed the time frame allowed. Some agencies have dealt with this challenge by classifying files as protection while continuing with their original EPFA service plan. Although this may benefit the individual and their family affiliated with EPFA, it skews data with inaccurate representations of the breakdown of protection versus EPFA files serviced by the agency.

The province also introduced a foundational standard following the death of Phoenix Sinclair, which articulates the requirement of face-to-face contact as part of any child protection investigation, usually every 30 days. Although the reasoning behind introducing this standard is clear, this has added additional pressure to social workers in agencies with large service areas. During certain times of the year, agencies serving remote communities must use planes and/or helicopters to fly people (staff, children, parents, etc.) in and out of the communities while paying for lodging and other expenses at a high cost to the agency.

5.3 To what extent has progress towards intended outcomes been achieved as a result of EPFA?

Finding: Progress has been made towards all intended outcomes

Culturally Appropriate Prevention/Protection Services

Agencies clearly operate from the basis of their cultural values and beliefs. This is most commonly illustrated through cultural activities like sharing circles (60 percent of agencies) and cultural camps (80 percent of agencies). Many agencies design care plans, services and programs within a Medicine Wheel framework ensuring a holistic and coordinated approach to service delivery. Culturally relevant approaches to agency operations are common with a focus on kinship placements, Circle of Care Family Planning Models, and developing placement opportunities within the community or Aboriginal foster homes outside of the community. It is important to note that culturally relevant placements are challenging for agencies to achieve since foster homes are limited. One agency explained that Aboriginal foster parents are aging out of the system and retiring from their involvement with CFS. Three agencies have dealt with the lack of available Aboriginal foster homes by providing foster parents with cultural training.

More Secure and Stable Family Environment

A third of FNCFS agencies' business plans discussed offering parenting classes as a means to prevent children from coming into care and strengthening the family unit. Half of the agencies offer in-home supports like respite and home-aides, providing families with additional support in their own family environment. EPFA programming emphasizes the importance of relationship building between prevention staff and clients. Staff are building trust with families and are working on being seen as extension of their family and a resource for guidance or help before protection services are needed. Interviews with four agencies found that an unexpected outcome of EPFA was that clients are now proactively contacting the agency for support.

Improved Outcomes for Children On-Reserve

Almost half the FNCFS agency business plans listed an overall decrease in the number of children coming into care since the implementation of the EPFA. Agencies focus on maintaining a secure and stable environment for children by focusing on practices that prioritize the needs of the child. Agencies refer to these strategies as 'least disruptive measures,' and they often include strategies to keep the child in place in their own home by removing the parents and bringing in family or appropriate community members instead. Additionally, in order to keep children in their community when the need for apprehension arises, a few agencies have rented placement resources from the Band Council or built their own group home. Still, many children are being placed out of their community, mostly in Winnipeg, to access the resources in the city. For example, Southeast CFS has reported that approximately 80 percent of their children in care are sent to Winnipeg, and Intertribal CFS has approximately 75 percent of their children placed off-reserve. In recent years, Southeast has reported that the cost of maintaining contact between the parents in remote communities and their children in Winnipeg is very high; almost three million dollars was spent for activities associated with family visits, including travel for clients to Winnipeg, including hotels, meals, court appearances, etc. This speaks to a need to assist agencies in finding in-community solutions, which could help keep families close together and improve outcomes, as well as reduce maintenance costs over time.

5.4 Have there been positive or negative unintended outcomes?

Finding: The most significant unintended outcome of the implementation of the EPFA in Manitoba is the effect of the new funding model on West Region CFS.

West Region CFS is in a unique position under the EPFA. In 1992, the West Region CFS servicing First Nations communities in Western Manitoba negotiated a block funding arrangement (Flexible Funding Option for maintenance) with AANDC whereby funding for the agency would be paid as a block grant rather than through actual costs for the number of days of care provided. This allowed the agency to retain surpluses in maintenance and fund culturally appropriate prevention and community-based programming; the first of its kind in Canada.^{Footnote 51} With this new funding, West Region was able to provide a wide array of culturally appropriate prevention services with the goal of keeping children at home. Such services included the Reclaiming Our Voices Project, a retreat for persons with addiction, Fetal Alcohol Spectrum Disorder initiatives and a life skills training and family healing program called Vision Seekers, to list a few.^{Footnote 52} According to the agency's business plan, such innovative and successful prevention programming has given West Region a strong reputation across Canada, the United States and even internationally, and is looked towards as a leader in best practices.

