Recommendation Seven: The Manitoba Advocate for Children and Youth recommends that the Government of Manitoba develop an inpatient or community-based long-term treatment resource that offers stabilization, assessment, treatment, and aftercare for youth who are at the top tier of mental health and addictions care needs, and for whom less intensive options have been ineffective.

DETAILS:  

• Review national and international best-practice and evidence-informed research from experts in the areas of youth mental health and addictions.
• Using information gathered from experts and in consultation with community stakeholders, including Indigenous leadership, Elders, and children and youth, develop a plan for a provincial application of a long-term treatment model. The model must be culturally informed and safe and staff must be culturally competent.
• Put into practice the treatment model and evaluate its effectiveness in achieving the intended outcomes.

IMPACT:

• Youth will have access to a long-term resource in their province that provides wrap-around assessment, treatment, and aftercare for their complex mental health and addictions needs. This resource would reduce the risk of further decline by accessing meaningful interventions that promote positive mental health and wellbeing.

Recommendation Six: The Manitoba Advocate for Children and Youth recommends that the Department of Health, Seniors and Active Living (now Health and Seniors Care), in collaboration with rural and First Nations communities in Manitoba, and the federal government, where applicable, implement recommendation 2.11 of the Virgo Report, as summarized below: In the RHAs other than the WRHA, create mental health hubs (as identified in the Peachey report), with a view to: (a) developing these as integrated regional mental health and substance use/addictions (SUA) “focal points”, and (b) harmonizing a core set of regional services and supports to the hospital emergency departments and crisis services including: Screening, assessment, and support for SUA. 24/7 access to psychiatric consultation and acute assessment/treatment services. A core set of professionals in addition to psychiatrists with capacity in SUA support – e.g., clinical psychologists and psychiatric emergency nurses, Cross-trained mental health and addiction liaison workers co-located in hospital emergency departments/other hospital programs. Infrastructure and staffing to ensure safety and security of patients and staff. Links to community mental health and addictions services, including centralized intake (Virgo Planning, 2018; full wording may be found at p. 225).

DETAILS:  

• Ensure that each focal point has the ability to service children and youth, unless other specialities housed at a larger centre are required.
• Develop a provincial plan to initiate scale-up of focal points in each of the five regional health authorities across Manitoba.

IMPACT:

• Access to psychiatric and other professional supports in a locally available setting will act to ensure that children and youth will be assessed close to their homes and families, avoiding the stressful and costly medivac procedure. In addition, mental health or addiction liaison workers, such as a professional in a mental health navigator role, and a form of centralized intake integrated at a single location, would ensure children and youth in crisis would be connected to supportive community resources prior to be discharged and a professional would be connected to follow-up with the child or youth in the community to ensure their plan was effective.

Recommendation Five: The Manitoba Advocate for Children and Youth recommends that the Department of Health, Seniors and Active Living (now Health and Seniors Care), in collaboration with rural communities in Manitoba, and the federal government, where applicable, implement recommendation 4.8 of the Virgo Report: Building upon the successful experience of the NorWest Youth Hub and lessons learned from the experience of other provinces, develop a provincial plan for scale-up of the youth hub model, or similar models of integrated youth services, taking advantage of support from philanthropy as it may be available (Virgo Planning, 2018, p. 235).

DETAILS:  

• Develop a provincial plan to initiate scale-up of the youth hub model based on a province-wide gap analysis assessment of need to determine which populations would best benefit from this resource. Special consideration must be provided to rural and remote locations throughout the province.
• Review the considerable literature and experiences in other Provinces to engage individual communities to guide the implementation of their youth hubs.
• Integrate multiple access points into communities to promote youth engagement in the hubs, including offering services in places where children are, such as in schools, community centres, health care facilities, and more.

IMPACT:

• When services and supports are available locally and integrated in one location, youth are more likely to engage with supportive professionals and programming that could act to enhance their overall health and wellbeing. These early interventions could prevent mental health and addictions concerns from worsening and resulting in complex crises over time.

Recommendation Four: In line with Article 24 of the United Nations Convention on the Rights of the Child, the Manitoba Advocate for Children and Youth recommends that the Government of Manitoba conduct an annual review of what therapeutic trauma interventions are available to children and youth in Manitoba and create an inventory of resources, whether the resources require formal referrals from service providers or are open for self-referrals, any associated eligibility criteria (age, location, care status, etc.) and promote the annual inventory and its findings in the public.

DETAILS:  

• The annual review should focus on services for children and youth from birth to 17, be compiled in a document organized by health authority region that includes a list of program names and contact information, who the program serves, intended program outcomes, eligibility and referral requirements and criteria, and occupancy rates.
• The resulting annual inventory should be accessible to all Manitobans, taking preferred languages into consideration.
• This document should be available in web format and distributed in print to agencies and organizations that serve the public throughout each region.

IMPACT:

• By ensuring service providers and families have knowledge of what services and supports are available in each health region, including contact information and descriptions for each service and support, there will be fewer barriers for children and youth to access the appropriate interventions to address their experiences of trauma, reducing the effects that trauma can have on health and development as children grow.

Recommendation Three: The Manitoba Advocate for Children and Youth recommends that the Government of Manitoba provide early childhood trauma education and training about trauma and its effects to service providers across all government departments delivering services to children and youth.

DETAILS:  

• Operating from a child’s rights perspective, develop a curriculum for education and training concerning early childhood trauma and its effects that includes provincially relevant information, such as the history of colonization and its impact on Indigenous Peoples.
• Develop a sustainable strategy by which to deliver, evaluate, and revise the curriculum as required based on impact evaluations.

IMPACT:

• Education and training will increase the knowledge of service providers to understand early childhood trauma and its effects on a child’s overall health and development. This knowledge will increase the capacity of service providers to respond to the needs of the children, youth, and families they serve to ensure interventions are implemented effectively and efficiently.

Recommendation Two: The Manitoba Advocate for Children and Youth recommends that the Department of Health, Seniors and Active Living (now Health and Seniors Care) demonstrates its framework and strategic plan for transformation of the youth mental health and addictions systems in Manitoba ensures equitable access to services across all areas of Manitoba, which are tailored to the unique needs of children and youth in our province.

