Introduction

Background

1. A complex range of issues—such as family violence, poverty, alcohol and drug misuse, and the intergenerational effects of the former residential school system—put some children and families in the Northwest Territories at risk and in need of child protection and family services. The link to a portable document format (PDF) fileChild and Family Services Act recognizes that all children are entitled to protection from abuse, harm, and neglect and promotes the best interests and well-being of children. The Act outlines the Government of the Northwest Territories’ responsibility to protect children and provide for their well-being and development when parents do not meet their fundamental responsibilities. According to the Department of Health and Social Services, an average of about 1,000 children per year have received either protection or prevention services under the Act over the past 10 years.

2. In March 2014, the Office of the Auditor General of Canada reported an audit of child and family services in the Northwest Territories. The audit found systemic, serious, long-standing deficiencies in services provided to children and families that put children’s safety at risk and failed to support their best interests and well-being.

3. Following the audit, in August 2014, the Department launched the Building Stronger Families action plan to transform and improve the child and family services system. This action plan included commitments to increase accountability for the front-line delivery of child and family services, revise standards and procedures to better support the delivery of these services, and audit the services delivered.

4. Another key change occurred in 2016, when six of the eight regional Health and Social Services authorities (HSSAs) were combined under one larger authority, the Northwest Territories Health and Social Services Authority (NTHSSA). The objective was to improve services and provide consistent access to care across the Northwest Territories. These six former authorities now operate as regions of the NTHSSA. The Tlicho Community Services Agency and the Hay River Health and Social Services Authority continue to operate independently (Exhibit 1).

5. Other notable changes since 2014 included amending the Child and Family Services Act in April 2016 to address gaps (such as services for youth), adopting new child protection assessment tools to help make decisions on required services for children and families, and introducing a new child and family services database.

6. Department of Health and Social Services. The Department of Health and Social Services, under the Child and Family Services Act, is responsible for the overall management of the child and family services system (Exhibit 1). This requires that it ensure the safety and well-being of children when parents are unable or unwilling to do so. One of the Act’s primary objectives is to promote the best interests, protection, and well-being of children.

7. Director of Child and Family Services. The Director of Child and Family Services (the Director)—a statutory appointment under the Child and Family Services Act—is a departmental employee. The Deputy Director, also within the Department, carries out the Director’s responsibilities in his or her absence. Under the Act, the Director is responsible for ensuring that children are protected from abuse, harm, and neglect, and has many of the rights and responsibilities of a parent for the children in his or her care. To carry out this responsibility, the Director authorizes child protection workers to intervene with children and families on his or her behalf and to carry out many of the Director’s duties and powers. Since our last audit, the Director has also appointed assistant directors in each region to carry out some of these duties and powers. However, the Director remains accountable for all decisions made by both child protection workers and assistant directors.

8. Health and Social Services authorities. There are now three HSSAs. One is the NTHSSA, which has five regions plus the Stanton Territorial Hospital. (The hospital does not provide front-line child and family services.) The NTHSSA and remaining two authorities—the Tlicho Community Services Agency and the Hay River Health and Social Services Authority—are responsible for delivering child and family services in accordance with the Act. Child protection workers, all of whom are employees of the HSSAs, deliver these services, which include

• investigating reported child protection concerns,
• helping families address child protection issues,
• arranging care for children who cannot safely live at home, and
• administering foster care and prevention services.

Under the Act, child protection workers act on behalf of the Director of Child and Family Services. They are accountable to the Director and Assistant Director in their regions.

9. The Child and Family Services Standards and Procedures Manual sets out the minimum standards that the Department and HSSAs must meet to fulfill their obligations under the Act to protect children from abuse, harm, and neglect, and to support families. Therefore, it is imperative that they meet key requirements each and every time they interact with children, youth, and families.

Focus of the audit

10. This audit focused on whether the Department of Health and Social Services and the Health and Social Services authorities met key responsibilities for the protection and well-being of children, youth, and their families. This included examining whether the Department and the Health and Social Services authorities had implemented selected recommendations from our 2014 audit. A key element of our examination included a review of a selection of 37 child files and 37 foster care files to determine whether the Department and the Health and Social Services authorities met key responsibilities under the Child and Family Services Act to protect and care for children and youth. We reviewed child and foster care files from the same three regions examined in 2014.

11. This audit is important because social issues—precipitated largely by alcohol and substance misuse, family violence, poverty, and intergenerational trauma—can put children and families at risk and contribute to the need for child protection and family services. The number of children and families requiring these services has remained consistent over the last 10 years.

12. We did not examine the role of the Stanton Territorial Hospital, as it does not play a direct role in delivering child and family services. We did not examine adoption (custom or regular), youth justice, how the court system administers child and family services, or the role of the Office of the Children’s Lawyer. We also did not examine the new Matrix database system, since its implementation did not begin until October 2017. Our work on prevention was limited to whether the Department had identified and obtained the resources necessary to help child protection workers and other support staff provide prevention support.

13. More details about the audit objective, scope, approach, and criteria are in About the Audit at the end of this report.

Findings, Recommendations, and Responses

Overall message

14. Our audit determined that there continued to be serious deficiencies in the delivery of child and family services in the Northwest Territories. We found that many of the services provided to children and families were worse than when we examined them in 2014.

15. Families involved in the child and family services system face many challenges, including struggles with poverty and alcohol and drug use, which limit parents’ abilities to care for their children. Almost 80% of the files we reviewed referred to alcohol or drug misuse as a factor that put children at risk. In about 50% of the files, domestic violence put children at risk. When parents are unable or unwilling to care for their children, the Department of Health and Social Services and the Health and Social Services authorities are required to intervene, becoming in essence the parent for some of those children.

16. Since our 2014 audit, the Department of Health and Social Services had focused on changing its processes without sufficiently considering the impact of introducing complex changes into an already overburdened system. We found that many of the changes we examined were not well implemented or resourced and, in our opinion, produced worse services for children and their families.

17. For example, we found that Health and Social Services authorities had adopted an approach of permanently placing some children by transferring guardianship to a family member or other person without basic checks—such as home studies, criminal record and family background checks, or in-person interviews with potential guardians—to ensure that the children were being placed in safe and appropriate homes.

