A Review of Jordan's Principle

Operating Context and Service Gaps

Projects that had existing infrastructure or were extensions of existing projects experienced fewer implementation challenges than did new projects. Generally, projects that were new lacked a solid understanding of program design, program theory (linking activities to outcomes), assessment and intake procedures, case management processes, assessment and measurement processes, and development of service plans. When located in rural or remote locations, programs also struggled with the availability of qualified and trained staff in the community and availability of other resources (training, referral service providers, etc.). Across all sites, the lack of funding for youth older than 17 years of age was noted as the major service gap.

Roles and Responsibilities

Roles and responsibilities among partner organizations or other community service providers were best documented in pre-existing programs. While relationships existed between the project and some primary partners, program design was not based on an extensive consultation with all stakeholders and/or service partners. Consultation and communication had occurred between the funded projects and other stakeholders, but such consultation was generally initiated by project staff during informal case management rather than as part of a formal communication/outreach strategy.

Service Delivery Similarity Across Funded Projects

Each of the five projects reviewed had considerable variation in program consultation, design, implementation and execution. Most had enhanced or aimed to enhance case management, most had introduced new program activities, all had some focus on providing parents supports (although it was limited), and all had introduced some new staff, while two used existing staff and support services.

Changes Under Jordan's Principle for Children Families

Jordan's Principle funding appeared to have positive outcomes for children and their families. Case study participants identified a range of outcomes such as a reduction of negative incidents among youth, improved school attendance, the ability for families to remain living on‑reserve, and improved supports for parents. More specifically, parents noted that of significant benefit was the: introduction of an active champion who helped assess and meet the needs of their children, positive child outcome from the supports provided (e.g. improved ability of their child to communicate their needs when they are non-verbal), and improved educational outcomes.

Jordan's Principle Contribution to Improved Service Coordination or Partnerships

Coordination of services was likely improved under Jordan's Principle, but for the projects that were visited, a high degree of service coordination was not observed (although relationships exist with referral agencies). As part of the program roll-out, programs undertook consultations with communities and service providers as to program objectives and elements; however, programs were not always designed in a stepwise manner (program coordination and consultation, funding for program design, and funding for program implementation).

Key Strengths

Generally all programs provided new funding to fill gaps in services and programs were designed to meet local/community need. Similarly, parents were provided with needed supports that were otherwise missing. An important strength of Jordan's Principle noted by stakeholders was the rapid and timely approval of funding (for families) and the high level of project approval.

Lessons Learned

Key lessons learned included:

• Program effectiveness was impacted by the operating time, the availability of resources to design and implement programming, and the availability of resources and staff to maintain programming.
• Programs require support in developing program theory to link program activities to intended outcomes. Further, programs require support in measuring and monitoring these outcomes.
• More guidance should be provided to programs to allow program implementation to occur in a stage wise approach that includes community consultation, program design and program roll-out.
• Capacity and infrastructure challenges can be addressed at a high level through "tool‑kits" and training.

Project or program effectiveness varies considerably on the basis of prior program history

The results of the Review suggest that program implementation (and ultimately program effectiveness) is highly correlated with the prior history of the project or program. For example, from the case studies, programs that were in operation prior to Jordan's Principle funding (My Child, My Heart, ECIPs) were much better able to launch "new" programs/services as they had existing program administration, management structures and relationships in place. In contrast, projects that were only just started as a result of Jordan's Principle (Choose Life) experienced significant challenges in terms of program design, implementation and service delivery.

Need for clear program theory underpinning programming actives

As noted previously, some programs were unclear if the activities they were completing clearly linked to the outcomes they were seeking (i.e. positive mental health outcomes). Good program design requires sound theories of change that show the link between program activities and the desired program outcomes. Simply developing a robust program theory and implementing it could take two years. At the community level, communities did not have the capacity to complete such a task, and as noted, nor did the administrative organization. Time is required for the administrative organization to build this capacity prior to rolling out program funding. Thus program design funding is required prior to program funding.

It should be noted however, that given the CHRT's ruling that applications be reviewed within a 12 to 48 hour timeline, the challenges associated with program design/implementation reflect a desire to satisfy CHRT's vision of "quick" service delivery to meet unmet needs, as opposed to a more comprehensive approach that would likely have better addressed program design and implementation issues.

More guidance /support should be provided to newly developed programs funded under Jordan's Principle

It is clear that given the limited funding window, projects and programs were often "rushed" in order to meet financial targets. However, such an approach resulted in disjointed service delivery and ultimately, development of programs in isolation of broader community requirements. In the future, "new" project or programs funded under Jordan's Principle should be funded in a staged approach. These stages could include:

Text alternative for Figure 1

The figure depicts the three stages of Program Delivery.

The first, Stage 1, is described as "Community consultation, community service map development, program conceptualization including linkages to other programs and services."

The second, Stage 2, is described as "Program design and early implementation. Early implementation could involve use of "pilot projects" or phased implementation to allow for learnings to be incorporated in the broader program roll-out."

The final, Stage 3, is described as "Program roll-out with defined monitoring and assessment protocols."

Examples of supports that could have been developed by the administrative organization and made available at the community level would include:

• Workshops outlining Jordan's Principle;
• Workshops on application completion;
• Workshops and toolkits on program design;
• Workshops and toolkits on theories of change, logic models and program monitoring and measurement;
• Toolkits with commonly used program protocols such as intake forms and consent forms; and
• Workshops on Human Resources processes for hiring, contract development, etc.

Address Capacity and Infrastructure Challenges

Under Jordan's Principle funding, there was a desire to implement new programs and services, many of which required trained and qualified health professionals, as well as the need to hire significant numbers of staff to work in the programs/projects. It was clear that while Jordan's Principle resulted in the injection of considerable resources to meet community need, there were gaps/challenges in terms of having the available infrastructure (offices, space, other) and human resources (trained and qualified health staff, project coordinators, various support workers etc.) to effectively support the funded programs/projects. In this context, it would be important to not only provide funding to support programs, but a portion of the funding under Jordan's Principle could be earmarked for infrastructure and/or other capacity building at the community level.

2.1 Program History

As a pilot program, My Child, My Heart (Integrated Approach to Services for Families with Children with Complex Needs) began operating in 2015, under Health Services Integration Funding, through collaboration between Pinaymootang Health Centre, Anishinaabe Child and Family Services, Pinaymootang School, Pinaymootang Social Program and Health Canada, First Nations Inuit Health Branch (Manitoba Region). The pilot ran from December 15, 2015, to March 31, 2017, under Health Services Integration Funding.

The pilot resulted from a complaint filed by a Pinaymootang family with the Canadian Human Rights Commission, which argued that their child's complex health care needs were not met by the services available in the community. Health Canada's subsequent request to the Pinaymootang Health Centre to submit a proposal to meet the needs of this child lead the centre to instead submit a proposal to meet the needs of 11 families of children with special health care needs thus fulfilling their role as health care advocate for the community. 