DETAILS:  

• Look to previously published provincial reports, such as the Virgo Report (2018), as well as best-practice nationally and internationally, to guide the implementation of a framework for a functioning continuum of services and supports that serve to meet the mental health and addictions needs of children and youth in Manitoba whose needs fall in each of the five tiers.
• Implement culturally-informed and safe services and supports, modified or new, incorporating feedback from important stakeholders, including children, youth, and families, service providers, and Indigenous leadership and Elders, which serve to meet the mental health and addictions needs of children and youth in Manitoba who fall in each of the five tiers.

IMPACT:

• With system enhancement across all five tiers, children and youth in Manitoba will have equitable access to services and supports at to meet their needs and enhance their overall health and wellbeing. Investments across all five tiers are investments supporting the health and wellbeing of all Manitobans for the present and future.

Recommendation One: The Manitoba Advocate for Children and Youth recommends that the Department of Health, Seniors and Active Living (now Health and Seniors Care) conduct a gap analysis of the youth mental health and addictions system, based on the tiered model proposed in the Virgo Report. The gap analysis ought to speak to the overall transformation framework and strategic plan for child and youth mental health and addictions services. Further, the Manitoba Advocate recommends the gap analysis, framework, and strategic plan is released publicly to Manitobans.

DETAILS:  

• Conduct a jurisdictional scan to complete a full-service inventory of youth mental health and addictions services and supports available at each of the five tiers, ranging from prevention initiatives to those designed to meet the highest needs.
• Conduct a gap analysis using the inventory of services and a needs-based assessment of children and youth in Manitoba, taking into consideration what current services in the inventory can be modified or adapted (i.e., increase capacity, needs modification to enhance functioning, or based on new evidence or evaluation, etc.) to better meet needs of children and youth.
• Provide to the public the short-term (1 year) and long-term (3-5 year) vision and strategic plan for program development and investment to guide system enhancement.

IMPACT:

• A strong assessment and analysis is required for any strategic plan. Manitoban children and youth will be better served if a provincial strategic plan for transforming mental health and addictions services is informed by an accurate assessment of the services available as well as the current needs across the province.

Recommendation Eight: Proclaim the outstanding sections of the ACYA. The Manitoba Advocate for Children and Youth recommends that the Government of Manitoba set a proclamation date for the remaining portions of The Advocate for Children and Youth Act in the spring of 2020.

Recommendation Seven: A transparent framework for child and youth mental health and addictions health system transformation. The Manitoba Advocate for Children and Youth recommends that in a commitment to transparency and accountability, Manitoba Health, Seniors and Active Living (now Manitoba Health and Seniors Care) publicly release its framework and plan for transforming the youth mental health and addictions system in Manitoba so recent and anticipated investments and announcements can be understood by Manitobans not as one-off announcements, but as part of an overall tiered strategy for improving access, coordination, content, and capacity of the child and youth health care system in the province.

Recommendation Six: Long-term residential mental health treatment for youth. The Manitoba Advocate for Children and Youth recommends that the Government of Manitoba, through the Department of Health, Seniors and Active Living (now Manitoba Health and Seniors Care) create a long-term, residential treatment centre for youth who are in the top tier of mental health care needs and for whom less intensive options have been ineffective.

Recommendation Five: Create mental health system Navigators to help children and youth. The Manitoba Advocate for Children and Youth recommends that Manitoba Health, Seniors and Active Living (now Health and Seniors Care) develop, implement and fund mental health and addictions system Navigators, who act as case managers for children and youth who are accessing the upper tiers of the youth mental health and addiction system, similar to Ontario’s model. These Navigators should be knowledgeable and well-trained and offer case coordination and rapid response services to ensure children and youth know their health care plan, can access appropriate services, and ensure case reviews are initiated when services are not effective. Further, much like the requirement for child and family services workers, mental health and addictions Navigators should provide services in accordance with provincial standards of care that change in their intensity and frequency according to the assessed levels of risk to a child or youth.

Recommendation Four: Improve access points for children and youth experiencing a mental health crisis. The Manitoba Advocate for Children and Youth recommends that Manitoba Health, Seniors and Active Living (now Health and Seniors Care), along with representatives from Shared Health, children’s emergency staff and child and adolescent psychiatry – in accordance with their master plan overview of Health Sciences Centre – evaluate practices at the Health Sciences Centre – Children’s Hospital Emergency Room, with the intent of developing and implementing a child and youth-centred, separate and specialized access point that meets the needs of children and youth who are experiencing a mental health crisis.

Recommendation Three: Safe and Caring Schools: A Whole School Approach to Planning for Safety and Belonging is a valuable tool created by the Department of Education and is an example of best practices for creating positive school environments. The Manitoba Advocate recommends that Manitoba Education continue its work to promote these supporting documents with Manitoba school divisions because all schools in Manitoba should be implementing the optional tools in the Safe and Caring Schools supporting documents.

Recommendation Two: The Manitoba Advocate for Children and Youth recommends that the Department of Education, with participation from all school divisions, develop a province-wide policy to limit, reduce, and phase-out exclusionary practices, except in situations of imminent safety risk to students and staff. This policy should provide evidence-informed disciplinary alternatives that are in line with the best interests of the child and respect the right of children and youth to education.

Recommendation One: The Manitoba Advocate for Children and Youth recommends that Manitoba Education, in conjunction with Manitoba school divisions, highlight and promote the provincial learning objectives that focus on mental health literacy and mental well-being coping skills for all students from Grades K-12. Secondly, Manitoba Education and Manitoba school divisions should ensure that training is available to all teachers that will support and facilitate their classroom skills in mental health promotion.

Recommendation Thirteen: The Manitoba Advocate for Children and Youth recommends that Manitoba Families work with child and family services authorities to develop a provincial standard that requires all child and family service providers to assess infants’ sleep environments as part of prescribed face-to-face contact with anyone receiving child welfare services, including all infants who are not in care.

DETAILS:  

• Child services professionals will assess the safety of infant sleep environments.
• Families receiving child welfare services and requiring resources and/or information on safe sleep practices will be identified.
• Families will be resourced with a crib or other safe sleep surface, if none is available.