18. In our view, the Department of Health and Social Services and Health and Social Services authorities must start working on how they will achieve their common objective of providing better services and achieving better outcomes for children, youth, and families. Children will remain at risk until the Department and the Health and Social Services authorities make the changes they said were critical, and that they committed to making.

Services for children in parental care

Health and Social Services authorities did not meet key requirements to protect children and support families

19. We found that the Health and Social Services authorities (HSSAs) did not meet key requirements to protect children and support families when children remained in their parents’ care. The HSSAs did not always see and interview children when they conducted child protection investigations to ensure they were safe. Nor did they always ensure parents were keeping commitments they had made to ensure their children’s safety and well-being. This was similar to what we found in 2014. The Department’s own information also showed that often HSSAs did not properly use the new tools meant to help them assess a child’s safety and risk and make decisions on what protective services children required (see paragraphs 97 to 99).

20. Our analysis supporting this finding presents what we examined and discusses the following topics:

• Responding to reported child protection concerns
• Following the key investigation processes, including assessing child safety and risk
• Monitoring children at risk under parental care

21. This finding matters because HSSAs are responsible for intervening on behalf of the Director of Child and Family Services to ensure the safety and well-being of children when parents are unable or unwilling to do so. Failure to properly use assessment tools to support child protection decisions or maintain required contact with children who need protection puts children at greater risk.

22. Our recommendation in this area of examination appears at paragraph 32.

23. What we examined. We examined a selection of children’s files to determine whether the HSSAs followed the requirements of the Act and the Child and Family Services standards and procedures when responding to reported child protection concerns and for children at risk who were allowed to remain in their parents’ care.

24. Responding to reported child protection concerns. Both the Act and the standards and procedures require HSSAs to assess all reported child protection concerns to determine whether a child’s safety may be at risk. Child protection workers decide on the urgency of concerns and whether investigations should be initiated. When investigations are initiated, they decide whether they need to begin within 24 hours or within five days. To help make these decisions, the Department and HSSAs began using a new screening system in 2016 known as the Structured Decision Making® system (SDM®).

25. In the 37 child files we reviewed, there were 149 investigations. We found that when HSSAs decided a child might be in an unsafe situation, they usually responded within the required time frame. However, we found instances in which HSSAs did not respond to reported child protection concerns at all. We also found such instances in 2014 (Exhibit 2).

26. Following the key investigation processes, including assessing child safety and risk. HSSAs are required to follow a series of steps when investigating reported child protection concerns. These steps include interviewing children and assessing their safety and risk. The SDM® system provided additional guidance to child protection workers in carrying out these steps.

27. In the files we reviewed, we found that HSSAs did not always perform the required steps (Exhibit 2). For example, they did not always see and interview children who were the subject of protection concerns, or use the SDM® system (once it was implemented) to assess child safety, which could have put the children’s well-being at risk.

28. Assessing a child’s risk of potential future harm (longer-term risks) is also part of the process of investigating child protection concerns. Our 2014 audit found that none of the investigations we looked at had assessed longer-term risk. The SDM® system contains a mandatory tool to assist HSSAs in assessing this risk. However, even with this new tool in place, in the files we reviewed, HSSAs often still did not assess child risk.

29. Monitoring children at risk under parental care. In some cases, when an investigation confirms that a child is in an unsafe situation, the child can remain in parental care if a “plan-of-care agreement” has been signed with the parent(s). This agreement identifies the conditions parents must meet to ensure a child’s safety, such as maintaining sobriety or attending counselling, and the support needed to help parents meet these conditions. Depending on the best interests of the child, a child can remain at home with the parents or may live in foster care while under a plan-of-care agreement. HSSAs must also maintain regular contact with children under these agreements to assess their safety and well-being.

30. In the files we reviewed, we found that HSSAs’ management and monitoring of these plan-of-care agreements were worse than what we found in 2014 (Exhibit 3). In most cases, we found that agreements were not monitored as required, and that the monitoring that did take place focused mostly on parents instead of on the children these plans were intended to protect. For example, we found that in most cases, HSSAs had some contact with parents but did not interview children as often as the plans required to make sure they were safe and to assess their health and well-being. We found that this occurred even in some high-risk cases.

31. We also found that HSSAs allowed some children to remain under a plan-of-care agreement even when it was clear the conditions were not being met, and sometimes extended these same agreements. Further, in a few cases we examined, authorities allowed a parent to terminate the plan-of-care agreement early without being assured that the child was no longer at risk. These findings are significant because these agreements are often an alternative to removing a child from the home, and the termination of the agreement by the parents may not be in the best interests of a child.

32. Recommendation. The Health and Social Services authorities should ensure that requirements of the Child and Family Services Act and the Child and Family Services standards and procedures are met when responding to reported child protection concerns and providing protective services to children who remain in their parents’ care. This includes ensuring that requirements are met when investigating concerns about children’s safety and well-being and when implementing agreements that are meant to keep children safe.

The Department’s and the Health and Social Services authorities’ response. Agreed. The Department of Health and Social Services and the Health and Social Services authorities (HSSAs) recognize their accountability for ensuring that child and family services standards are met to enhance child safety and well-being per legislative requirements. The Department and the HSSAs have improved the compliance audit process by including regular regional quality reviews of investigations throughout the year and are directly following up with front-line staff. These quality reviews will allow the Department and the HSSAs to measure adherence to standards and provide support and assistance to child and family services teams.

To improve quality and compliance, the Department and HSSAs have also been engaging managers, supervisors, and front-line staff to better understand and address the challenges they face in delivering child and family services, including completing investigations and plan-of-care agreements. The Health and Social Services system has developed and is implementing a clinical supervision model, and recently began training supervisors and managers, focusing on improving the quality of clinical decision making and care planning.

The Department will put key standards in place by 31 March 2019 to provide improved direction to the system. It has identified areas that require refinement and is working to align its standards and processes with best practices that are responsive to diverse communities across the Northwest Territories.