From April 2017 to March 31, 2018, as well as in the current fiscal year (April 2018 to March 2019), My Child, My Heart was funded through Jordan's Principle.

2.2 Program Objectives

The goal of Niijaanis Nide: My Child, My Heart is to allow children to access services where their families and support networks are located and in a home setting where they feel comfortable and safe. My Child, My Heart has six key values: ^{Footnote 8}

1. Children are best cared for at home and within families;
2. Special needs of children and families have to be met as well as their basic needs;
3. Parents know their child better than anyone else and must be treated respectfully;
4. Professional supports must be coordinated and responsive to the needs of individual children and families;
5. Identify risks to be managed in ways that provide safety and good quality of life to the child and family; and
6. Partnership working across disciplines and agencies is essential.

My Child, My Heart supports children with complex needs in Pinaymootang from birth to 21 years of age. Children can live on- or off‑reserve. Children with complex health care needs are defined as children with a congenital or acquired long-term condition that are attributed to impairment of the brain and/or neuromuscular system that create functional limitations.

3.1 Staff

The program includes:

• One Case Manager/Project Coordinator;
• One full-time equivalent (FTE) Nurse or Social Worker;
• Three to five FTE's Child Development Worker (CDW), Health Care Aids or Early Childhood Educators (ECE's);
• Ten part-time respite workers for evening and weekend family respite; and
• One Administrative Assistant/data entry position.

3.2 Services

A wide range of activities are carried out by the program:

• Provide evening and weekend respite care for families;
• Collaborate with service providers;
• Advocate for continuum of care for children with complex needs;
• Provide a continuum of family training;
• Build partnerships across disciplines and agencies within the community that provide services to the children with complex needs;
• Provide staff education and training related to caring for children with complex needs;
• Provide day and evening programming for children with complex needs; and
• Provide one-on-one work between the CDW and the child.

Many of the services are provided in the Pinaymootang First Nation Health Centre. The addition of the kitchen and meeting room in July 2018 has enabled the program to hold day and evening programs for children and families.

The program has developed a program delivery process aimed at providing continuous, integrated care to children with complex needs so as to allow them to remain living in Pinaymootang. The five phase program delivery process is as follows^{Footnote 9}:

1. Phase 1: Establishing a relationship:
   • Meet with the child and parent to allow them to share the child's strengths, challenges and preferences. The phase allows workers to get to know the family and child and establish trust.
2. Phase 2: Identifying needs and objectives:
   • Identify what the parents want for their child.
   • Develop one to three objectives with the CDW.
   • For each objective, develop benchmarks for goal attainment and scales to measure attainment of goals.
3. Phase 3: Implementing the program:
   • The CDW implements the program based on the goals and objectives identified in Phase 2.
   • There are two components to program implementation:
     1. Basic Care and Support (e.g. occupational therapy (OT) and physical therapy (PT)); and
     2. Goal-Oriented Work (e.g. behavioural goals).
4. Phase 4: Generalizing Goals:
   • The CDW works with the child, family and others to ensure objectives are generalized across different people and different settings using a variety of materials and tools.
   • The CDW support and coach the parents/caregivers and train any secondary caregiver.
   • Services are provided in different environments (home or school) using a variety of resources.
5. Phase 5: Conducting evaluation and providing continuing care support needs:
   • Provide support to parents and caregivers and evaluate continuing basic care and support needs.
   • The following are evaluated:
     1. Child-oriented goals; and
     2. Family-oriented goals; (stress and coping mechanisms);

3.3 Case Management

Once a child's service plan is developed the program holds regular case management meetings with the necessary service providers to discuss implementation, provision and generalization of services for each child. The families are included in the case management meetings. Case management is critical to continuity of care and ensures that teaching and services are reinforced and provided across a wide range of environments including the home, school and community. All service providers interviewed stressed the importance of the case management meetings and noted that the program has successfully leveraged the case management model in part due to the strong partnerships that the program has established.

3.4 Partnerships and Service Providers

The program has established a number of partnerships or working relationships which allow the provision of services to children with complex needs within the community. While in the pilot phase My Child, My Heart began working with several partners to provide services to the 11 families. The range of partnerships has since expanded with the introduction of funding through Jordan's Principle. In the case of the Rehabilitation Centre for Children, the St. Amant Centre, and the Manitoba Adolescent Treatment Centre, the services partners, at the request of ISC (formally (INAC), have established contractual preferred service provider relationships that allows provision of services to children with complex needs on any reserve across Manitoba. These contracts were developed through a proposal-based procurement process and are funded by Jordan's Principle.

Pinaymootang First Nation Health Centre: the centre provides significant in-kind contributions to the program, including office space for their staff, program space and program oversight (the salary of the Health Director is entirely covered by other funding although they are involved in program oversight). Additionally, the centre is accredited which helps to ensure the overall quality of all services provided to children with complex health care needs within the centre.

Pinaymootang School: representatives of the school sit on the Community Advisory Committee and attend the case management meetings as needed. The school works with the program to coordinate services provided to children in school by Special Educational Assistants and CDWs. Support to children with complex needs while in school is funded through the school budget. Since the implementation of the program, the school has noted improved attendance among children with complex health needs, as well as improved integration and inclusion by other children. School representatives were unable to speak to improved academic performance. The school is currently not concerned about being able to meet the needs of children with complex health care needs during school hours.

Pinaymootang Daycare: the program works with the staff of the daycare to identify children potentially in need of services. The daycare refers families to the program if it is believed that special services may be required.

Anishinaabe Child and Family Services: coordinates services provided through the agency and My Child, My Heart, including in-home care services, during case management meetings.

Rehabilitation Centre for Children: provides OT, PT and speech therapy to children in the program. Given the Centres' more recent involvement in the program roles, responsibilities and communication lines are still being established between the Rehabilitation Centre for Children, the program and other service providers. High levels of investment from My Child, My Heart case managers have supported the introduction of services from the Rehabilitation Centre for Children to date. As well as providing OT, PT and speech therapy to children in the program, the Rehabilitation Centre for Children has completed training with program staff, and provided developmental checklists to community service providers to assist them in identifying children that should be referred to the My Child, My Heart program. Additionally, the Rehabilitation Centre for Children has developed and provided to the program a brochure explaining the services they provide for distribution among families. Representatives from the Rehabilitation Centre for Children noted that the program had resulted in developmental delays among community children being caught and treated earlier. Further, interviewees noted that necessary equipment that was not covered through Non-Insured Health Benefits has been provided through My Child, My Heart program funding.