IMPACT:

• All infants in Manitoba will have a safe sleep surface as is necessary to realize their inherent rights to the highest attainable standard of health and to live and thrive (UNCRC, Articles 24 and 6).
• The Government of Manitoba will ensure that caregivers have the financial and physical resources they need to support child health and wellbeing (UNCRC, Article 27).

Recommendation Twelve: The Manitoba Advocate for Children and Youth recommends that Manitoba Families, as part of the changes to provincial child welfare standards announced to end the use of birth alerts, include an assessment of the infant sleep environment in every safety plan for expectant mothers, and provide mothers and primary caregivers with the safe sleep surfaces and public education information they need to ensure the safety of their child.

DETAILS:  

• Child services professionals will assess the safety of infant sleep environments.
• Families receiving child welfare services and requiring resources and/or information on safe sleep practices will be identified.
• Families will be resourced with a crib or other safe sleep surface, if none is available.

IMPACT:

• All infants in Manitoba will have a safe sleep surface as is necessary to realize their inherent rights to the highest attainable standard of health and to live and thrive (UNCRC, Articles 24 and 6).
• The Government of Manitoba will ensure that caregivers have the financial and physical resources they need to support child health and wellbeing (UNCRC, Article 27).

Recommendation Eleven: The Manitoba Advocate for Children and Youth recommends that the Collaborative Inter-departmental Working Group on Infant Mortality be reinstated and review cases of sleep-related infant deaths quarterly to look at trends and leverage this information to create and implement interventions to prevent future deaths.

DETAILS:  

• The Collaborative Inter-departmental Working Group on Infant Mortality will meet quarterly in a year.
• Annual reports on trends of sleep-related infant deaths will be produced, detailing suggestions for improvement of programs and initiatives.

IMPACT:

• All infants in Manitoba will have a safe sleep surface as is necessary to realize their inherent rights to the highest attainable standard of health and to live and thrive (UNCRC, Articles 24 and 6).
• The Government of Manitoba will ensure that caregivers have the financial and physical resources they need to support child health and wellbeing (UNCRC, Article 27).

Recommendation Ten: The Manitoba Advocate for Children and Youth recommends that Manitoba Justice provide the resources necessary for the Office of the Chief Medical Examiner to develop an electronic database, in partnership with the Manitoba Advocate for Children and Youth, to collect and report on the incidence of and risk factors associated with all suspected sleep-related infant deaths in Manitoba.

DETAILS:  

• Data collected in suspected sleep-related infant deaths will be systematically and consistently collected in a database.

IMPACT:

• Through the systematic collection and analysis of data, gaps in healthcare will be identified to inform and evaluate interventions that reduce infant mortality, in partial fulfillment of the Truth and Reconciliation Call to Action No. 19.

Recommendation Nine: The Manitoba Advocate for Children and Youth recommends that Manitoba Justice and the Office of the Chief Medical Examiner work with RCMP and police services across the province to develop (if necessary) and implement a form based on the CDC’s SUIDIRF data collection form, to be used by all law enforcement officers in the province who attend the scene of an infant death.

DETAILS:  

• A form that is appropriate and user friendly to police and RCMP for use during infant death investigations.
• Officers will be trained in the use of this form.

IMPACT:

• Through the systematic collection and analysis of data, gaps in healthcare will be identified to inform and evaluate interventions that reduce infant mortality, in partial fulfillment of the Truth and Reconciliation Call to Action No. 19.

Recommendation Eight: The Manitoba Advocate for Children and Youth recommends that the Government of Canada resource an implementation strategy to expand prenatal and postnatal maternal child health programs, in consultation with First Nations and Metis Governments, into all of Manitoba’s First Nations communities.

DETAILS:  

• Consideration will be given to the expansion of existing programs such as the Strengthening Families Maternal Child Health Program.
• A long-term funding model will be developed to expand maternal and child health programs to all First Nations communities in Manitoba.

IMPACT:

• All infants in Manitoba realize their inherent rights to the highest attainable standard of health by ensuring appropriate prenatal and postnatal care for mothers (UNCRC, Art. 24)

Recommendation Seven: The Manitoba Advocate for Children and Youth recommends that Manitoba Health, Seniors and Active Living (now Health and Seniors Care), in consultation with the Assembly of Manitoba Chiefs’ First Nations Health and Social Secretariat of Manitoba, develop a smoking cessation resource that prenatal healthcare providers and child welfare service providers can make available to expectant mothers.

DETAILS:  

• A Manitoba-made resource will be developed that explains the risks associated with prenatal smoking and sleep-related infant deaths.
• All pregnant women who disclose smoking will be provided with accurate and culturally appropriate information about smoking cessation.
• The resource will be distributed to all prenatal healthcare providers and child welfare service providers across Manitoba.

IMPACT:

• All infants in Manitoba realize their inherent rights to the highest attainable standard of health by ensuring appropriate prenatal and postnatal care for mothers (UNCRC, Article 24).

Recommendation Six: The Manitoba Advocate for Children and Youth recommends that Manitoba Health, Seniors and Active Living (now Health and Seniors Care), in partnership with the Assembly of Manitoba Chiefs’ First Nations Health and Social Secretariat of Manitoba, develop an accredited online training module on safe infant sleep practices, accessible through the Shared Health Learning Management System (LMS).

DETAILS:  

• Training will be informed by the best available evidence, including the AAP Recommendations on Safe Sleep.
• All Public Health Nurses, child and family services providers, and Families First Home Visitors in Manitoba should complete the online training about safe infant sleep practices.
• Training should become part of mandatory training for newly hired Public Health Nurses, Families First Home Visitors, child welfare providers, and Early Childhood Educators.
• Healthcare providers and child and family services providers across the province will have access and receive accredited training.

IMPACT:

• All infants in Manitoba realize their inherent rights to the highest attainable standard of health by ensuring that all segments of society – including parents – have access to education and are supported in the use of basic knowledge of child health (UNCRC, Article 24).

Recommendation Five: The Manitoba Advocate recommends that public education materials (e.g., books, pamphlets, videos, posters, etc.) developed by the Government of Manitoba, as part of any safe sleep education campaign, be written in accessible language and available in the prominent Indigenous languages of Manitoba.