Services for children in temporary and permanent care

Health and Social Services authorities did not fulfill their parental responsibilities to protect and care for children in temporary and permanent care

33. We found that the Health and Social Services authorities (HSSAs) did not fulfill their parental responsibilities for children in temporary or permanent care on behalf of the Director of Child and Family Services. In particular, HSSAs did not maintain the required regular contact with many of the children they had removed from homes and placed in foster care or other out-of-home placements. As a result, they had no way of knowing whether these children were receiving the care they needed. They also did not develop permanency plans for most of these children. In some cases, this contributed to children moving between foster care homes multiple times. Such frequent moves make it difficult to provide children with stability and support.

34. Our analysis supporting this finding presents what we examined and discusses the following topics:

• Case management for children in the temporary and permanent care of the Director
• Transferring guardianship of children in the care of the Director

35. This finding matters because HSSAs carry out responsibilities on behalf of the Director of Child and Family Services at the Department, who has parental responsibilities under the Child and Family Services Act for all children in temporary or permanent care. This responsibility is significant, because the Director is ultimately accountable for the children’s well-being and outcomes.

36. Children in the temporary or permanent care of the Director of Child and Family Services often have a long history of involvement in the child and family services system. They live in out-of-home placements, because they cannot safely return to the care of their parents. According to departmental data, as of September 2017, there were about 167 children in the temporary or permanent care of the Director, ranging in age from six months to 18 years.

37. HSSAs must stay in regular contact with children in temporary and permanent care to ensure they have an improved quality of life and to build relationships with those entrusted with overseeing their care. These relationships are important because children and youth in the temporary or permanent care of the Director require support and stability.

38. Our recommendations in this area of examination appear at paragraphs 49 and 50.

39. What we examined. We examined whether the HSSAs maintained regular contact with children in the temporary or permanent care of the Director and conducted the required case reviews every three months to assess a child’s needs, current care, and required services.

40. Case management for children in the temporary and permanent care of the Director. In the files we reviewed, 17 children were in the temporary or permanent care of the Director. We found that in most cases, HSSAs did not maintain regular contact with these children. Further, HSSAs did not do case reviews at the required times for the majority of these children (Exhibit 4). This means there was limited assessment of children’s ongoing needs and quality of care.

41. We also saw little evidence of permanency planning for these children. This planning was supposed to take place through ongoing case reviews, and was intended to help ensure children received continuity of care and stability and that they had a future plan. Further, as in 2014, in the files we reviewed, we saw cases in which children experienced multiple moves between foster homes. For example, in the 2016–17 fiscal year, three children in the care of the Director were moved five or more times between various foster homes, with one child moving at least 20 times. According to child welfare literature, moving from one foster home to the next can have serious negative effects on children’s well-being.

42. The Department and HSSAs had long known about deficiencies in permanency planning for children, but had not yet effectively addressed it. In 2015, the Department assessed permanency planning by reviewing the files of 101 children in permanent care, and found significant problems. For example, the Department determined that only 31 of these children had a permanency plan, and that on average, children in permanent care moved homes about 12 times.

43. Foster parents in the Northwest Territories who care for children in temporary or permanent care also expressed concern about the lack of information, case reviews, and permanency planning. Both the Department and HSSAs acknowledged the importance of information for foster care parents about the children in their care, including a child’s history, needs, and future plans.

44. Transferring guardianship of children in the care of the Director. In our review of child files, we were very concerned about an approach that had emerged for the placement of children for whom the Director had parental responsibilities. In five of the files we reviewed, HSSAs worked with the child’s biological parents to transfer guardianship—by signing a guardianship agreement—to a family member or other person, who then were given full parental rights and responsibility for that child. Officials within HSSAs told us this was part of their approach to permanency planning for these children. However, we found that this practice does not fall under the Act. As well, there were no standards to assess these placements, neither to ensure children were being placed in safe and appropriate homes, nor to assess whether the placements would be viable and long term. For example, foster homes required a home study, criminal record checks, child and family services history checks, and an interview with the prospective foster parents, but no such requirements existed for potential guardians.

45. Assessing prospective guardians through screening is important because once a guardianship agreement is in place, the Director no longer has the authority to monitor or oversee the child, as the child is no longer under the Director’s care. In the absence of screening requirements, we looked to see what, if any, screening had occurred before children were placed with their new guardians. In the five files we reviewed where biological parents had transferred guardianship, we found that only two of the five guardians were screened by doing a criminal record check, a child and family services history check, a home visit, and an interview. In one of the files we reviewed, where screening did not occur, we found that the guardian had been charged with assaulting the child. This child was later placed in another guardianship home that had also not been screened. While screening may not guarantee a child’s safety, it is one way that HSSAs can exercise due diligence before placing children with guardians.

46. As a result of our findings, we obtained more information from HSSAs about other children under the care of the Director who were subject to guardianship agreements during our audit period to see what, if any, screening had occurred. We found that 17 more children had guardianship agreements, but that only 6 of them had been placed in homes where the guardians had been screened.

47. Through our review of files and interviews with HSSAs, we also noted that some guardians did not understand they were assuming full parental rights and responsibilities for these children and would not receive ongoing support from the HSSAs. This increased the risk that children could end up returning to the care of biological parents who had previously been deemed unfit to care for them, if the guardians decided they no longer wanted or could care for the child.

48. In our view, already vulnerable children are exposed to increased risk if prospective guardians are not screened sufficiently and if mechanisms to help guardians understand their parental roles are lacking. We were seriously concerned when senior departmental and authority officials told us they were unaware this was occurring. Given the seriousness of our findings, we notified the Director of Child and Family Services of our concerns in June 2018.

49. Recommendation. The Health and Social Services authorities should ensure that requirements of the Child and Family Services Act and the Child and Family Services standards and procedures are met for children in the temporary and permanent care of the Director, including maintaining required contact, case planning, and permanency planning for these children to provide them with the required stability and support.

The Department’s and the Health and Social Services authorities’ response. Agreed. The Department of Health and Social Services and the Health and Social Services authorities (HSSAs) have taken action by initiating quality reviews of children and youth who are in the Director’s temporary and permanent care to ensure they have meaningful contact with their child protection workers as well as appropriate case planning and permanency planning. These ongoing quality reviews will enable the Department and the HSSAs to implement strategies to make improvements in these areas.