This pilot project was evaluated by scholar Brad McKenzie ten years after the project first began, and McKenzie found that prevention measures had succeeded in saving the province millions of dollars and provided better outcomes for Aboriginal families. By 2005, this approach resulted in the reduction of the rate of children in care from 10.5 percent to 5.2 percent over the 13 years, and an estimated $21 million dollars in savings.^{Footnote 53} Sharing his findings with the Sinclair Inquiry, McKenzie stated: "I found plenty of tangible evidence that the monetary cost saving and cost avoidance from prevention are substantial."^{Footnote 54}

West Region, which was reported to be thriving before block funding was reversed, is now experiencing funding shortages. The new financial allotment is considerably lower than the previous funding levels. According to the agency, this has affected the level of services provided. The agency described how workers are required to work in protection and in prevention at the same time, in addition to answering the crisis lines, which has resulted in unmanageable caseloads. During interviews, the West Region remarked that the suite of services they were providing can no longer be maintained with the current funding model, such as a number of community crisis services provided by a program called Living the Good Life.

In addition to this program, West Region mentioned the termination of several programs in 2013-14 due to the lack of funding, and how treatment workers providing counselling, supports, intervention, crisis management, and assessment, have been laid off, falling on health and other service providers. As a result, West Region CFS is anticipating an increase of children in care cases for the 2014-15 fiscal year. According to one key informant, "we were further ahead in the way that we were funded before. We were a forerunner. Now it seems like the other agencies are catching up, and we're losing out on certain programs that benefited our communities."

West Region described how the new funding model is insufficient as it does not reflect the multi-site organizational structure of the agency or the costs associated with servicing an area so geographically vast. The agency's business plan described how for the 2011 calendar year, for example, agency staff travelled over three million kilometers, which equates approximately 31 workings days a year per staff member in travel time. Despite regular management meetings where ways to cut on costs were discussed and implemented, West Region still maintains that the new funding arrangement does not allow for the degree of prevention programming their communities require.

6.1 Is the current approach an economic/efficient means of achieving the intended objectives?

Finding: Investing in prevention activities has the potential for substantial societal and economic benefits, and a number of agencies are employing cost effective practices.

Improving the life outcomes of Aboriginal children continues to be an important societal and economic investment, according to a number of sources. The literature provides ample evidence of how prevention initiatives will reduce government costs in the long term, especially when compared to the costs associated with protection and removing a child from the family home.^{Footnote 55} Academics have also drawn direct links between child welfare outcomes and criminality. According to one study, children who have experienced abuse are nine times more likely to become involved in juvenile delinquency and adult criminality.^{Footnote 56} Bowlus et al. (2003) speak to the need to increase investment in prevention as benefits to society would result in the reduction of overall costs of the multiplying effects of child maltreatment.

In a 2003 study entitled The Economic Costs and Consequences of Child Abuse in Canada, the authors state: "the investment of Canadian governments at all levels in social service directed at this serious social problem represents only a small fraction of the billions of dollars lost each year. A well-planned and thoughtful investment of significant public funds in early detection, prevention and treatment of all forms of child abuse is not only a moral necessity for Canadian society; it is also sound fiscal policy that would directly benefit us all."^{Footnote 57}

The use of a Circle of Care approach mentioned previously in this report also has the potential to offer efficiencies in case management. By including a variety of parties typically involved in care provision associated with child welfare, the duplication of services can be avoided. A coordinated response can simplify the referral process and is therefore able to address multiple factors contributing to child welfare risks at once. This model strives to implement services efficiently to offer a more holistic service for clients, as formed partnerships can result in the cost sharing of preventative programs and events. In addition, the reform which allowed CFS agencies to provide services both on- and off-reserve created the opportunity for exploring new partnerships with businesses and municipal governments, which were not there previously, according to one key informant.