DETAILS:  

• This public education campaign will be targeted to vulnerable families and be culturally appropriate, both in content and delivery.
• Education materials will be developed for different audiences including expectant mothers, other caregivers such as fathers, grandparents, and extended family members.
• Education materials will include multiple risk factors, given that few sleep-related infant deaths involve a single risk factor.
• The public education campaign will recognize barriers to information access by considering various types of media including print, radio, video, public advertisement, internet and social media. In particular, radio has been successfully used by the Sacred Babies program to reach remote communities.
• Education campaign materials will be distributed to families during prenatal care, in hospital, at The Birth Centre, and by Public Health Nurses post-partum public health visits. Materials will also be made available to all childcare centres, obstetrician and pediatrician offices in Manitoba, community organizations that deliver prenatal and post-natal education classes, and First Nations community health centres/nursing stations.

IMPACT:

• All infants in Manitoba realize their inherent rights to the highest attainable standard of health by ensuring that all segments of society – including parents – have access to education and are supported in the use of basic knowledge of child health (UNCRC, Article 24).

Recommendation Four: The Manitoba Advocate for Children and Youth recommends that the public education campaign be informed by data presented in this report and by evidence on effective risk communication and behaviour modification.

DETAILS:  

• This public education campaign will be targeted to vulnerable families and be culturally appropriate, both in content and delivery.
• Education materials will be developed for different audiences including expectant mothers, other caregivers such as fathers, grandparents, and extended family members.
• Education materials will include multiple risk factors, given that few sleep-related infant deaths involve a single risk factor.
• The public education campaign will recognize barriers to information access by considering various types of media including print, radio, video, public advertisement, internet and social media. In particular, radio has been successfully used by the Sacred Babies program to reach remote communities.
• Education campaign materials will be distributed to families during prenatal care, in hospital, at The Birth Centre, and by Public Health Nurses post-partum public health visits. Materials will also be made available to all childcare centres, obstetrician and pediatrician offices in Manitoba, community organizations that deliver prenatal and post-natal education classes, and First Nations community health centres/nursing stations.

IMPACT:

• All infants in Manitoba realize their inherent rights to the highest attainable standard of health by ensuring that all segments of society – including parents – have access to education and are supported in the use of basic knowledge of child health (UNCRC, Article 24).

Recommendation Three: The Manitoba Advocate for Children and Youth recommends that Manitoba Health, Seniors and Active Living (now Health and Seniors Care), in partnership with the Assembly of Manitoba Chiefs’ First Nations Health and Social Secretariat of Manitoba, and First Nations and Metis governments develop, carry out, and subsequently evaluate, a new public education campaign that raises awareness of the known risk factors associated with sleep-related infant deaths.

DETAILS:  

• This public education campaign will be targeted to vulnerable families and be culturally appropriate, both in content and delivery.
• Education materials will be developed for different audiences including expectant mothers, other caregivers such as fathers, grandparents, and extended family members.
• Education materials will include multiple risk factors, given that few sleep-related infant deaths involve a single risk factor.
• The public education campaign will recognize barriers to information access by considering various types of media including print, radio, video, public advertisement, internet and social media. In particular, radio has been successfully used by the Sacred Babies program to reach remote communities.
• Education campaign materials will be distributed to families during prenatal care, in hospital, at The Birth Centre, and by Public Health Nurses post-partum public health visits. Materials will also be made available to all childcare centres, obstetrician and pediatrician offices in Manitoba, community organizations that deliver prenatal and post-natal education classes, and First Nations community health centres/nursing stations.

IMPACT:

• All infants in Manitoba realize their inherent rights to the highest attainable standard of health by ensuring that all segments of society – including parents – have access to education and are supported in the use of basic knowledge of child health (UNCRC, Article 24).

Recommendation Two: The Manitoba Advocate for Children and Youth recommends that the Government of Canada, in consultation with the First Nations governments of Manitoba, develop and implement a plan to ensure that no infant living in Manitoba First Nations communities is without a safe sleeping surface (crib, bassinette, or culturally appropriate safe alternative), in line with Jordan’s Principle.

DETAILS:  

• An action plan will prioritize the rights of children over jurisdictional or administrative barriers (child-first principle) and achievement of true equality in outcomes (substantive equality).
• The action plan will explore recycling and loan programs, and other cost-effective and innovative approaches.
• Parents or caregivers living with low incomes and needing a safe sleep surface will be identified through multiple systems including the health care system, Employment and Income Assistance, the Manitoba Prenatal Benefit Program, and Child and Family Services.
• Parents or caregivers in need of a safe sleep surface will be able to self-identify.
• As per the principle of non-discrimination detailed in the UNCRC, eligibility criteria will ensure that there is no discrimination of any kind, including national or social origins, or on the basis of race, or residence in a rural or remote community.
• Existing governmental policies in the child welfare and social assistance programs that relate to the distribution of safe sleep surfaces will be reviewed and revised if they do not comply with the child-first principle.
• Barriers to accessing cribs will be identified and mitigated.

IMPACT:

• All infants in Manitoba will have a safe sleep surface as is necessary to realize their inherent rights to the highest attainable standard of health and to live and thrive (UNCRC, Art. 24, 6).
• The Government of Manitoba will ensure that caregivers have the financial and physical resources they need to support child health and wellbeing (UNCRC, Article 27).

Recommendation One: The Manitoba Advocate for Children and Youth recommends that the Government of Manitoba develop and implement an action plan, in consultation with First Nations and Metis governments, to ensure that every infant in Manitoba under 24 months has a safe sleep surface (crib, bassinette, or culturally appropriate safe alternative) in which to sleep. The action plan ought to be targeted to both expectant parents and caregivers of infants under 24 months who cannot afford to purchase a safe sleep surface. The action plan will be designed and delivered based on the child-first and substantive equality principles.

DETAILS:  

• An action plan will prioritize the rights of children over jurisdictional or administrative barriers (child-first principle) and achievement of true equality in outcomes (substantive equality).
• The action plan will explore recycling and loan programs, and other cost-effective and innovative approaches.
• Parents or caregivers living with low incomes and needing a safe sleep surface will be identified through multiple systems including the health care system, Employment and Income Assistance, the Manitoba Prenatal Benefit Program, and Child and Family Services.
• Parents or caregivers in need of a safe sleep surface will be able to self-identify.
• As per the principle of non-discrimination detailed in the UNCRC, eligibility criteria will ensure that there is no discrimination of any kind, including national or social origins, or on the basis of race, or residence in a rural or remote community.
• Existing governmental policies in the child welfare and social assistance programs that relate to the distribution of safe sleep surfaces will be reviewed and revised if they do not comply with the child-first principle.
• Barriers to accessing cribs will be identified and mitigated.