In conjunction with the HSSAs, the Department is also revising its key standards to include enhanced permanency planning tools. This work will be completed by 31 March 2019. Following the implementation of these revised standards and tools, training will be provided to support and improve practice.

Over the past two years, the Department and HSSAs have collaborated to improve child and family services (CFS) outcomes by implementing the Structured Decision Making® (SDM®) model, which is aligned with CFS best practices. This model provides tools that enhance CFS practice, including but not limited to case management, family reunification, and permanency planning for children. The Department and the Health and Social Services authorities are in the middle phase of this work and are firmly committed to its full implementation to improve CFS practice. This will address many of the concerns outlined in this report, including this recommendation. The Department and the Health and Social Services authorities anticipate full implementation of SDM® by 31 March 2021.

50. Recommendation. The Department of Health and Social Services and the Health and Social Services authorities should undertake a detailed review of the practice of assigning guardians to children in the care of the Director, including any required revisions to the Child and Family Services Act and the Child and Family Services standards and procedures. This review should also identify risks, required screening, and other standards that may be required to ensure that risks to children are reduced in considering placement options that are in the child’s best interests.

The Department’s and the Health and Social Services authorities’ response. Agreed. The Department of Health and Social Services and the Health and Social Services authorities (HSSAs) agree there should be a standard to provide appropriate direction to staff on all processes for ensuring the proper placement approvals are in place when families are involved in child protection matters.

In the cases identified by the Office of the Auditor General of Canada, the Department notes that child protection workers, duly delegated by the Director under the Child and Family Services Act, in consultation with legal counsel, participated in the coordination of guardianship agreements to enable family members to assume interim or full guardianship of these children. The Department recognizes that these child protection workers acted with good intentions in an effort to achieve appropriate concurrent or permanency planning for these children.

The Department, in collaboration with the HSSAs, is conducting a detailed file review where this practice has occurred. This review, along with a legal opinion, will inform the establishment of a standard that will be completed by 30 November 2018. This standard will provide clear direction to staff to ensure that the practice of assigning guardianship to children in the care of the Director is completed in the child’s best interests.

Inadequate supervision of children placed out of the territory put some children’s safety at risk

51. We found that the Department and HSSAs did not adequately supervise some children and youth placed out of the territory, putting their safety at risk. These children and youth have specific and often complex needs, and require monitoring and supervision to protect them.

52. Our analysis supporting this finding presents what we examined and discusses the following topic:

• Monitoring and supervision of children placed in out-of-territory treatment facilities

53. This finding matters because according to departmental information, approximately 40 to 50 children and youth in the child and family services system receive treatment in facilities outside of the Northwest Territories each year when their needs cannot be met within the territory. These include children with high needs, including behavioural or mental health issues and fetal alcohol spectrum disorder.

54. Our recommendation in this area of examination appears at paragraph 61.

55. What we examined. We examined whether the Department and HSSAs ensured that children in the care of the Director who were placed in treatment facilities outside of the Northwest Territories received the required monitoring and supervision.

56. Monitoring and supervision of children placed in out-of-territory treatment facilities. Both the Department and HSSAs have responsibilities for children placed in treatment facilities outside of the territory. The Department is responsible for ensuring that a courtesy supervision worker in the receiving jurisdiction is assigned to each child while the child is placed out of the territory. HSSAs are responsible for the child’s ongoing case management, including monitoring the child during placement and tracking the child’s progress. While children are under the day-to-day supervision of facility staff, the courtesy supervision worker acts on behalf of the Department and HSSA to provide oversight. The worker must visit the child regularly—anywhere from monthly to once every three months—and deal with any ongoing issues as they arise.

57. We found that the Department and HSSAs did not ensure the safety and supervision of these children. Our selection of child files contained three children placed in out-of-territory treatment facilities. We found that only one of these children had the required courtesy supervision in place.

58. Without courtesy supervision workers, children who are out of the territory have no one to oversee their care. For example, in one case we reviewed, a child without courtesy supervision ran away from a care facility several times and at one point was missing for about a week. During that time, it was unclear who was responsible for overseeing efforts to ensure the child was found and safely returned. Moreover, we found that neither the Department nor HSSAs had assessed how to prevent these sorts of incidents from occurring.

59. As a result of our findings, we obtained more information from the Department on the number of children in the care of the Director who were placed in out-of-territory facilities during our audit period. We found that 33 other children had been placed in out-of-territory treatment facilities, but only 7 had the required courtesy supervision in place.

60. Department officials told us that staff responsible for managing out-of-territory placements could not meet demands for processing courtesy supervision arrangements due to excessive workloads resulting from staff vacancies. Further, we found that HSSAs did not confirm that supervision arrangements for children were in place for the children under their care.

61. Recommendation. The Department of Health and Social Services and the Health and Social Services authorities (HSSAs) should ensure that courtesy supervision is in place for all children in the care of the Director of Child and Family Services who are placed in out-of-territory treatment facilities. The Department should also put in place the required staff to oversee out-of-territory placements and work with HSSAs to verify that courtesy supervision is in place for all children in treatment facilities.

The Department’s and the Health and Social Services authorities’ response. Agreed. The Department of Health and Social Services and the Health and Social Services authorities (HSSAs) recognize that children and youth placed outside of the Northwest Territories require careful monitoring to ensure that they are being appropriately supported and that their needs are being met.

The Department has worked with the HSSAs to conduct a review of children in out-of-territory placements to ensure a current interprovincial placement agreement for each child is in place with applicable provisions for courtesy supervision. The Department has initiated an update of all interprovincial placement agreements.

To better coordinate services, the Department restructured the job duties for the position supporting this portfolio. The Department also redesigned the program’s database to better manage and track interprovincial agreements and their renewals. The HSSAs have also initiated quality reviews to monitor adherence to minimum contacts and case reviews.

By 30 November 2018, roles and responsibilities between the Department and HSSAs for the out-of-territory program will be clarified and communicated to all staff. This work will include a new review process to increase the oversight of out-of-territory placements. It will also provide the foundation for restructuring the out-of-territory program and determining the required human resources to effectively deliver it. A monitoring plan and enhanced out-of-territory program will be implemented by 1 April 2019.