St. Amant Centre: a basket of services are available to the My Child, My Heart program children and families through the St. Amant Centre including: non-crisis counselling for parents, siblings and the child, the family care program (advocacy and navigation), dietician services (dealing with challenging eating), and counselling for dealing with challenging behaviour in children with complex health care needs. Uptake of the St. Amant Centre services has been high among program families. As with other newer service providers, the St. Amant Centre works directly with the program case management team to coordinate and deliver services. The centre has also provided training to school staff to better support the children in the program. The centre noted improved family dynamics in the home, reduced difficult behaviours among the children, and increased positive behaviours in children (e.g. using the toilet, traveling in a vehicle, and return to school). The center is still working to establish an appropriate caseload for their staff but have needed to hire additional staff to meet demand for services from this program and other programs across Manitoba. A significant outcome noted by interviewees from the centre was the reunification of one child with their family and the planned reunification of another. In both cases, the children could now return to Pinaymootang where services are available rather than staying in a special care facility to have their needs met. Interviewees also noted that parents previously considering putting their child in a full-time care facility were no longer considering this option.

Manitoba Adolescent Treatment Centre: has worked with the My Child, My Heart program for four years providing mental health and psychiatric services, including preliminary assessments, arranging initial consultations for diagnosis, and ensuring medication is obtained. The centre provides mental health supports to youth, their families, and will consult with other service providers and the school. Consultations with psychiatrists and counsellors are completed through Tele-Health at the Pinaymootang First Nation Health Centre; in-person consultations can be scheduled if the doctor feels it is needed. After diagnosis, ongoing monitoring and prescription renewal is completed by community-based physicians that visit the Pinaymootang First Nation Health Centre. Barriers to service access noted by the interviewee included access to Manitoba Tele-Health, which is in high demand. Additionally, the central location of the Tele-Health equipment reduces privacy and can introduce confidentiality concerns. Clinicians stay in direct contact with the child's CDW to support case management as required. The Manitoba Adolescent Treatment Centre is still working with the service providers within My Child, My Heart to define roles, responsibilities and lines of communication on a case-by-case basis. Regular meetings among service provider management were said to be helping to support collaboration and the establishment of clear roles and responsibilities. The most significant challenges noted by the interviewee to the provision of services is the availability of on-the-ground support for individuals who are a threat to themselves or others. While this was not noted as a concern in the My Child, My Heart program, it has been noted in more remote programs in isolated communities.

Eagle Urban Treatment Centre: the My Child, My Heart program provides families referrals to the Eagle Urban Treatment Centre when they are leaving Pinaymootang to relocate elsewhere in Manitoba. Conversely, the centre notifies the program when a family is returning to the community to ensure continuity of services. Within Manitoba communities, the Eagle Urban Treatment Centre provides advocacy and referral to families. Advocacy was said to be important to support families navigating the provincial system to ensure children with complex health needs receive the required services under Jordan's Principle.

3.5 Program Outreach

The program received referrals from service providers as well as services in the community (school, daycare, etc.). Additionally, the program advertised available services through various methods including booths during community events.

3.6 Scope of Service Provision

Currently, My Child, My Heart provides services to approximately 60 children, many of whom receive ongoing support. Of the 60 children, 15 are currently transitioning to school, 12 received support services and 33 are actively involved in the program. Examples of the types of services provided included:

• Day program activities (reading club, physical activity night, "nagamon" music club, Moe the Mouse-read);
• Parent support meetings;
• Parent and caregiver classes;
• American Sign Language training for two families;
• Physiotherapy and occupational therapy;
• Speech and language therapy and audiology therapy;
• Visual therapy;
• Dietician services;
• Behavioural/cognitive behavioural therapy;
• Psychologist and psychiatrist consultations, spiritual wellness supports, and mental health therapy;
• Child development supports (individual);
• Home modifications;
• Home visits for extended families; and
• Respite care.

3.7 Program Budget

The annual budget for the My Child, My Heart program during the years it was funded through Jordan's Principle is shown in the Table 4. Across both years, the budget has remained the same, with it costing approximately $12,660 per child (60 children) to provide service. In addition to the core budget, the program received one-time funding for a handibus ($78,864.32) and American Sign Language Training (training: $7,800 plus facilitator travel: $1,560). In should be noted that the Pinaymootang First Nation Health Centre provides in-kind resources (facility space and utilities), which would need to be covered under the project budget if this facility was not available.

3.8 Monitoring of Child and Family Outcomes

The program monitors child and family outcomes at three, six, nine and 12-months post-intake. A goal attainment scale is used to determine if the family has been able to meet the goals they set for their child. Standardized tests used by the program include the:

• Measure of Processes of Care (20-item measure on parents' perception and satisfaction of the services provided for their child);
• Parenting Stress Index – Short Form (36-item measure tool that documents levels of stress – whether or not families are feeling supported);
• Social Support Index (17-item measure that taps into parents' experience of their support networks both with and outside the family); and
• Family Quality of Life (25-item measure that evaluates family quality of life, through five domains):
  1. Family Interaction;
  2. Parenting;
  3. Emotional Well-Being;
  4. Physical/Mental Well Being and;
  5. Disability Related Supports.

3.9 Program Outcomes

In 2016, the Canadian Home Care Association published a report on the impacts of the My Child, My Heart program. Among children, increased independence, socialization and sense of accomplishment were all observed. This was accompanied by a decrease in problematic behaviours. As a result of their interaction with the program, parents and caregivers were said to have increased connection with their child, trust in the health system, feelings of competency, coping, connection with other parents and ability to actively participate in the child's care.

Service providers were unanimous in their agreement that without My Child, My Heart, children with complex health needs living on Pinaymootang First Nation Reserve would be unable to access the necessary services required to meet their needs. Without such services these children were less likely to attend school, remained socially-isolated, and were unable to reach their potential. Further, many families would be unable to remain in the community if these supports were not available.

Parents who attended the focus group all felt that they had received the supports they required for their children through the program. Parents were unable to list gaps in supports and felt that the available services were meeting their child's immediate and long-term needs. Parents noted that their children's behaviour was more manageable and their children were less socially-isolated. Respite care was appreciated, as was the ability to share stories with other parents. Parents noted that they felt less isolated and that the program had helped take away feelings of self‑doubt or blame that their child's development or behavioural challenges were their fault. Some of the children had returned to school or began attending school for the first time as a result of the support. Many parents stressed that without the program they would need to move to Winnipeg to ensure their child's needs were met; however, in doing so, they would be left without social, emotional and respite support from friends and family.