IMPACT:

• All infants in Manitoba will have a safe sleep surface as is necessary to realize their inherent rights to the highest attainable standard of health and to live and thrive (UNCRC, Art. 24, 6).
• The Government of Manitoba will ensure that caregivers have the financial and physical resources they need to support child health and wellbeing (UNCRC, Article 27).

Recommendation Five: The Manitoba Advocate for Children and Youth recommends that Manitoba Families, in consultation with other government departments and relevant stakeholders, create a new protocol to ensure that response plans are created for missing youth in general, and sexually exploited youth in particular who are at risk of imminent harm.

DETAILS – Manitoba Families to ensure that this protocol:  

• Distinguishes between absent and missing youth.  
• Require that plans are initiated the first time a child goes missing, and that there is a further requirement to ensure the response plan is consistently reflective of the harm and dangers that are present in the individual child’s life.  
• Provide timelines for when service providers must report missing children and act to locate them as quickly as possible, including when their whereabouts are known, when and how to report their absence to police.  
• Include clear components for response plans and include any known addresses where the youth may be located or is known to frequent.  
• Include 24/7 provisions for a joint child welfare and justice response in Winnipeg and ongoing capacity for a joint child welfare and justice response for missing and sexually exploited youth in rural areas.  
• Includes consultation with persons with lived experience, community members, and relevant stakeholders.

Recommendation Four: The Manitoba Advocate for Children and Youth recommends that the Manitoba government, through its Deputy Ministers of Health and Social Policy and Priorities (DMHSPP) committee, work with the government’s Legislation and Strategic Policy Branch to analyse the province of Alberta’s Protection of Sexually Exploited Children Act and Alberta’s Drug-Endangered Children Act to determine how safe and secure treatment facilities can be introduced in Manitoba. It is
further recommended that the DMHSPP committee develop a plan to ensure the continuum of services for children and youth includes safe, secure, home-like settings for treatment and programming when children and youth are at imminent risk of harm or death.

DETAILS:

• The continuum of services plan developed by the DMHSPP committee must define imminent risk, ensuring the definition contemplates issues of homelessness, addiction, and sexual exploitation.
• The development of a plan for safe and secure treatment facilities must include consultation with subject matter experts, persons with lived experience, and community stakeholders to ensure the treatment settings are safe, secure, therapeutic, effective, and culturally informed.

Recommendation Three: The Manitoba Advocate for Children and Youth recommends that Manitoba Justice evaluate the continuum of victim support services for children and develop quality control measures to ensure that services are child-centred and provided in a timely manner.
DETAILS:

• Manitoba Justice to examine the criteria regarding how child benefits are approved or denied and subsequently clarify and distributed to victim applicants.
  
• Manitoba Justice to clarify current legislation and policies that are contradictory related to access to compensation services and benefits.

Recommendation Two: The Manitoba Advocate for Children and Youth recommends that Manitoba Health and Seniors Care expedite the public release of a clear implementation plan to address the child and youth-specific recommendations contained in the report on Improving Access and Coordination of Mental Health and Addiction Services: A Provincial Strategy for all Manitobans (“Virgo Report”).

DETAILS:

• Manitoba Health and Seniors Care’s plan must ensure that resources are prioritized in rural and remote locations to ensure equitable service levels for children and youth regardless of where they are living.
• The implementation plan must reflect the client populations who require them and must, therefore, be culturally-informed, and be developed in ways that reflect the voices and preferences of Indigenous health experts, Indigenous leadership, children and youth, and others with lived experiences.

Recommendation One: The Manitoba Advocate for Children and Youth recommends that Manitoba Education and Training ensure its recently established Commission on Kindergarten to Grade 12 Education review the measurement of and response to absenteeism across Manitoba. It is further recommended that the Commission review the use of out-of-school suspensions and expulsions, with the goal of developing a province-wide strategy to limit, reduce, and phase-out exclusionary practices,
except in situations of imminent safety risk to students and staff. This review and strategy should provide evidence-informed practices that are in line with the best interests of the child and respect the right to education for children and youth.

DETAILS:

• The Commission to identify how school divisions can be resourced with the capacity to measure, assess, and respond to the underlying causes of school absenteeism. Building and sustaining relationships with students who are experiencing absenteeism and their families.
• Manitoba Education and Training continue efforts to improve student attendance by increasing public awareness of the right to education, identifying improvements to communication with parents and guardians around absenteeism, and to provide transparent information to the public about suspensions and expulsions.

Recommendation Six: The Manitoba Advocate for Children and Youth recommends that Manitoba Justice and Manitoba Health, Seniors and Active Living immediately embark on the development of a specialized health facility led and run by mental health professionals to provide evidence-informed programming for youth with mental illnesses or cognitive vulnerabilities in custody, including youth who are found not criminally responsible.

DETAILS:

• That Manitoba Justice conduct comprehensive mental health assessments, followed by ongoing treatment and assessments by mental health professionals within 72 hours of youth entering custody.
• That Manitoba Health, Seniors and Active Living, with the full cooperation of Manitoba Justice, evaluate the ability and capacity for the Manitoba Youth Centre to serve as a mental health facility as provided by Facilities Designation Regulation for the purposes of The Mental Health Act.
• That Manitoba Justice collaborate with Manitoba Families, Manitoba Health, Seniors and Active Living, youth with lived and living experience in correctional facilities, subject-matter experts, correctional officers, and Indigenous Knowledge Keepers as well as representatives with critical perspectives from the juvenile justice, health care, advocacy, and legislative arenas in the development of a detailed action plan with timelines and measurable outcomes to address the mental health and
  wellness of youth in custody.
  
• That Manitoba Justice identify, measure, and publicly report on the therapeutic alternative outcomes of the action plan annually, including rates of recidivism and the proportion of Indigenous youth in custody as outlined by the Truth and Reconciliation Commission of Canada’s Calls to Action.