Youth leaving the system received new support

62. We found that once youth who were in the permanent care of the Director left the child and family system at the age of 19, HSSAs used new tools to support them to become independent adults.

63. Our analysis supporting this finding presents what we examined and discusses the following topic:

• Use of new tools to support youth who have left the system

64. This finding matters because youth who leave the child and family services system frequently continue to need support to become independent adults. Many have been in the care of the Director for most of their lives and have experienced challenges such as instability, trauma, substance misuse, and mental health issues. As a result, continued access to support for youth who need it is critical to helping them transition to independent adulthood.

65. Amendments to the Child and Family Services Act in April 2016 included providing Extended Support Services Agreements (ESSAs) for youth aged 19 to 23 who were previously in the permanent care of the Director. These agreements allow youth to continue to be supported as they leave permanent care; for example, they can receive financial support. According to departmental data, 21 youth in the Northwest Territories were using ESSAs at the time of our audit.

66. We made no recommendations in this area of examination.

67. What we examined. We examined the files of 5 of the 21 youth currently receiving support through ESSAs to determine the types of support being offered and whether these youth were being monitored as required.

68. Use of new tools to support youth who have left the system. In the files we reviewed, we found that HSSAs worked actively with youth who were receiving support through ESSAs to provide them with a range of support depending on their needs. This included financial support to meet their basic needs, such as food, clothing, and housing; funding for post-secondary education; and help in accessing life-skills training and counselling services. We also found that HSSAs maintained regular contact with most of these youth while they were accessing extended support. Further, in our review of child files, we saw some examples of HSSAs assisting youth to develop plans to transition out of permanent care. This included discussing options such as ESSAs.

Foster care

Serious deficiencies persisted in foster care monitoring and support

69. We found that serious deficiencies in the screening, review, and support of foster care homes persisted. Many foster homes were not screened or monitored to ensure that children were safe and well cared for, and that they were placed in appropriate homes. We also found significant disparities in the support provided to foster care parents.

70. Our analysis supporting this finding presents what we examined and discusses the following topics:

• Screening and annual reviews of foster homes
• Support and consistency in foster care

71. This finding matters because it is vital that the Health and Social Services authorities (HSSAs) ensure that foster homes are safe and appropriate for children who cannot live with their parents, and that foster parents have adequate support to care for and meet the needs of these children. Placing children in foster homes that have not been screened or monitored puts vulnerable children at greater risk.

72. Our recommendations in this area of examination appear at paragraphs 82 and 83.

73. What we examined. We examined whether HSSAs screened prospective foster care homes as required, and whether they conducted annual reviews of approved foster care homes where children had been placed. We also examined whether there had been any changes to help standardize foster care services for children across the Northwest Territories since our last audit.

74. Screening and annual reviews of foster homes. We reviewed a selection of 37 foster care home files in the same three HSSAs we examined in 2014. Our review of these files showed that serious deficiencies in the screening and ongoing monitoring of foster homes persisted (Exhibit 5).

75. In about two thirds of the foster care files we reviewed, we found that the required initial screening of the home—to ensure the home was a safe and appropriate placement for a child—was not completed. This was the same finding we had in 2014. Deficiencies included failing to perform criminal record checks or obtain references for foster parents.

76. We also found that the required annual reviews were incomplete in almost all of the foster home files we reviewed. In the majority of cases, these reviews were incomplete because the children placed in those foster homes had not been interviewed. In five of these homes, there were years in which an annual review had not been done at all. Annual reviews are intended to ensure the safety and well-being of children and youth in foster care and ensure that homes remain an appropriate placement for children.

77. As of 1 April 2015, HSSAs must also complete quarterly reviews of a foster home to assess the care that each child in the home is receiving. These are used to review the child’s case, identify any changes in the child’s circumstances, and decide if the child’s caregivers require more support. We found that quarterly foster care reviews were not done for any of the foster care homes we examined.

78. Support and consistency in foster care. In 2014, we reported that each of the HSSAs managed foster care differently. This resulted in significant disparities across regions in the levels of support and services provided to foster children and families. Our audit found that the situation had not changed since then. The Department of Health and Social Services had no staff position that manages the delivery of foster care across the Northwest Territories and there were no minimum support and services for foster care children and families beyond the daily rates paid to foster parents.

79. We noted, for example, that the Department did not require foster parents to have any minimum training to ensure they were well equipped to deal with the various and complex needs of children placed in their care. The training that was available was voluntary. However, we noted that in the majority of other provinces and territories, foster parents must complete minimum training either before or soon after assuming care for a child. In our review of child and foster care files, we also found that one HSSA offered specialized training to some foster parents to help deal with common issues facing children in foster care, while the other two HSSAs offered very little or no such training.

80. We also found that other support and services for foster parents, such as respite care and funding allowances for non-standardized items, were not consistently available across HSSAs. For example, we found that some HSSAs actively supported foster parents with respite care, while in other regions this was rarely provided. Also, while some HSSAs allocated specific amounts to cover the cost of items such as formula and diapers, foster parents in other regions were expected to cover these expenses from the daily rate paid to them for their foster children. Given the critical role of foster parents in the lives of children, it is essential that they be consistently supported by the authorities, regardless of where they live.

81. We did note, however, that in April 2018, the Department redistributed foster care funding between HSSAs, which resulted in an increase in the daily rate paid to foster parents across the territory for the first time in about 10 years. Foster parents now have more funding to meet children’s basic needs, such as for food and clothing.

82. Recommendation. The Health and Social Services authorities should ensure that the requirements of the Child and Family Services Act and the Child and Family Services standards and procedures are met in the management of foster care, including ensuring that all foster homes are screened and subject to annual reviews in order to support the appropriate placement of children.

The Department’s and the Health and Social Services authorities’ response. Agreed. The Department of Health and Social Services and the Health and Social Services authorities (HSSAs) are working closely together to ensure all foster homes are appropriately screened, assessed, and reviewed, and that the required supporting documentation for these activities is placed in all files. In recognizing this issue, a decision was made to implement a consistent approach to managing and supporting foster families by creating specialized foster care caseloads in all regions.