3.10 Program Challenges

Given the length of time the program had been operating and strong program leadership, the My Child, My Heart program was experiencing few challenges. Program staff, however, estimated that they had been unable to reach all children with complex health needs who required support within the community; in part due to the reluctance of parents to have their children assessed. Program leaders also acknowledged that many families with high needs children had relocated to urban centres to assess provincial supports and had not yet decided to return to the community now that on-reserve supports had increased. It was expected that demand for services would increase as families displaced during the 2011 flood began moving home. The expansion of the Pinaymootang First Nation Health Centre had resolved the program's facility challenges, as there was now sufficient space for program staff and programming activities. Staffing was also not a challenge for the program as individuals with the necessary skills reside in the community.

The most significant challenges highlighted by stakeholders interviewed were:

• Uncertainty of funding; and
• Lack of funding for individuals aged 22 and older.

Without long-term funding, the program is less able to plan and retain staff. The uncertainty of funding also impacts families who were unclear what they would do if funding was discontinued.

Lack of funding for individuals with complex health needs aged 22 years and older was universally seen as the biggest program challenge. Stakeholders noted that the need for support services on‑reserve for adults (aged 22 and older) remains unmet. Currently, when youth "age-out" of program, the only source of funding to meet their needs is Home Care.

In January of 2016, the Pinaymootang First Nation Health Centre submitted a proposal to INAC to provide young people with complex needs with the support required to transition into adulthood; the proposal was not accepted.

3.1 Program History

As a two-year pilot program, Choose Life began operating in 2017 under Jordan's Principle with the 49 NAN communities.^{Footnote 23} The program will operate until fiscal year 2018‑19 year under current funding. Choose Life was established as a requested order to the Canadian Human Rights Tribunal on behalf of NAN as there was acknowledgement that northern First Nation communities were being systemically discriminated against with regards to the provision of services and funding for mental health in the area.

3.2 Program Objectives

Choose Life is designed to:

• Fast track proposals for youth mental health prevention program/services regardless of the timing of their submission;
• Allow the development of appropriate services for NAN youth;
• Enhance mental health services for youth; and
• Incorporate healing activities that focus on culture (holistic approaches such as land-based programming).

4.1 Scope of Services

In the fiscal year 2017‑2018 year, FNIHB, ISC provided 27,445,716 in funding for 57 applications, which equated to 12,222 youth receiving support.^{Footnote 24} Funding of 62,247,736 for 64 applications has already been provided in the fiscal 2018‑2019 year. This equates to 20,170 youth receiving support.

4.2 Application Criteria

In order to be considered, a NAN Choose Life application must meet the following criteria:

• Be submitted by a First Nation community located in the NAN territory;
• Include programming that targets youth at a serious risk of suicide; and
• Include a service delivery plan, which includes land based activities or a land based prevention and intervention program.

4.3 Application Process

The process of applying and successfully being granted program funding includes:^{Footnote 25}

• Plan tasks and expected outcomes: a program plan must be put forward that outlines the expected outcomes of the program activities;
• Rationale: the program plan must give a rational as to why the services are needed in the community (e.g. community profile of youth; current mental health status of youth; evidence of suicide/suicide attempts/suicide risks);
• Tasks outline: the program must outline what tasks will be completed and by whom (e.g. who/what/approach and philosophy/required training/accountability);
• Budget outline and analysis: the program budget should be outlined and include descriptions of costs such as salaries/benefits, rent, training, travel, land based activities, materials, and computers;
• NAN application review: NAN reviews the community application looking at such things as the community, number of children served, program dates and budget request;
• ISC review and approval process: ISC reviews the application and provides immediate crisis intervention supports if necessary during the application process;
• Appeals process: should an application be declined by ISC, the Choose Life Working Group will discuss and review the application (No applications have been denied as of July 31st, 2018);
• Interim reporting: programs must report 45 days following the last day of September. Reports must indicate the number of children that have received services as well as a comprehensive cost total by services/support;
• Programming reporting: programs must provide an annual report by July 29th of the applicable fiscal year. This report must specify the services provided and the number of children receiving these services and supports, total cost, challenges and future needs;
• Financial reporting: there are annual audits and a ISC Internal Tracking Sheet for financial reporting; and
• NAN Choose Life revised budget submission: at times, a program may require additional funding. Choose Life has a format for the revised budget submission.

4.4 Challenges Associated with Program Design

Due to the short program implementation time frame, NAN was required to be "up and running" immediately. Issues associated with the short implementation window included:

• Insufficient training for the NAN Choose Life Staff: staff did not receive training in application/proposal development or application review.
• Insufficient NAN staff to provide adequate supports to the NAN communities: Initially, Choose Life was rolled out by NAN with only one staff person. An additional person was later hired, however, more staff and training would be needed if NAN was to be able to provide further administrative or program supports to the 122 programs funded under Choose Life.
• Poor direction from INAC on program reporting requirements: NAN staff noted that they required a better understanding of INAC's (ISC) reporting requirements so that they could better guide communities in completing the interim and annual reports.
• Lack of time for community collaboration: The short funding timeframe meant that communities did not have time to collaborate or learn from one another during the application process or program implementation phase.
• Insufficient communication to the communities from INAC: NAN staff noted that it would have been more effective if INAC had initially made community health directors aware of the Choose Life program.

Since NAN staff were involved in the development of community applications, they were familiar with the challenges communities commonly experienced when developing their Choose Life applications. Thus communities commonly lack:

• Safe and private spaces for programming (e.g. private space for counseling);
• Office space for program staff;
• Trained or qualified staff to run the program and program activities;
• An understanding of the case management process;
• An understanding of evidence-based intervention activities aimed at reducing suicide or self‑harm;
• Access to training in mental health;
• Transportation to mental health services;
• Access to mental health workers; and
• Tele-health access.

The two‑year funding window was also noted to be a significant challenge in the design and implementation of programs.

Despite these barriers, communities do not want to use external service providers or external staff since in the past, this approach has not worked for the community. Communities were said to want to train their own people and use culturally relevant approaches that would resonate with community members and youth.

4.5 NAN Provided Supports

In addition to providing communities with support in application development, NAN provided communities with the following supports:

• Program review: NAN Choose Life staff use an internal program review process to assess whether the programs have been implemented as planned. Specifically, they compare the program description in the application against the program activities described in the annual report;
• Training: NAN has held two training sessions with community Choose Life coordinators. These in-person sessions were held in June and September 2018; and
• Reporting support: NAN staff support communities in completing the annual report.

In the future, NAN intended to increase support available to the communities and provide additional training sessions with the Choose Life Coordinators, as well as establishing a networking group and teleconferences between the Coordinators to allow the sharing of activities and successes. NAN also would like to encourage Choose Life Coordinators to work more in collaboration with community Education Coordinators, although this is not always supported by community leaders who do not always understand the intent of Choose Life programming.

4.6 Gaps in Service

NAN staff noted a gap in mental health services for youth aged 19 to 30, suggesting the definition of youth be extended to allow this group to access Choose Life programming. Funding timelines were said to have made it impossible for NAN to have established a case management approach that could be used across programs as it takes a very long time to establish these relationships. Additionally, communities need more training in proposal development and approaches to suicide prevention.