Certain agencies have performed cost analysis on prevention activities to design programming in the most efficient way possible. For example, Kinosao Sipi Minisowin Agency looked at the cost of CFS services to single parent families struggling with substance abuse addictions. The agency compared the cost of four weeks of foster care while the parent was away for treatment to an alternative arrangement of homemaker services, keeping the child at home. It not only produced significant cost-savings but proved to be more effective as children were allowed to remain in a familiar environment. Moreover, through a cost analysis lens, the Kinosao Sipi Minisowin Agency established a counseling unit where 26 staff members were trained by a professional counseling trainer as an alternative to paying $100,000/year for a contracted counsellor.

Another promising practice for reducing costs while maintaining quality service is the West Region Child and Family Services' Urban Services Resource team/case aides who assist in day-to-day activities that facilitate and support case plans. Activities include supervising family visits, accompanying/ transporting children-in-care to appointments, visits or therapy. Case aides provide children with challenging behaviours additional support in getting settled in their foster homes. West Region Child and Family Services explains, "Case aides provide an essential service in assisting mandated workers through their activities because often children and families are located throughout Manitoba, so it is a more cost effective use of their service and a better use of time." Having case aides help children transition into their foster care placements, as opposed to the social worker arranging the placement as the final step, increases the likelihood of the child getting settled in their new placement and reduces the risk of needing to seek out a new placement in the near future.

The ability to diffuse the pressure experienced by agencies that have become the "catch-all" resource for any issues faced by the community is often a determining factor in an agency's ability to economize. For example, one agency explained how the local school would expel a student and would refuse to allow the child back into school without a psychiatric assessment, which school authorities told families CFS would provide without charge. Balancing financial and service needs can be difficult for agencies, which are expected to fund many services which are outside of their mandate.

6.2 Are there more economic/efficient alternatives for achieving the same outcomes?

Finding: While the flexibility of the EPFA is one of its greatest strengths, the rise in maintenance and operations costs in Manitoba has meant that agencies have had to take funding from their prevention dollars and put them into these other streams. Consideration is needed on how to ensure prevention dollars are retained for prevention programming.

According to data reviewed, maintenance costs are on the rise across the country. Manitoba agencies have seen some of the highest maintenance increases between 2007-08 and 2011-12, as well as the highest increase in operational costs south of 60º. The most significant reason given for the increase in maintenance costs in Manitoba was higher rates for foster care, with an increase of 28 percent in foster care rates within the same time frame. Additional evidence suggests that group home/institutional care rates have increased by 20 percent, despite the number of days in care being reduced by 17 percent.

In terms of operations, AANDC provides funding based on the amount of children on-reserve between the ages of 0-18, as well as an amount per band and by remoteness. This formula does not take into account the multi-site agency model that is found in multiple Manitoba agencies, and key informants from these agencies noted that they have struggled to keep up a high quality level of service. A cost benefit analysis could assist the Department in determining the sustainability of this model versus having fewer sites strategically placed throughout the province, taking into consideration issues such as operational overhead, travel, and the importance of accessibility of clients to case workers.

Based on the current funding model, some agencies may have to move resources from within their allocated funding between the maintenance, operations and prevention streams. One key informant noted: "if there's a deficit in one area it has to be absorbed within the other, and that's a real challenge. One of the things that we don't want to do try to do is ad hoc planning. We've seen a reduction in the amount of children coming into care, so we know that our efforts are starting to pay off out there."

AANDC has acknowledged that the rise in maintenance and operational costs has affected the ability of agencies to provide sustainable prevention programming and is considering ways to resolve it. In summary, if prevention dollars are being used to cover maintenance and operational costs, the ability of agencies to address the problems families encounter through preventive measures before they reach a crisis is significantly diminished.

7.1 Conclusion

This review was undertaken to consider the relevance, performance/effectiveness and efficiency/economy of the implementation of the EPFA in Manitoba. Its findings and conclusions are based on the analysis and triangulation of four lines of evidence: document review, literature review, key informant interviews and case studies.

7.2 Recommendations

It is recommended that AANDC:

1. Consider increased funding for operational costs for multi-site agencies and travel to remote communities in any revisions to the costing model;
2. Explore how to ensure prevention dollars are being utilized for prevention activities so that agencies are able to develop sustainable prevention programming and explore other areas of activity to support a reduction of children being sent off-reserve;
3. Work with the province and FNCFS organizations to address the issue of managerial capacity and business supports in agencies; and
4. Continue to pursue data sharing opportunities with the Province of Manitoba and streamline reporting for agencies.