In addition, with the implementation of the new child and family services electronic case management system in October 2017, there are now tools such as checklists, reminders, and approval processes to improve the screening and monitoring of foster homes. This feature was not available in the previous child and family services information system.

To complement the departmental auditing process, the authorities have introduced regular quality reviews to monitor compliance on key foster care requirements, including completion of screenings and annual reviews. Ongoing quality reviews will enable the Department and the HSSAs to implement strategies for improvements in this area.

83. Recommendation. The Department of Health and Social Services and the Health and Social Services authorities should work together to establish mechanisms to help promote equity in the delivery of foster care across the territory, including support and services provided to foster care parents.

The Department’s and the Health and Social Services authorities’ response. Agreed. The Department of Health and Social Services and the Health and Social Services authorities (HSSAs) recognize and appreciate the significant role foster parents across the Northwest Territories play in supporting children in the care of the Director. The Department and HSSAs understand there is a need to provide standardized supports to foster care families while ensuring that supports are responsive to foster parents and children in all Northwest Territories regions and communities.

The Department, in conjunction with the HSSAs, will ensure that training is consistently available to foster parents. The Department will work with the Foster Family Coalition to strengthen the relationship with foster families and engage them to understand the training and support required to better serve children under their care.

In addition, the Department and HSSAs are working together to revise the key standards and procedures related to supports and services for foster parents and children to ensure they are universally appropriate across the Northwest Territories and equitably meet the needs of children who are being cared for out of the parental home. These standards and procedures will be finalized by 31 March 2019. The Department and HSSAs will ensure that the revised standards and procedures are appropriately communicated and that training for foster parents is provided.

The system for delivering child and family services

System changes did not result in better services for children and families

84. We found that some of the key changes made by the Department of Health and Social Services and the Health and Social Services authorities (HSSAs) since our 2014 audit had not led to better services for children and families. In some cases, changes to the accountability framework and the organizational structure for delivering child and family services, and the introduction of child and family services assessment tools to help guide decisions, created new challenges.

85. Our analysis supporting this finding presents what we examined and discusses the following topics:

• Accountability framework for child and family services
• Roles and responsibilities for child and family services
• Support for the Structured Decision Making® system

86. This finding matters because HSSAs have wide-ranging responsibilities to deliver child and family services on behalf of the Director of Child and Family Services and to comply with the Child and Family Services Act. Problems with the system for delivering child and family services, including the accountability framework between the HSSAs and the Director of Child and Family Services, were identified by the Child Welfare League in 2000.

87. The Director of Child and Family Services at the Department is ultimately accountable for the well-being of children under the Child and Family Services Act. Our 2014 audit found that the accountability structure between the Department and HSSAs left the Director with little control over, and with little information about, the day-to-day decisions for ensuring that children are protected from harm, abuse, and neglect. The 2014 audit recommended that the Department thoroughly review its accountability framework and consider changes to enhance the accountability set out in the Act. At that time, provisions in the Act to enhance accountability had not been used.

88. The Department issued its Building Stronger Families action plan soon after the 2014 audit. The plan made several commitments to improve the overall quality of child and family services, including improved accountability for the delivery of services and the adoption of new assessment tools to guide the management of children’s cases. In 2016, another significant change was the creation of the Northwest Territories Health and Social Services Authority (NTHSSA).

89. Our recommendations in this area of examination appear at paragraphs 100, 101, and 102.

90. What we examined. We examined whether the Department had revised the accountability framework for child and family services to make HSSAs more accountable and to ensure that those delivering the services had clear roles and responsibilities. We also examined the Department’s support to implement the new Structured Decision Making® system.

91. Accountability framework for child and family services. We found that following the 2014 audit, the Department made changes to its accountability framework by appointing senior officials in each of the HSSAs as assistant directors. Under the Act, assistant directors are accountable to the Director for services provided to children, youth, and families in each of their regions. However, we found significant issues that undermined the accountability framework:

• Most of the assistant directors did not have qualifications or experience in child and family services. While the Department provided training to assistant directors, we were told that the training was insufficient to understand the day-to-day requirements or how to carry out the oversight role required of assistant directors.
• Some assistant directors did not have access to the child and family services database, so that they could monitor and assess how the services for which they are accountable were delivered, including whether these services complied with key requirements of the Act. However, in one HSSA, we found that the Assistant Director had developed a tool to collect quarterly information from staff about the delivery of child and family services, including key requirements such as contact with children.
• The Director did not adequately oversee the assistant directors. For example, quarterly reports that each Assistant Director was required to submit to the Director contained little information on whether the delivery of child and family services in each region complied with key requirements. In addition, up until May 2018, there was no forum for assistant directors to meet with the Director, or each other, to discuss common challenges and good practices or to seek advice on these issues.

92. This is significant because assistant directors are also accountable under the Act for a wide range of child and family services delivered in their respective regions, including day-to-day decisions to address child protection concerns, the care of children in temporary and permanent care, children placed in treatment facilities outside of the territory, and youth leaving the child and family services system.

93. Roles and responsibilities for child and family services. The NTHSSA’s Child and Family Services division was created to help improve these services by directing and overseeing their delivery across HSSAs so that services are delivered consistently and comply with the Act and the Child and Family Services standards and procedures.

94. However, at the time of our audit, although an organizational structure was in place, the NTHSSA and the Department had not clearly defined or agreed on how to divide their roles and responsibilities, including to whom regional child and family services staff report, and who has the authority to give directions to regional staff, most notably on decisions for children and families receiving services. This lack of clarity created confusion and, in some cases, disagreement about who was responsible for what, rather than contributing to improved services.

95. We noted that the NTHSSA had identified several initiatives to help standardize the delivery of child and family services, such as standards to improve clinical supervision and provide on-call services to children and families across the Northwest Territories. However, in our view, it is unclear how these initiatives can succeed if the Department and the NTHSSA have not clearly identified their roles and responsibilities and decided who has the authority to direct and oversee child and family services.