5.1 Background

KOSSS supports approximately 150 students annually from grade 9 to grade 12 who must relocate from their community, without their family, in order to complete their high school education. The communities the youth come from include: Deer Lake, Fort Severn, Keewaywin, McDowell Lake, North Spirit Lake, and Poplar Hill. The students attend urban schools in Thunder Bay, Sioux Lookout, Red Lake, and Pelican Falls First Nation School. Core KOSSS services include administering boarding homes, on-call student transportation and tuition agreements.

Prior to the Choose Life funding, KOSSS had Student Support Workers in place in all four communities, as well as Student Home Workers in the boarding houses. KOSSS was currently piloting a number of same gender student houses that were being funded through INAC (ISC). Parents signed guardianship of the children over to the Student Support Workers while they lived away from home to allow the workers to meet emergent and emergency needs of the children.

5.2 Choose Life Program (KOSSS) Rational

As a result of an increase in anxiety, suicide and self‑harm amongst youth relocated for school, KOSSS implemented the Choose Life program with the following objectives:

• Creating a program that assists students/youth at school while they are relocated;
• Helping students reach success by helping their youth make positive choices; and
• Increase programming by providing supports (e.g. counseling, well-being, mental health, personal growth, opportunities for success, programming, engagement, communication, cultural awareness and healing, personal safety and security, and to empower our students to follow a healthy and successful path; and help students/youth become successful

5.3 Choose Life Program (KOSSS) Program Description

The onset of Choose Life funding allowed the introduction of Well Being Workers in each community, as well as, land based programming, which required the introduction of Land Based Coordinators and Land Based Program Helpers. All students were welcome to participate in the land based activities; although when a student was struggling, they were strongly encouraged to participate.

At the beginning of the school year, the Well Being Workers complete an intake assessment with the students to determine their support requirements with a focus on mental health and well-being. Students also receive an orientation session, plus handbook, that clearly identifies the roles and responsibilities of each of their support workers. The Well Being Workers maintain an ongoing relationship with the students throughout the school year, acting as a support as needed. Well Being Workers may have their office in the school depending upon the community and spend a great deal of time in the school interacting with the students.

The Well Being Workers interviewed all worked closely with the Student Support Workers and other service providers and the school (e.g. mental health workers, psychiatrists, general practitioners managing medications) to coordinate service provision, identify students at risk and generally support the students. Well Being Workers provided information to the Student Support Workers who work with the parents of students, keeping them informed of their child's needs and any services received.

Students participating in the KOSSS program were required to sign contract indicating that they would adhere to a code of conduct. They were allowed three incidents and then they would be sent home. Consequences become more negative with each successive incident. If no incident occurred after the first incident for 30 days, the student's record was returned to zero incidents.

In the summer, the Well Being Workers visit the students in their home community at least once. Well Being Workers noted that summer visits are very important since the visits help to reinforce positive life skills that students have gained while away at school, which may be lost when they return to their home community in an environment that does not foster these skills. Well Being Workers hoped to increase the number of home visits during the next summer break.

Land based programming included activities such as snow shoeing, medicine picking, trapping and hunting. Students were taught technical skills along with life skills during land based activities. Land Based workers strived to involve students in the planning and preparation of all land based activities. Thus, students helped pack equipment and prepare supplies and meals before leaving on an activity. Land Based Workers work closely with schools to keep them informed of upcoming activities and encourage student referral to the program activities.

In addition to land-based programming, Choose Life KOSSS had developed life skill workshops which students could attend.

KOSSS was in the midst of developing an Intervention House, which was slated to open in a week. The Intervention Program would take place at a retreat centre set up by KOSSS. The facility was a converted rural house with shared accommodation for girls (up to four) and boys (up to six), a kitchen, shared living spaces, program room and space for parents to stay. When students were undergoing challenges or had asked to leave the program they could attend the Intervention House for up to five days to refocus and receive the extra support they required to remain in school.

5.4 Choose Life Program Budget (KOSSS)

5.5 Choose Life Program (KOSSS) Challenges

Stakeholders commented that the application process had been difficult and that in the future it would be ideal if the funding agreements for all four KOSSS sites could be combined into a single agreement.

Limited term funding (two years) had made it difficult to hire staff for the positions of Well Being Worker and Land Based Coordinators or Workers, particularly since the positions asked for specific qualifications such as a College or University degree, including the ability to travel using their own vehicle, and provide security checks. Stakeholders suggested that a five year funding period would be more appropriate.

The two‑year funding window also meant that the program had to begin running very quickly leading to insufficient time for program design and to build relationships to support case management. The program was required to develop all of their own templates (e.g. plan or care, release forms, confidentiality forms) and staff suggested that it would have been helpful to have received templates.

The training budget was also said to be insufficient as ongoing staff training was required for new staff hire. Staff turnover was noted to be high due to the demands of the positions. This was strongly noted by Land Based Workers who felt that the position came with many responsibilities that extended beyond those of a 9 to 5 job (e.g. student safety, extended work hours, etc). Well Being Workers suggested it would be helpful if workers could be brought together from all four sites for training and to share best practices. Well Being Workers also expressed the need for more regular debrief meetings; although it was suggested that these were being introduced. Staff generally required more supports to deal with the intensity and stress of the job responsibilities, including training on how to work with students who had undergone trauma. Budgets also need to better account for the number of hours of overtime that staff were required to take on, although they were not able to take sufficient time in lieu as a result of job responsibilities.

A lack of psychiatrists and psychologists made accessing support difficult. Similarly, a lack of support for people in the community was problematic since students experienced more stress during transitions to and from home particularly when their home environment was not stable.

Land Based Workers expressed concerns over the equipment budget noting that many budget line items were to be onetime costs, however, natural wear and tear on equipment meant that it would need to be replaced regularly. Example of such equipment included winter clothing. Additionally, there was no budget for upkeep or maintenance of equipment (e.g. cleaning of winter clothing). Winter clothing for activities was an issue in part because many students came from their home communities without proper winter attire. The Land Based Program Coordinator also suggested that staff required additional training to support land based activities as it was not always possible to find guides with the necessary skills (e.g. first aid, boat license, firearms use). Having the skills in-house could also make the program more cost effective.

Workers also noted that they ended up paying for student snacks on their own since there was no budget item for this and programming took place prior to dinner; sometimes running late.

Lack of clarity and guidance from NAN or ISC on required reporting was said to be a challenge. Program staff had made decisions on what to track but were unclear if they were tracking the correct outputs and outcomes.