Recommendation Five: The Manitoba Advocate for Children and Youth recommends that Manitoba Justice respond to the overrepresentation of youth with mental illnesses, cognitive vulnerabilities, and childhood trauma by developing an action plan with Manitoba Health, Seniors and Active Living and Manitoba Families for the implementation of evidence-informed and culturally-safe therapeutic behavioural management alternatives to solitary confinement and pepper spray, with the goals of
enhancing the rehabilitation and successful reintegration of youth into Manitoba communities, reducing recidivism, and improving the public safety of all Manitobans.

Recommendation Four: The Manitoba Advocate for Children and Youth recommends that Manitoba Justice immediately prohibit the use of pepper spray in youth custody facilities except in situations of immediate risk to life* to correctional staff or other youth in custody by amending The Correctional Services Regulation.

DETAILS:

• That Manitoba Justice prohibit the use of pepper spray to halt self-harming behaviour, barring no other serious and imminent risks to the lives of other youth or correctional officers  
• That Manitoba Justice consider the funding of cell doors which open both ways and can prevent the deployment of pepper spray due to forced entries.  
• That Manitoba Justice immediately notify the Manitoba Advocate for Children and Youth of any incident where pepper spray was discharged. Notification must include the full incident report, age of the youth, race, ethnicity, reasons for use, number of times pepper spray was deployed, and followup medical and psychological treatment.  
• That Manitoba Justice appoint an external and independent body to review and investigate every incident of pepper spray use, and provide recommendations of how the incident could be prevented. 

*For the purpose of this recommendation, ‘immediate’ shall be defined as proximate danger to life as perceived by an objective third party in the circumstances.

Recommendation Three: The Manitoba Advocate for Children and Youth recommends that Manitoba Justice collect, track, analyse, and report on incidents of segregation across youth custody facilities to ensure transparency and accountability.

DETAILS:

• That Manitoba Justice invest in the development of a centralized information management system to implement a process to aggregate data and analyse trends on the use of segregation by youth, reflecting transfers between institutions.  
• That Manitoba Justice submit a report quarterly to the Manitoba Advocate for Children and Youth on the number of youth placed in any form of segregation; the length of time each youth was in segregation, the race, ethnicity, age, and gender of each youth; facility staffing levels at the time of confinement; the reason each youth was placed in segregation; any knowledge of mental health (illness or cognitive vulnerability), and services provided while in confinement.  
• That Manitoba Justice report publicly on aggregated data of the use of segregation practices in youth custody facilities through their Annual Report.

Recommendation Two: The Manitoba Advocate for Children and Youth recommends that the Manitoba government and Manitoba Justice restrict the use of any form of segregation under 24 hours in youth custody facilities through an amendment to The Correctional Services Regulation.

DETAILS:

• That Manitoba Justice restrict the use of any form of segregation for the purposes of discipline, punishment, coercion, convenience, or retaliation.  
• That Manitoba Justice restrict the use of segregation by legislating maximum time limitations for these vulnerable populations and communicate clear expectations of what is required from the youth to be removed from segregation.  
• That Manitoba Justice track and require comprehensive mental health assessments for youth subjected to any period of segregation.  
• That Manitoba Justice conduct consultations with relevant stakeholders, including the Manitoba Advocate for Children and Youth, in preparation for amending The Correctional Services Regulation.

Recommendation One: The Manitoba Advocate for Children and Youth recommends that the Manitoba government and Manitoba Justice amend The Correctional Services Act to prohibit the solitary confinement of youth for a period exceeding 24 hours, per the Nelson Mandela Rules.

DETAILS:

• That Manitoba Justice establish a maximum time limit on the use of segregation of 24 hours without exception, thereby prohibiting solitary confinement by amending The Correctional Services Act.  
• That Manitoba Justice immediately identify all youth that are currently in solitary confinement conditions and develop a youth-centred and trauma-informed transitional process to ensure they successfully exit from the conditions of solitary confinement. This shall include: 
  1. Engaging a team of licensed mental health professionals to conduct and document a comprehensive mental health re-evaluation of all youth held in solitary confinement, including a confidential face-to-face out of cell interview by a licensed mental health professional; 
  2. A plan for substantial re-socialization of youth in a group setting; 
  3. Offering and documenting regular mental health counseling and culturally appropriate spiritual care, if requested, to assist in the transition; and 
  4. Including the participation of youth in the process and, if requested, the youth’s legal counsel and/or a representative of the Manitoba Advocate for Children and Youth in the development of this transition plan.  
• As per the practices of other Canadian provinces, and until the above recommendation is fully implemented to ban the practice, Manitoba Justice notify the Manitoba Advocate for Children and Youth of any incident of segregation extending over 24 hours and collaborate with the Manitoba Advocate on the development of a plan to address such incidents going forward. This measure should begin immediately. 
• That Manitoba Justice conduct consultations with relevant stakeholders, including the Manitoba Advocate for Children and Youth, in preparation for amending The Correctional Services Act.

Recommendation Six: The Manitoba Advocate for Children and Youth recommends that Manitoba Health and Seniors Care, in collaboration with the Addictions Foundation of Manitoba and other stakeholders, amend The Youth Drug Stabilization (Support for Parents) Act so that longer warrants or successive warrants are possible to ensure children and youth get the medically supported withdrawal management services they need based on evidence-informed treatment best practices for addictions (e.g. methamphetamine, alcohol, opioids).

DETAILS – Work to this effect should:  

• Be overseen by an existing inter-departmental working group such as the Deputy Ministers of Health and Social Policy and Priorities (DMHSPP) committee/Healthy Child Deputy Ministers’ Committee (HCDMC); and  
• Be guided by evidence-informed best practices and knowledge in the areas of supported withdrawal management, addiction and mental health assessments, and accessibility of treatment services for children and youth.

Recommendation Five: The Manitoba Advocate for Children and Youth recommends that Manitoba Health and Seniors Care and Department of Families, in collaboration with the Addictions Foundation of Manitoba, (1) review and reform the province’s treatment programs for children and youth and (2) create safe and secure facilities for youth in Manitoba who are sexually exploited and harmfully involved in substance misuse.

