BEST START NETWORK
eARLY CHILD DEVELOPMENT PLANNING
March 6, 2013
Deliverable 6:
Functional Analysis of Current Programs, Services and Supports
1.Provide a graphic or pictorial representation(s) of programs and services by function in your community. What are the key findings from the analysis of the representation(s)?
Graphic representations of programs and services by each local service area are attached (see Appendix ____).
Each of the four local service areas is geographically distant from the closest urban centre (the City of Greater Sudbury), especially Sudbury North and, to a lesser extent, Manitoulin Island, particularly the further reaches of the Island. All have to provide services across large rural or remote areas. The range of services and supports available in the four areas is similar and discussions with the local service providers indicate that the gaps and challenges are quite similar as well. The demographics of each local area influence the diversity of services to some extent, i.e. areas with a high proportion of Aboriginal people, such as Manitoulin Island, have more services specific to First Nations.
Some providers offer services in some parts of the District and not others (e.g. Our Children, Our Future provides services in Sudbury East and Lacloche) but in these cases, another service provider offers the same or similar services in the other areas. Two of the planning areas have some jurisdictional overlap in terms of their planning tables, i.e. the Sudbury East table includes service providers from areas outside the catchment of the Best Start Network,and in Lacloche there are some differences in service catchment area by agency, especially for communities like Beaver Lake/Worthington and Birch Island.
2.Is there an appropriate mix of universal (available to all children and families) and targeted (intended for specific populations) programs and services across service functions? Describe.
In all of the service areas, planning table members agreed that the mix of services (universal and targeted) is, for the most part, appropriate. Accessing services can be a challengehowever. This is more of an issue for targeted than universal services, as the latter are open to all and do not have wait lists, but where the geography of the area is large, even accessing universal services can be difficult, depending on where people live and if they have transportation.
The Manitoulin group spoke to challenges accessing universal services, due to the size of the geography and limited transportation. Sudbury East, respondents pointed out that the mix of services is appropriate, but there are limited resources to provide the services. This likely also relates to the distribution of the population across the large geographic size of the service area, so that like the Island, universal services such as those offered by Best Start Hubs, are only accessible at certain locations.
In all areas, access to certain targeted or specialized services can be difficult. In Sudbury North, access to targeted children’s services that are available in the community did not emerge as a significant issue, although there are some service gaps. However, access to specific specialized services not available in the community, such as psychiatry and optometry, can prove challenging if people do not have transportation. On the Island, accessibility to certain targeted services is also limited. These include specialized medical care for specific medical issues (there is a visiting pediatrician, but he only visits once a month), OT and PT, and speech and language services (only available in Little Current during working hours). Indeed hours of service are limited for many services (e.g. after hours services are very limited) because of the population size. In Sudbury North, the same issue was identified (e.g. there is no mental health crisis response after hours). The Lacloche group agreed that accessibility to targeted services is limited, with most having lengthy wait lists. Wait lists are particularly long for speech and language services and for OT (two-year wait).
On the other hand, both the Lacloche and Manitoulin groups indicated that, for some services, wait times can be shorter than in the urban area. On the Island, speech and language services and OT/PT services can be accessed quite readily, for those with high priority needs. For instance, speech and language screenings occur within 30 days of referral and after that, the family generally begins receiving therapy within a couple of months. Similarly, OT and PT services have a short wait list for who are high risk and under 6 years of age (older children will have a longer wait). This appears to be different from the situation in Lacloche, where providers indicated that wait times for speech and language, OT and PT services are quite long.
The reason for this variability is not clear. The Lacloche group noted that wait times seem to vary based on whether the program is operated out of Sudbury or locally, with the local Infant Development Program wait time being about two months, for example, while the wait period for services from the CTC (originating in Sudbury) is much longer. However, the Manitoulin group said that wait times are based on priority needs, with those having higher needs receiving services more promptly.
3.Are diverse cultural and linguistic groups effectively supported across all service functions?
With regard to supporting diverse cultural and linguistic groups, two key themes emerged across the planning areas.
Linguistically Appropriate Services
In three areas (Sudbury East being the exception), services are not always available in French, even though the agencies are mandated to offer services in both official languages.