5.6 Choose Life Program (KOSSS) Outcomes

Interviewed parents generally felt more comfortable sending their children away to school knowing that there were additional supports available to help the child. Parents reported that their children participated in the land-based activities and showed more confidence as a result. Program support workers also suggested that parents were more comfortable sending their children after the program introduced personal cell phones for each student.

Well Being Workers noted that they had been able to develop a case management approach to working with the students, which included all relevant support workers and the parents. To measure success, KOSSS Well Being Workers tracked the number of incidents by type (e.g. drinking, self‑harming) for the students, as well as, whether they stayed for the full semester and the number of credits they obtained during the semester. It was noted that since the introduction of the Well Being Workers, students were having fewer incidents.

Land Based Workers noted a number of positive outcomes in students who had participated in land‑based activities, including:

• Student acquisition of positive life skills (e.g. the ability to prepare and plan, respect for elders and other people, cooperation, etc);
• Increased understanding of First Nation culture among students;
• Students being challenged and learning that they can meet those challenges;
• Students gaining a better appreciation of their inner strengths and capacity;
• Increased connection with parents and grandparents as students learn traditional practices or land-based skills;
• Increased interaction among students and building of friendships and positive peer relationships; and
• Students taking on leadership roles with friends and new program participants.

Other positive outcomes stakeholders noted among students as a result of the Choose Life program included:

• Increase in the number of students graduating high school;
• Increased retention: typically half of the students went home while in the last year 18 of 23 remained the full year;
• Fewer incidents;
• More well‑adjusted students;
• Less self‑harm;
• Making friends more easily;
• Parents happier with student outcomes (e.g. grades and retention); and
• Youth more talkative and more willing to open up and seek support.

5.7 Choose Life Program (KOSSS) Gaps

A number of gaps were noted in the program, including:

• No student hand off process: by which students could be handed off to post-secondary institutions and new support workers (if available);
• No year round supports and transition supports: to help the students when they returned home for summer or winter breaks as the stressors they left in the community are still there when they return. During transition mental health issues were said to increase. The program was in the process of developing such supports (e.g. tele-health connections, regular summer visits to the community). As an example, safety plans were being developed for when students did not want to return to a potentially unsafe environment or when the student was concerned about the well‑being of a sibling they had left behind;
• A sufficient focus on preventative services: currently program staff were focused on student intake and meeting their current needs. Staff did however acknowledge that the program needed to also include prevention programming (e.g. life skills training, smoking cession programming);
• Need for a student welcome package: Many students were said to arrive with insufficient toiletries and supplies. A welcome package was thought to be needed to help reinforce work later completed by the support workers to teach the students about self‑care and hygiene. 
• Need to improve parental involvement: It was noted that there was still a need to better engage parents in their child's education/care while away from home. Additionally, stakeholders suggested that the whole family commonly requires help and that addressing the needs of the student without addressing precipitating factors in place in the home will not result in a sustainable solution for the child;
• Insufficient spaces to meet student demand: More students request to participate in the land based activities than the program can accommodate;
• Student in-take timelines: Well Being Workers indicated that the number of students to Well Being Worker means that some wait a long time for intake assessment, which can result in negative consequences for the child;
• Lack of standardized validated intake assessment tools: It was noted that Choose Life sites did not use standardized in-take assessment tools that could identify mental health issues in the students when they arrived. In order to implement such an approach the appropriate tools would need to be identified and all Well Being Workers would need to be trained on how to use the tools. This would ensure that all workers could proactively identify issues among students and refer them for diagnosis and treatment as required. It would also allow all staff to speak the same language with respect to mental health; and
• Poor or undetermined linkages between program activities and positive mental health outcomes: It was stressed that current programming was not proven to act as a protective factor in mental health and that programming should focus more on prevention and promotion of mental wellness with greater reliance on standardized mental health assessment tools and trained mental health professionals.

3.1 Program History

This program came to fruition in Saskatchewan in 1980 (Health Canada, 2017: 1). At this time, children aged 0-6 who were experiencing a variety of developmental delays such as "genetic, environmental, medical or organic conditions that require interventions for language, gross and fine motor, visual, hearing and behavioural challenges" were eligible for community based supports (Health Canada, 2017: 2). Initially, the program was funded by the Saskatchewan Ministry of Education (provincially), and by FNIHB. It is now funded through Jordan's Principle (Health Canada, 2017: 2). INAC (now two departments referred to as Indigenous Services Canada and Crown-Indigenous Relations and Northern Affairs Canada)^{Footnote 28} originally funded the program for First Nation Communities in Saskatchewan before FNIHB-Saskatchewan took over in 2014 (Health Canada, 2017: 2).

In fiscal year 2016‑17, ECIPs in Saskatchewan applied for additional funding under Jordan's Principle to extend services and supports to First Nations youth aged 6 to 17 years of age (or up to 21 years if still in school) including youth who lived on-reserve. Under this "new" program, the ECIPs across the province undertook a variety of activities. A common program element of these programs was however, the hiring of "specialized support facilitators" (SSFs) whose role was to coordinate the provision of services to parents and children. In addition, each region could also utilize Jordan's Principle funding for other activities. For example, whereas Regina ECIP hired two specialized support facilitators, other regions tended to hire only one such facilitator but implemented other programs or services. For example, in the Children North (La Ronge) ECIP, in addition to the hiring of one SSF, the ECIP also established a mentorship program where First Nations Elders/Role models would work with at risk First Nations youth in terms of assisting those who may have mental health/other health issues. In other regions, in addition to the SSF, some regions hired specialized clinicians (i.e. Speech Language Pathologists, Occupational Therapists etc.) to provide home based services to First Nations youth (this was done due to the challenges of getting such professionals to visit rural remote communities to provide such services).

A major role of the SSF workers were to serve as an advocate for First Nations parents and children. This typically meant undertaking liaison with the school to ensure that students were receiving appropriate services in provincial schools, as well as to coordinate with local health authorities as appropriate. In addition, the SSF/ECIPs also served to manage parent applications to Jordan's Principle to obtain such supports as respite, assistive technologies, or other services (Equine Assisted Learning) as required.

It should be noted that funding for the additional programming offered by the ECIPs in Saskatchewan ends on March 31, 2019.

3.2 Program Objectives

ECIPs have existed in Saskatchewan for more than 20 years and were established to provide support to those children who either at risk for, have a diagnosis of, or exhibit developmental delay. The program is available to all children aged zero to six throughout Saskatchewan and includes both First Nations and non-First Nations youth.

The overarching goals of ECIP include:

1. Maintaining or enhancing the development of children in the ECIP program;
2. Increasing the knowledge of families in reference to their child(ren)'s and family needs and strengths;
3. To develop and increase the families' advocating abilities for those who either experience or are at risk for developmental delays; and
4. To create more inclusivity within the community "as families connect to other programs and services that meet their needs".