DETAILS – This should:  

• Involve community organizations;  
• Address the limitations, barriers and occupancy rate concerns of existing resources (e.g. Compass, YASU);  
• Include a harm reduction policy specific to children and youth; 
• Recognize that “secure facilities” do not need to be institutions, but can be secured via adequate staffing, geographic locations, and can further be holistic and culturally-based home-like settings; 
• Involve youth, experiential, and Indigenous stakeholders;  Address accessibility challenges related to addiction and mental health treatment services;  
• Be informed by a scan of jurisdictions who successfully incorporate short and long-term safe and secure settings in their continuum of care models for youth who are sexually exploited; and  
• Be included in the Provincial Mental Health and Addictions Strategy.

Recommendation Four: The Manitoba Advocate for Children and Youth recommends that the Minister of Families, through the Child and Family Services Division (CFSD), in collaboration with the four child and family services Authorities, (1) conduct an evidence-informed review and update of existing provincial service standards, and (2) establish province-wide measures of service accountability through a provincial quality assurance framework. Both the service standards and the quality assurance measures must be consistent throughout the province, culturally appropriate, and supported and enforced by the governing child and family services Authorities within their child and family services agencies. As per provincial legislation, quality assurance measures at the authority level must then be assessed and monitored by the Minister of Families.

DETAILS – This province-wide quality assurance framework should include:  

• An evidence-informed review and update of existing Child and Family Service standards.
• That the updated standards reflect a requirement that service models being used in the CFS system move away from an apprehension model and toward service models that require meaningful engagement of family, extended family, and community, which is in the best interests of children.

Recommendation Three: The Manitoba Advocate for Children and Youth recommends that Communication Services Manitoba, Manitoba Education and Training, Manitoba Families, Manitoba Justice, Manitoba Health, Seniors and Active Living, Manitoba Status of Women, and Manitoba Indigenous and Northern Relations collaborate with youth advisory groups, the Canadian Centre for Child Protection, Winnipeg Police Service, Royal Canadian Mounted Police, Indigenous and community organizations, and the Manitoba Advocate for Children and Youth to carry out ongoing public education via awareness campaigns that (a) denounce the sexual exploitation of children and youth and (b) raise awareness about the ongoing demand for purchasing sex and/or sexually exploiting children and youth in Manitoba.

DETAILS – This plan should:  

• Be centrally driven by an existing inter-departmental working group such as the Deputy Ministers of Health and Social Policy and Priorities (DMHSPP) committee/Healthy Child Deputy Ministers’ Committee (HCDMC);  
• Consider how best to reach those most in need of its information;  
• Include youth, survivor, and Indigenous community consultation;  
• Consider if names of adults who are sexually exploiting youth should be publicly shared as is the practice in other provinces;  
• Be evidence-informed in terms of clear outputs and outcomes and learn from successful campaigns in other jurisdictions;  
• Avoid sensationalism, inappropriate imagery, or language;  
• Draw awareness to bystander legislation that provides that all Manitobans must report child sexual exploitation; and  
• Include provisions for public education and awareness campaigns that coincide with Manitoba’s Stop Child Sexual Exploitation Awareness Day every March.

Recommendation Two: The Manitoba Advocate for Children and Youth recommends that Manitoba Education and Training, Manitoba Families, Manitoba Justice, and Manitoba Health, Seniors and Active Living engage with experts in childhood trauma and Adverse Childhood Experiences (ACEs) in order to develop a trauma prevention and response plan of action to (a) educate service providers and the public on ACEs, and (b) create appropriate, accessible immediate and long-term evidence informed interventions to address the trauma crisis that is ongoing in Manitoba.

DETAILS – These activities should include:  

• The release of the Department of Families’ research entitled, Collaboration and Best Practices to End Human Trafficking and Sexual Exploitation in Manitoba;  
• Ongoing data collection to inform clear performance measurements reflected in service purchase agreements (SPAs); 
• An independent third party external evaluation of the outcomes and outputs of the Strategy to be published upon completion. This evaluation should utilize the Department of Families’ research and specifically include analysis of existing 
  • specialized group and foster care placements for sexually exploited youth, 
  • crisis stabilization support for sexually exploited youth, 
  • sexual exploitation investigations, 
  • regional teams funded by Tracia’s Trust,
  • provincial training on the sexual exploitation of children and youth, 
  • the effectiveness of the Strategy for children and youth who are not in care; and 
  • the effectiveness of the Strategy in Indigenous communities as per Indigenous methods of evaluation;  

• A pilot of TERF’s Sexual Exploitation Risk Assessment Tool across the four Child and Family Services Authorities;  
• The development of a continuum of care informed by youth consultation and collaboration with Indigenous partners (e.g. Manitoba Keewatinowi Okimakanak and Southern Chiefs’ Organization) to create/reform service programs to address the co-occurring needs of sexually exploited youth (e.g. mental health, addictions, justice, and education); and  
• An expansion of StreetReach (including youth who are not in care), the Winnipeg Outreach Network (WON), and services for youth who are sexually exploited in First Nations and remote and rural communities. The expansion of each of these services should be paired with continuous quality improvement tracking tools to monitor outcomes, track progress towards service delivery goals, and respond to the evolving needs of sexually exploited youth.

Recommendation One: The Manitoba Advocate for Children and Youth recommends that Manitoba Education and Training, Manitoba Families, Manitoba Justice, and Manitoba Health, Seniors and Active Living engage with experts in childhood trauma and Adverse Childhood Experiences (ACEs) in order to develop a trauma prevention and response plan of action to (a) educate service providers and the public on ACEs, and (b) create appropriate, accessible immediate and long-term evidence-informed interventions to address the trauma crisis that is ongoing in Manitoba.

Recommendation Six: The Manitoba Advocate for Children and Youth recommends that the Department of Families in partnership with the Child and Family Services (CFS) Authorities: (1) clarify training content and expectations of workers and supervisors with respect to CFS minimum provincial standards, and (2) prioritize the development of high quality, culturally appropriate, modernized, and accessible training on the minimum provincial service standards within two years. The Advocate further recommends that all existing workers who have not received training on minimum standards and all new CFS workers be required to complete this training within three to six months.