In Sudbury North, this occurs because it can be difficult to find trained bilingual staff, e.g. the resource consultant in the child care program speaks English only. Although most French speaking people in the area are bilingual, the percentage of the population that speaks French is high (52%).
On Manitoulin Island and in the Lacloche area, Francophone services are also limited. On the Island, almost no one offers services in French, even the organizations that are mandated to do so, and people wishing to access services in French would have to leave the Island. However, the Manitoulin group noted the service language (English) is probably appropriate given the low number of Francophone families in the area (about 5%). In the Lacloche area, the percentage of the population speaking French is higher, about 18%. There are no programs in the area that are specific to the Francophone population, except through the hubs and library (e.g. story times in French). However, few service providers encounter clients who are unable to access services in French and, if needed, most of the services can make accommodations, i.e. by bringing in a Francophone staff from Sudbury. There have been cases however of children who were referred to French Wordplay, which means the clients have to go to Sudbury to access the services.
Culturally Appropriate Services
Immigration rates into the District are very low andthere does not appear to be much of a demand or need for culturally appropriate services for newcomers. The issue of culturally appropriate services for Aboriginal people was discussed at every table. Universal services such as early learning and parenting programs, child careand general medical services are available both on and off reserve. Jurisdictional barriers to accessing some specialized services on reserve remain, which can be confusing and frustrating for families living on reserve and, with some exceptions, mainstream targeted and specialized services operate within the context of a Eurocentric world-view.
Three of the planning tables (Sudbury North, Manitoulin and Lacloche) talked about the jurisdictional issues that govern whether or not certain service providers can go on reserve. It was noted that, for the most part, there are no barriers to accessibility to some of the more universal programs like early learning services and child care, because similar services are available both on and off-reserve. In addition, some service providers, such as OCOF in the Sudbury East, do offer services for the Aboriginal community and First Nations families will access these services off-reserve.
However, the situation is quite different with regard to specialized services. For instance, the CTC does not go on reserve, while the IDP program does. CCR will go on reserve, but CFC does not. Public health service providers do not go on reserve. This can be confusing for First Nations families living on reserves, and it can be difficult for them to access services not provided on reserve, whether because of need or preference. If First Nations families have to go off-reserve for services, the services are unlikely to be culturally appropriate, i.e., they will be more geared to the Western worldview. However, it was noted that First Nation communities on the Island are working diligently to provide their own culturally safe services.
In Sudbury North, it was felt that educational services are culturally appropriate and well-developed. However, the planning group would like to engage more with Aboriginal service providers. First Nations partners are members of the planning table but rarely attend meetings. There is a high turnover of workers and also, they would only be reporting on their own services (on reserve), so they may not feel the need to attend on a monthly basis. However, this is seen as unfortunate as the planning table is a good forum for all partners (Aboriginal and non-Aboriginal) to share information about the various programs and services available in the community.
4.Are there potentially overlapping programs and services in your community?
Existing Services
Duplication or overlap of programs and services does not appear to be a significant issue in any of the four service areas. Because resources are limited, service partners generally work together and realign resources to address any duplication of service, and the local planning tables have been very helpful in this regard.
In Sudbury North, for example, some of the services offered by public health can be accessed through other service providers, such as the dietician at the hospital, who is very active and involved in the community. However, the Health Unit recently conducted a service review and realigned some of its services to address issues of duplication. This has freed up time and resources for the Health Unit to begin offering new services, with the new sexual health clinic a prime example. There are quite a few Triple-P trainers (five) given the size of the population, but together the service partners have found effective ways to re-align and add value to the program, e.g. the trainers work on different levels of Triple-P. There has been also been some overlap with speech and language services between Wordplay and the school boards, e.g. with regard to screenings, but this has largely been worked out between the service partners.
Similarly, the Sudbury East group reported that providers work in partnership, which is required because human resources are limited. For example, if the Centre de Santé and the Health Unit see an overlap, they will work together to ensure there is no duplication.
The Lacloche groupsaid the same. The Service Provider Network members work well together and look at what is happening in the community so they can plan collectively to ensure there is no overlap in programming. They also work together to improve accessibility, e.g., the childcare program provides childcare for parenting programs such as Triple P, on a volunteer basis. Where duplication has occurred in the past, for example, prenatal classes were being offered by both Family Health Teams and the Health Unit, but the two services are now collaborating to avoid duplication.