For the purposes of the additional Jordan's Principle funding received in 2016‑17, the objectives of the ECIP were further expanded to include the provision of specialized support to First Nations families and youth aged 6 to 17 (and up to 21 if still in-school) with complex health needs.

4.1 Staff

In general, the ECIPs utilize existing administrative support functions to manage the program. Under the Jordan's Principle funding received in fiscal year 2016‑17, the ECIPs were provided with limited administrative funding to manage the additional services to be provided, including the hiring and management of SSFs, management of other programs and services (mentorship, Speech Language Pathologist, OTs), as well as cash management of parental applications made directly to access funds under Jordan's Principle.

For the purposes of the review, analysis of the impact of Jordan's Principle funding was focused on the additional programs and services provided in the fiscal year 2016‑17 funding allocation. As noted previously, each ECIP could identify what services were needed in the community and design programs appropriate to their specific communities. While almost all ECIPs established a specialized support facilitator position (typically a contract position), the other services introduced varied on the requirements of the region. In Regina, given the relative close proximity to special clinicians, it was decided that they would hire two SSFs to provide services. In contrast, rural and northern ECIPs reported that they had difficulty in obtaining specialized clinician services (Speech Language Pathologists, OTs), so, in some regions, they developed special contracts with such professionals to provide services on a "staff" basis (and only hired one SSF). Other regions introduced other programs such as mentorship and even land-based programs as appropriate.

In most regions, the Executive Director of the ECIP will manage the additional programs and services funded under Jordan's Principle since 2016‑17. The directors interviewed as part of this research indicated that they spent much time early on in the program to design the program (including conducting consultations with First Nations communities as to what the program should do), however, now that the program is in operation, they spend between 10 percent to 15 percent of their time managing this additional programming provided under Jordan's Principle funding. The ECIPs also use existing administrative staff to handle the "cash management" of parent applications to Jordan's Principle (i.e. will pay service providers directly so that parents are not out of pocket waiting for funds to arrive from Jordan's Principle).

4.2 Services

In examining the additional services provided by the ECIPs under the 2016‑17 Jordan's Principle funding, there emerges several core activities/services provided across almost all ECIPs in Saskatchewan. These include:

1. Establishment of a "coordinator" position (SSF) whose role was to serve as an advocate for the child and to coordinate service needs of First Nations youth aged 6-17 (or to 21 for special cases) that included the parents, schools, and other health/social service agencies.
2. As appropriate, implement specific programs/services that addressed unique regional needs. This could include for example, establishment of a mentorship program, development of land-based cultural programs, and/or the hiring of clinical specialists (Speech Language Pathologists, Occupational Therapists etc.) to provide direct service to youth.
3. Via the SSF's assist in the submission of applications to Jordan's Principle by parents to access additional supports including respite, assistive technologies, and other services as necessary. Typically, many ECIPs also managed the cash management of such services where they would pay for the services and obtain reimbursement from Health Canada so that parents were not "out of pocket" for such expenses.

4.3 Partnerships and Service Providers (Regina ECIP)

Just prior to the launch of the 2016‑17 program, ECIP staff conducted consultations with First Nations communities as well as local service agencies. The goal of such consultations were to better understand the needs of the communities (with respect to the health needs of First Nations youth aged 6-17) as well as to provide information as to the services that could now be provided via the additional Jordan's Principle funding.

The program has established a number of partnerships or working relationships, which allow the provision of services to children with complex needs within the community. In Regina, this included relationships with both the public and Catholic school boards as well as the local regional health authority. In addition, relationships were also expanded to include the Saskatchewan Department of Social Services and other social welfare agencies as appropriate.

It should be noted that due to the very tight timelines for the roll-out and implementation of the program, ECIP stakeholders noted that they had to often "develop policies and procedures on the fly" and as such, they did not have extensive documentation as to what the program could/could not do that could be shared with other service partners. In discussions with Service Partners, it was noted that it was often the SSF who communicated key program elements to other service providers. For example, in discussion with local school officials, they noted that until the SSF arrived, they were unsure as to what additional services/support would be provided to First Nations youth, aged 6 to 17 years, with complex medical conditions as part of the additional funding provided in fiscal year 2016‑17.

4.4 Program Outreach

As noted previously, the ECIP staff conducted a series of consultations with the respective First Nations communities as well as other education and health and social service agencies. These consultations occurred prior to program roll-out to explain key program elements as well as the role of ECIPs in now supporting older First Nations youth with complex health conditions. In the Regina ECIP, the SSF coordinators are key to establishing relationships with likely referral agencies, including health/education coordinators in the First Nations communities, local school boards, the regional health authority and the Ministry of Social Services to name a few.

It was noted that ECIPs were promoting the program directly to parents and/or caregivers via the ECIP website (although there appears to be only limited information on the Regina ECIP website about the program). In addition, in discussions with the SSFs, it was noted that parents were becoming more aware of the program through "word of mouth" and other unofficial communication/promotion.

4.5 Scope of Service Provision

Information provided by the Regina ECIP suggests that the region is currently directly supporting approximately 70 parents in which the SSFs are providing direct support. In addition, the ECIP may also assist First Nations parents in terms of accessing Jordan's Principle funding for additional supports such as respite, purchase of assistive technologies and/or other supports.

It should be noted that in the Regina ECIP, the key program element is the establishment of the SSF function, which is designed to be an advocate/case management service for First Nations parents and children with complex health conditions.  In this context, the Regina SSFs serve as a "program navigator" for First Nations children/families in terms of helping ensure that such families are supported in their application to Jordan's Principle funding for additional supports, or to coordinate services provided by schools/local health authorities/and other health providers as required.

Other ECIP executive directors interviewed as part of this review noted that the additional Jordan's Principle funding allowed for the hiring of a SSF, and that the funding also allowed for other services, including:

• Learning and behavioural assessments;
• Physiotherapy and occupational therapy;
• Speech and language therapy and audiology therapy;
• Visual therapy;
• Behavioural/cognitive behavioural therapy;
• Psychologist and psychiatrist consultations, spiritual wellness supports, and mental health therapy;
• Child development supports (individual);
• Mentorship programs; and
• Land-based cultural programs.

A key element of the services provided by all ECIPs was to support parents in completing applications to obtain funding or support from other health and social service agencies as well as Health Canada (Jordan's Principle) to provide additional supports to the child and/or families.

SSFs and parents most commonly reported that the SSFs were key in helping parents with applications for assessments, assistive technologies (i.e. obtaining an IPad for use at home with the same software as IPads provided to youth in the schools), respite as well as other learning/behavioural therapies (i.e equine assisted learning). It was also noted that the SSFs played a major role in terms of advocating for the parents/children to get other supports/services from other agencies. For example, several parents noted that the SSF was instrumental in terms of getting the local health authority/other agency to fund needed home adaptations.