DETAILS:

• That the Department of Families work with the four CFS authorities to clearly define training content, timelines, and requirement for CFS workers and supervisors per s.1.3.1 of the minimum standards manual.  
• That the CFS authorities ensure that their CFS agencies adhere to standard 1.8.1 Workforce Qualifications and that clear education and training plans are developed and monitored for staff who do not meet this standard.

Recommendation Five: The Manitoba Advocate for Children and Youth recommends that the Department of Justice improve communication across the divisions within its department, including probation services, victim services, and prosecution services, as well as with the legal community (e.g. legal aid), and the courts to ensure that probation orders are relevant, effective, child-centred, realistic (given limitations in remote and rural communities), and achievable. The Advocate further recommends that the Department of Justice evaluate their capacity to provide the programming for youth to meet their probation conditions and determine whether or not existing programs and services are sufficient and accessible to youth living in rural and remote locations. When gaps are identified, strategies for culturally appropriate alternatives and program delivery need to be developed.
DETAILS:

• The Advocate recognizes that it does not have jurisdiction over the courts. Following this report, we recommend that the Department of Justice initiate a process of improved communication and dialogue within its department, with the courts, and other key stakeholders to ensure that probation orders are relevant, effective, child-centred, realistic, and achievable. 
• The Department of Justice’s evaluation of existing capacity to provide programming for youth to meet their probation conditions should contain an overview of existing accountability data and analysis of the effectiveness and accessibility of current services and programming delivered to youth in Manitoba. 
• A plan is needed for situations when probation services do not have the capacity to provide ongoing supervision, monitoring, or formal programming such that collaboration and partnership with local communities occurs to devise a strategy to deliver these services.

Recommendation Four: The Manitoba Advocate for Children and Youth recommends that Manitoba Health and Seniors Care, together with front-line addiction service providers in Manitoba, Healthy Child Manitoba, Indigenous communities, and subject matter experts on addictions, immediately respond to the lack of effective substance use treatment services for youth by prioritizing the development and implementation of a youth addiction action strategy. This strategy should be based on best practice evidence with the objective of ensuring that children and youth across Manitoba can exercise their right to the highest attainable standard of health.

DETAILS:

• That Manitoba Health and Seniors Care, go beyond the VIRGO analysis and conduct a service inventory of all child and youth addiction services in Manitoba, their locations, target populations, philosophies, eligibility criteria, utilization rates, and occupancy rates. 
• That Manitoba Health and Seniors Care expand upon the VIRGO analysis to evaluate existing gaps in substance use treatment and addiction services available to children and youth, including recommendations as to how existing services could be repurposed. 
• That the Manitoba’s Mental Health and Addictions Strategy developed by Manitoba Health and Seniors Care include a plan that ensures implementation of evidenceinformed family-centred substance use and addiction programs. 
• That Manitoba Health and Seniors Care oversee regular performance monitoring and program evaluations to ensure that all publicly-funded and provinciallymandated agencies are accountable to provide evidence-informed addiction services and programs for children and youth. 
• That all provincially-funded addiction service providers working with children and youth implement policies and procedures for ongoing training on the identification and reporting of cases where a child is in need of protection as outlined in The Child and Family Services Act.

Recommendation Three: The Manitoba Advocate for Children and Youth recommends Manitoba Health and Seniors Care implement, in full, recommendation 5.4, per the Virgo report, as follows: Establish a concerted cross-sectoral process to reduce perceived and real jurisdictional boundaries that challenge access to, and coordination of, services. The process of developing this [Manitoba’s Mental Health and Addictions] Strategy, as well as any new opportunities and resources for working together (e.g., through Jordan’s Principle), should be viewed as an accelerator of a new period of trust and collaboration based on shared beliefs and strengths among all partners, and should include an interest in wellness, hope and family/community health.

DETAILS: 

• Specifically, provisions in the following areas are needed within Manitoba’s Mental Health and Addictions Strategy: 
  • Post-discharge supports for children and youth who have experienced mental health concerns, including addictions issues; 
  • A continuum of services, reflective of culturally-safe and trauma-informed approaches, for all of Manitoba’s children and youth, including Indigenous children and youth, and those who live in First Nations communities; and 
  • A continuity of care model that ensures equitable standards of service when First Nations children and youth return to their home communities.

Recommendation Two: The Manitoba Advocate for Children and Youth recommends that the Department of Education and Training through Healthy Child Manitoba, and with participation from all school divisions, conduct an urgent review of the current use of out-of-school suspensions and expulsions, and develop a province-wide strategy to limit, reduce, and phase-out exclusionary practices, except in situations of imminent safety risk to students and staff. This review and strategy should provide evidence-informed disciplinary alternatives that are in line with the best interest of the child and respect the right of children and youth to education.

DETAILS:  

• The Department of Education and Training will develop quality assurance and information management processes to: (1) define “imminent safety risk to students and staff”, (2) assess the prevalence, duration, and nature of school suspensions and expulsions in Manitoba, (3) analyse and ensure compliance with standards and best practices, (4) provide school boards with the necessary information to develop strategies to reduce and end school suspensions and exclusionary practices, and evaluate initiatives. Changes should be data informed and made considering the unique dynamics in Manitoba.  
• The Department of Education and Training will implement province-wide and evidence-informed suspension and exclusion prevention policies and procedures for Manitoba schools. This is to then, in turn, inform training for: 
  • School division training for teachers, principals, and superintendents; 
  • Mentorship programs; and, 
  • Alternative approaches to suspension.

Recommendation One: The Manitoba Advocate for Children and Youth recommends that the Province of Manitoba respond to the persistent lack of coordination between services for children and youth by developing and implementing a provincial strategy to train service providers on the requirement to share information across systems and ensure children and youth are at the centre of all service provision. This is to be developed, delivered, and evaluated in consultation with Manitoba Education and Training, Manitoba Families, Manitoba Justice, and Manitoba Health, Healthy Living and Seniors.

DETAILS:  

• In line with The Protecting Children (Information Sharing) Act, this training needs to be provided to all relevant service providers in Manitoba.  
• As part of this strategy, an inter-ministerial working group at the director, manager, and staff levels is needed to identify and address barriers to collaborative sharing of information and ensure oversight of quality assurance protocols related to case management across service providers.