96. In our review of files, we observed that access to mental health services for children and families in the child and family services system was an area where such standardization may also be useful. For example, in a case we reviewed, a child identified as needing mental health services waited for almost a year to receive these services due to long wait times. In another file we reviewed, a child who needed these services was not referred at all because the services were not available. Officials told us that staff in one region had developed a scheduling approach for mental health services that significantly reduced wait times.

97. Support for the Structured Decision Making® system. Changes to the child and family services system since our last audit also included the adoption of the Structured Decision Making® system (SDM®). This system contains six assessment tools meant to assist child protection workers with case management, including conducting child protection investigations. The Department and HSSAs began rolling out the first of these assessment tools in early 2016, and had implemented four of the tools by the time of our audit. However, most child protection workers we met told us that they had not received enough training to support them in using these tools. Department and HSSA officials told us that insufficient training can result in improper use of the tools and create greater risks for children, because decisions made using the tools could be wrong.

98. We found that the Department did not do enough to manage risks or provide support when it introduced this new decision-making system. Notably, when the Department decided to review whether all HSSAs were using the SDM® assessment tools properly, it assigned one existing staff member to perform the approximately 3,000 required reviews. This was in addition to this person’s other duties. As a result, there was a significant backlog and delays in this review. For example, some reviews, undertaken months after decisions had been made, found problems with the use of the tools, including situations where HSSAs had screened out calls that should have been investigated. This could have left children in unsafe situations.

99. In October 2017, the National Council on Crime & Delinquency Children’s Research Center, which created the SDM® system, issued a report detailing a review of how the system was being used in all regions across the Northwest Territories. This review had been commissioned by the Department. The review found significant problems in the files it examined. For example, the review disagreed with approximately 50% of the decisions that had been made by HSSAs on a child’s safety when using this assessment tool, and also reported that authorities often did not use the tool to assess a child’s risk. It recommended more training and support and better documentation to support key child protection decisions. At the time of our audit, the Department had yet to act on the review’s recommendations.

100. Recommendation. The Department of Health and Social Services should work in collaboration with the Health and Social Services authorities to ensure that all assistant directors have the required oversight, training, information, and other support required to fully execute their responsibilities for ensuring compliance with the Child and Family Services Act.

The Department’s and the Health and Social Services authorities’ response. Agreed. The Department of Health and Social Services and the Health and Social Services authorities (HSSAs) recognize the importance of providing comprehensive training and support to assistant directors, who play a critical role in providing leadership to child and family services delivery under the Northwest Territories Child and Family Services Act.

The Department and HSSAs will ensure assistant directors have adequate training, access to information, and ongoing supports to fulfill their delegated responsibilities and ensure compliance with the Child and Family Services Act.

The Assistant Directors Forum was established in May 2018 to share information, improve oversight of the child and family services system, and provide mentorship and support to assistant directors to execute their responsibilities. The Statutory Director has met with the current and incoming assistant directors to identify their individual training needs and gather information to enhance the Assistant Director training curriculum. The Department and HSSAs are providing assistant directors with core child protection worker and specialized assistant director training, which will be completed by December 2018.

101. Recommendation. The Department of Health and Social Services and the Northwest Territories Health and Social Services Authority should work together to clearly identify and implement their respective roles and responsibilities for child and family services. This should include a clear identification of accountability and reporting relationships for the front-line delivery of services to children, youth, and families.

The Department’s and the Health and Social Services authorities’ response. Agreed. The Department of Health and Social Services and the Health and Social Services authorities (HSSAs) recognize the importance of having clear roles and responsibilities that enable the effective delivery of child and family services.

By implementing the Building Stronger Families action plan over the past four years, the Department and the HSSAs have embarked on a major transformation of the entire child and family services system, which includes several significant quality improvement initiatives and projects.

The accountability framework developed in 2014 reflected a structure with eight HSSAs. In August 2016, the health and social services system was transformed and six of these HSSAs were amalgamated into one larger authority. Given the changes that resulted from this transformation and the findings and recommendations outlined in the 2018 audit report, it is evident that there is a need to adjust some roles and accountabilities within the system while being careful to ensure that any changes made facilitate better outcomes for children and families.

Accordingly, by 1 January 2019, the Department and HSSAs will implement changes that clarify accountability, roles, and responsibilities in order to support and enhance child and family services across the Northwest Territories.

102. Recommendation. The Department of Health and Social Services and the Health and Social Services authorities (HSSAs) should work together to identify and provide the required training and ongoing support to HSSA staff in the accurate use of the Structured Decision Making® system. The Department and authorities should also undertake regular quality assurance checks of the system’s use to help ensure its assessment tools are being used correctly in decisions about child safety and risk. Further, it should use this information to update training and other support for child protection workers as needed.

The Department’s and the Health and Social Services authorities’ response. Agreed. The Department of Health and Social Services and the Health and Social Services authorities (HSSAs) view the Structured Decision Making® system (SDM®) as a cornerstone of the effort to improve the quality of child and family services practice and recognize the need to ensure that staff members have adequate training and that the tools are being used correctly.

Implementing SDM® is a large and complex initiative requiring a major shift in practice. Consequently, it has been an iterative process. While the SDM® assessment tools are now included in the child protection worker statutory core training, the Department’s and HSSAs’ experience indicates a need for additional support on these tools for current and new staff. Therefore, a survey was launched in September 2018 to assess the level of knowledge possessed by child and family services staff around the SDM® assessment tools. The Department is also working with the HSSAs to conduct SDM® quality assurance checks. This information, along with other reviews, will inform ongoing training and support for front-line staff.

As well, in partnership with the National Council on Crime & Delinquency Children’s Research Center, the Department has developed an improved implementation plan. By 31 March 2019, a train-the-trainer model will be implemented to provide ongoing, sustainable learning for child and family services staff.

The Department had still not determined the financial and human resources needed to deliver the required child and family services

103. We found that the Department had still not determined the financial and human resources required to deliver child and family services. It had only started to assess what was needed toward the end of our audit period.

104. Our analysis supporting this finding presents what we examined and discusses the following topic:

• Financial and human resources to deliver child and family services

105. This finding matters because the Department and authorities need to have enough people and money to protect children and youth and to support families as required under the Child and Family Services Act. Recommendations to assess the resources provided to HSSAs to deliver child and family services were made about 18 years ago and were reiterated by our Office in 2011 and 2014.