On Manitoulin Island, service providers also work together to ensure there is no unnecessary duplication and they are open to modifying services based on need, e.g. to changing programming if needed to make services more culturally appropriate. From a First Nation perspective, some services are available on and off reserve (e.g. child care) but this is not an overlap, as some First Nation families live off reserve and some live on reserve.
Respondents noted that there are some areas where it might appear that there is an overlap or duplication of services, but this perception would be misleading. For instance, in Sudbury North, there are a lot of groups doing early screenings, but this should not be considered an unnecessary duplication of services, as there are still young children in the community who are not being screened and are consequently “falling through the cracks.” Also, there are some services where it would not be appropriate or ethical to try to avoid duplication. As an example, the Manitoulin group talked about Food Bank services. There is no system coordination of these resources, e.g. one food bank would not call another to see if people were accessing the service already, but no organization would want to be doing this anyway– being the “food police”. It is more important to ensure that food is available for those who need it.
New Services
There is always potential for duplication when new services are offered. However, if a new service is implemented, it appears that the planning tables would invite the new provider to participate in collaborative planning, thereby avoiding any emerging overlaps or duplication of service.
For example, the Lacloche group talked about a new program of the CCAC, which will involve nurses providing mental health services in the schools. The group is not sure exactly what the CCAC will be doing and if this will represent any duplication of existing CFC services or of Health Unit programs, if the CCAC is planning on doing prevention work. On the other hand, the new services could represent a gap because the CCAC will not be going into all schools. In any event, the group plans to invite a CCAC representative to join the local Network to participate in service planning.
5.Are there gaps in programs and services in your community?
There were two gaps reported by all four local planning tables: transportationand access to specialized services. Recreation was identified as a gap by three planning tables. Food security, shelter and parenting support programs were identified as gaps by two of the local networks. Table 1, below shows identified gaps by local planning area.
Table 1Service Gaps by Area
Gap / Planning Areas Reporting GapSudbury North / Sudbury East / Manitoulin / Lacloche
Transportation / x / x / x / x
Access to Specialized Services / x / x / x / x
Recreation / x / x / x
Food Security / x / x
Shelter / x / x
Parenting Support Programs / x / x
Early Learning and Development Programs / x
Child Care Programs / x
Health Services / x
Transitional-Aged Youth / x
Other Gaps/Challenges / x / x
Transportation
All of the local networks identified transportation as a gap. None of the service areas has public transportation. In Sudbury North (Chapleau), transportation within and out of the service area can be challenging. Mostplaces in town are accessible by foot, but transportation to the child care centre can be challenging for parents without a vehicle. There is a community transport service run by the municipality but it costs $4.50 for one parent and child one way. Some of the reserves have buses for adults to come into town, but not for children to get to school. APANO has a van to pick up their clients for services, but they are very limited with regard to car seats. Travel to go anywhere out of town (e.g. for medical appointments) can be a real challenge. The Bud Car rail schedule is very limited. There has been some talk of the LHIN providing a vehicle for the community to transport clients to out-of-town appointments, and this is being looked into by the hospital board, but so far this has yet to materialize.
In Sudbury East, transportation within the service area (which is quite large) was cited as a significant gap, and it is very difficult for families without a vehicle to attend programming. People on Manitoulin Island face similar challenges. For example, subsidized daycare is available, but transportation to access it is often a barrier. Even if families have vehicles, they may not be able to afford the gas to travel. Transportation remains a significant barrier to accessing services in the Lacloche area, especially for those living in outlying areas. Even within the town of Espanola, there is only one taxi and the service is limited.
Access to Specialized Services
All of the local planning tables identified access to specialized services as a gap, although they vary somewhat in terms of which specialized services are difficult to access. In Sudbury North, the main issue is lack of access to after-hours mental health crisis services (for children or adults). People in crisis have to go to the hospital. If people call the crisis number, they are told that Chapleau does not have that service. In Sudbury East, there is a significant gap in terms of services for youth with substance abuse or addictions issues, and there is a high incidence of these problems in the area. There are also limited services for children with special needs, regardless of the nature of the special need, i.e. developmental disability, physical disability, autism spectrum disorder. Even for the Special Olympics, families have to travel into Sudbury. There is also a need for locally based respite services for children with special needs.