It was strongly felt that the SSF played a key role in terms of providing needed support to parents with children with complex health needs. As noted by a First Nations parent interviewed, the SSF role has played a major role in terms of reducing the isolation and frustration of First Nations parents in terms of accessing needed supports.

"the SSF coordinator is great..they are actively helping me access the supports I need for my daughter..in the past, I felt that I had to fight the system to get help for her, now, with the SSF coordinator, I feel that I have someone in my corner fighting for me and my daughter..it is a real Godsend"

4.6 Program Budget

The executive directors interviewed as part of the case studies noted that they provided financial information to Health Canada in their regular annual reports and could not release this information without Board approval. (Note: the consultants have recommended that ISC obtain these annual reports from Health Canada as part of this review.)

To date in the Regina ECIP, it appears that the funding is sufficient to allow for the two SSFs to manage an appropriate caseload (approximately 30-35 families per worker). It was noted that there was no wait list for parents to access the SSF, although it was unclear as to whether there may be other waitlists (i.e. waitlist for assessments, waitlist to see psychiatrist, other clinicians).

While the Regina ECIP receives funding for program administration, the Jordan's Principle funding is maximized in that the ECIP did not have to hire additional staff to manage or provide administrative support for the Jordan's Principle funded activities. It should be noted, however, that the Regina ECIP Executive Director felt that the 10 percent allocated to program administration was insufficient due to the amount of work being done by the ECIP to manage family applications to Jordan's Principle and the cash management of approved requests (i.e. confirm provision of services, pay for service providers directly etc.).

4.7 Monitoring of Child and Family Outcomes

In general, the Regina ECIP does not have an established program monitoring framework for the additional Jordan's Principle funding received. The program monitors the number of children case managed by each FFS, and tracks the number of Jordan's Principle applications submitted and managed by the ECIP. It was noted that in the future, Health Canada should identify what program outcomes/impacts should be monitored and reported (and, as appropriate, provide sufficient funding to support such reporting). In discussion with ECIP coordinators, it was noted that there could be several measures that could be implemented to assess program impacts. Among these include:

• Use of standardized assessment tools such as the Assessment, Evaluation, Programming Systems, which could measure development of the child over time;
• Wait lists;
• Use of time based monitoring including length of time to receive assessment, and length of time prior to receiving service from specialized clinicians (Speech Language Pathologist, OT, other);
• Family survey (ECIPs used to do this but have since discontinued their family survey due to funding pressures); and
• Service provider/partner survey to assess program impact.

It was also noted that the program could demonstrate net impact using a Social Return on Investment approach in which the positive outcomes observed could be contrasted against the increased costs that would be incurred if there was no improvement in youth health or education level. For example, service partners noted that with the increased use of respite services, there were fewer parents who were committing their children to the province for temporary guardianship (which was very costly to the province). Similarly, the representative from the Ministry of Social Services noted that with the supports provided to at risk youth with behavioural issues, they had more opportunities to "close" client files given that such youth could be discharged and receive required services to support such youth in their transition back into the community. Furthermore, the stakeholder noted that with the introduction of Jordan's Principle funding for youth aged 6 to 17 years of age, they were seeing fewer youth "returning" to the Ministry than had been the case in prior years (i.e drop in youth recidivism).

4.8 Program Outcomes

Despite the lack of formal performance measurement frameworks or outcomes reporting, the site visits did collect anecdotal information as to early impacts of the program. Of course, this data was qualitative in nature and cannot be construed to be representative of all outcomes experienced by children and/or parents. These various program outcomes as reported by parents and stakeholders include the following:

Improved Educational Outcomes. Teachers interviewed as part of this research noted that the children who were now being supported via the Jordan's Principle funding were benefitting from such supports. Educators cited such improvements as increased school attendance, improved academic scores (due to tutoring and other supports) and access to additional educational supports given that some student assessments were "fast tracked" due to the ability of using Jordan's Principle funding to obtain such assessments.

Enhanced Parent Well-Being. Parents gave high praise for the work done by the SSFs to help secure funding for respite services. Parents noted that in the absence of such support, they often had no recourse but to temporarily "sign over" guardianship of their children to Child and Family Services as they could not cope with the 24/7 demands of their children. In addition to providing relief for parents, many parents structured their respite services to provide additional supports to their children. For example, some parents mentioned that they used respite dollars to purchase tutors, or to hire "behavioural interventionists" to help with the socialization of their child. Almost all parents talked about being better "able to parent" because of the supports provided by the SSF as well as the Jordan's Principle funding for required supports/services. Parents were also very positive in the way the Jordan's Principle program operated in Regina. That in general the FFS would identify what services/supports that they should apply for, assist such parents in applications, and generally serve as an advocate in their interactions with other education, health and social service agencies.

Improved Service Coordination/Case Management. Educators noted that the SSF now provided a better link between school supports and broader community supports. As noted previously, the stakeholder from Child and Family Services noted that "at risk" youth with anger/behavioural issues would previously be discharged from the Ministry, but, without any community supports, would often end up back in Ministry care. By using the services of the FFS (as well as other Jordan's Principle funded supports), it was felt that the risk of recidivism for such youth was reduced. In addition, it was felt that the FFS would help coordinate the services received from the school as well as community health and/or private services.

4.9 Program Challenges

Notwithstanding the high level of support for the work done ECIPs in terms of supporting parents with children with complex health needs, stakeholders and parents identified several issues that affected service delivery and planning. These challenges are:

1. Possible service overlap. ECIP executive directors noted that the program was rolled out very quickly and without sufficient advance planning and service coordination. For example, in one ECIP, they decided to hire a Speech Language Pathologist to provide direct service to identified children. The ECIP was surprised to learn that while they were delivering this service, Health Canada funded a nearby First Nations Band under Jordan's Principle to hire a SLP to work with many of the same children who were receiving service from the ECIP SLP. The ECIP stakeholders noted that the first stage of funding should go to the establishment of a "Community Service Map" that identifies what services are available, what services are missing, and what agency would be responsible for addressing such service gaps.
2. Limited Funding Window. The ECIP coordinators noted that they had a very short time to get the program up and running, and now that they have the program staffed, there will be issues in terms of staff retention as funding is scheduled to end as of March 31, 2019. It was felt that the program needed a longer funding window (three to five years) to allow for the reasonable roll-out and administration of the program.
3. Limited Understanding of the Role of Jordan's Principle funding. Parents and some stakeholders noted that it was not clear whether Jordan's Principle funding was to the first, second or last funding source. Parents noted that often they were told that they needed to apply to other agencies for supports (i.e. home adaptation) and only apply for Jordan's Principle funding if they were denied by the other organization. The ECIP coordinators noted that better information as to what Jordan's Principle would/would not fund would help streamline the application route used by parents.