106. HSSAs are responsible for delivering front-line child and family services. Our 2014 audit found that the Department had not assessed whether the financial and human resource levels it allocated to HSSAs were enough to deliver the services children and families are entitled to under the Act. In 2014, we recommended that the Department work with HSSAs to assess what financial and human resources were required to deliver child and family services. In response, the Department committed to assessing workloads and ensuring that HSSAs had equitable and adequate resources to deliver child and family services.

107. It is important that HSSAs have enough staff given the demands placed on child protection workers who deliver these services. Child protection workers are often exposed to traumatic, stressful, and in some cases, unsafe situations, in which they must make difficult decisions about a child’s best interests. They are also responsible for the ongoing management of children’s cases, preparing legal documents, appearing in court, and dealing with child protection reports that often require their immediate attention. Many of these duties also require regular travel to remote communities. Further, some workers must also manage adoptions, family violence programs, or community programs.

108. Our recommendations in this area of examination appear at paragraphs 116 and 117.

109. What we examined. We examined whether the Department worked with HSSAs to put in place the financial and human resources needed to meet their responsibilities under the Child and Family Services Act.

110. Financial and human resources to deliver child and family services. We found that the Department continued to allocate funding to each HSSA based on historical amounts dating back to 1998 without knowing whether these amounts were enough to deliver the services to which children and families are entitled under the Act and without considering regional needs, except for foster care. Department officials informed us that they had decided to focus on carrying out other strategies instead, such as implementing the Structured Decision Making® system.

111. This resulted in inequities that affected the delivery of child and family services. For example, the Tlicho Community Services Agency (TCSA) had just as many cases as the Yellowknife region of the NTHSSA, but had been allocated less than half the number of child protection workers. This means that each TCSA worker had to manage a heavier workload, including many complex cases. The TCSA also did not have the support that the Yellowknife region did, such as family preservation workers to help manage cases.

112. Soon after our 2014 audit, the Department commissioned the Child Welfare League of Canada (CWLC) to do a workload management study to help identify what resources were required to deliver child and family services. This study identified a range of factors that contributed to child protection workloads, such as overtime and travel requirements, and recommended ways to manage these factors. The study also recommended that the Department clearly identify caseload standards for child protection workers. We found that the Department did not act on these recommendations. We also noted that in 2000, the CWLC recommended that the Department develop caseload standards.

113. Similar to 2014, child protection workers told us that workloads remained a significant issue, making it difficult to manage their cases and contributing to high turnover. Child welfare literature states that children are negatively affected when the turnover rates of front-line workers are high. In the files we reviewed, we found instances where the assigned child protection worker for a child had changed several times over a short period. Further, in our last audit, we reported that one region had only one family preservation worker to assist families that had been assessed as high risk. We found that since then, two more had been hired, but only in that same region. Child protection workers in other regions told us their workloads prevented them from providing prevention support that family preservation workers offer and that could benefit many families.

114. We also found that insufficient staffing for child and family services at the Department was an area of concern. Some key positions remained vacant for extended periods. As a result, some employees were performing the duties of three or four positions at various times. The Department was also tasked with implementing the Building Stronger Families action plan, but without additional staff. Officials told us that these combined factors have contributed to burnout and significant turnover.

115. Near the end of our audit period, the Department undertook a preliminary assessment of caseloads and the resources needed to support the delivery of child and family services. However, given its preliminary nature, we found that this assessment did not include a detailed analysis of the factors affecting caseloads for child protection workers in the Northwest Territories, such as those identified by the Child Welfare League of Canada. In the absence of detailed analysis, it is unclear whether the resources the Department identified in this preliminary assessment would be sufficient to deliver the required child and family services.

116. Recommendation. The Department of Health and Social Services, in collaboration with the Health and Social Services authorities, should perform a detailed assessment of the financial and human resources needed to deliver child and family services. This assessment should consider key factors affecting workloads to establish caseload standards—including factors identified by the Child Welfare League of Canada—in order to accurately identify the resources needed to deliver these services.

The Department’s and the Health and Social Services authorities’ response. Agreed. The Department of Health and Social Services and the HSSAs understand that it is critical to address workload capacity in the child and family services system to sustain and enhance the delivery of child and family services.

The Department recognized capacity challenges relating to workload and caseload issues in regions, and undertook a caseload analysis that considered the key factors presented in the Child Welfare League of Canada report and other literature.

Building on this initial review, the Department and Health and Social Services authorities will identify further changes to the workload, workflow, and caseloads required to ensure the delivery of better-quality services in the context of the Northwest Territories. This will include considering optimal team design and skill mix, developing options for caseload standards, and streamlining business processes. A project plan to undertake this work will be completed by 31 March 2019. The results of this work will inform future business planning processes.

117. Recommendation. The Department of Health and Social Services, in consultation with the Health and Social Services authorities, should develop a detailed action plan clearly setting out how it will ensure that the child and family services system operates in compliance with the Child and Family Services Act. As part of this plan, it should identify specific indicators to measure whether the system is achieving the desired results and is better supporting children.

The Department’s and the Health and Social Services authorities’ response. Agreed. The Department of Health and Social Services and the Health and Social Services authorities (HSSAs) have developed a quality improvement plan that addresses the recommendations provided by the Office of the Auditor General of Canada as well as those generated by internal quality assurance work. In order to effectively implement the plan, a partnership has been established between the Department and the HSSAs at the leadership and working levels. As part of this work, the Department has begun engaging front-line staff to discuss and collaborate on practice improvement initiatives.

In addition, the Health and Social Services (HSS) system is preparing for a system-wide accreditation in partnership with Accreditation Canada. This is scheduled for late September 2019. As part of its planning for child and family services standards and HSS system accreditation, the Department and HSSAs will be developing a set of key indicators to collect and track data that will help determine whether the child and family services system is meeting its goals and better supporting children and families.

Conclusion

118. We concluded that the Department of Health and Social Services and the Health and Social Services authorities did not meet key responsibilities for the protection and well-being of children, youth, and their families.