1. Declarations of Pecuniary Interest under the Municipal Conflict of Interest Act PHE-IDS-17-10, Harm Reduction and Opioid Response Update

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1 Regional Municipality of Waterloo Community Services Committee Agenda Tuesday, 9:00 a.m. Regional Council Chamber 150 Frederick Street, Kitchener, Ontario Media Release: Friday, December 1, 2017, 4:30 p.m. 1. Declarations of Pecuniary Interest under the Municipal Conflict of Interest Act 2. Presentations 2.1. PHE-IDS-17-10, Harm Reduction and Opioid Response Update (Information) 4 a) Lindsay Sprague, Coordinator, Waterloo Region Integrated Drugs Strategy b) Bruce Lauckner, CEO, and Rebecca Webb, Manager of Performance, Waterloo Wellington Local Health Integration Network c) Brian Larkin, Chief of Police, Waterloo Regional Police d) Michael Parkinson, Community Engagement Coordinator, Waterloo Region Crime Prevention Council e) Karen Quigley-Hobbs, Director, Infectious Disease, Dental and Sexual Health, Grace Bermingham, Manager, Information and Planning, and Robert Crossan, Deputy Chief, Paramedic Services. 3. Delegations 3.1. PHE-IDS-17-10, Harm Reduction and Opioid Response Update (Information) 4

2 CS Agenda /12/05 a) Dan Clements, For A Better Cambridge b) Kim Brabazon c) Cindy Watson Consent Agenda Items Items on the Consent Agenda can be approved in one motion of Committee to save time. Prior to the motion being voted on, any member of Committee may request that one or more of the items be removed from the Consent Agenda and voted on separately. 4. Request to Remove Items from Consent Agenda 5. Motion to Approve Items or Receive for Information 5.1. CSD-HOU-17-26, Portable Home-Based Support Program Framework 22 Recommendation: That the Regional Municipality of Waterloo approve the Portable Home-Based Support Program Framework as outlined in report CSD- HOU-17-26, dated CSD-HOU-17-27, Prioritized Access to Housing Support (PATHS) Framework 31 Recommendation: That the Regional Municipality of Waterloo approve the Prioritized Access to Housing Support (PATHS) Framework as outlined in report CSD-HOU-17-27, dated CSD-EIS-17-17, Provincial Income Security Report 41 Recommendation: That the Regional Municipality of Waterloo send correspondence to Ontario Premier Kathleen Wynne and the Ministry of Community and Social Services indicating support for the direction outlined in the Income Security: A Roadmap for Change report, as summarized in the community services report Provincial Income Security Report CSD EIS CSD-HOU-17-23, Community Housing Review System Update (Information)

3 CS Agenda /12/ CSD-HOU-17-25, Waterloo Region Housing Tenant Engagement Summary (Information) 5.6. CSD-HOU-17-28, Homelessness Update (Information) 5.7. CSD-EIS-17-16, Ontario Works Caseload: July - September 2017 (Information) CPC-17-04, Waterloo Region Area Survey (Information) CPC-17-05, Good Samaritan Drug Overdose Act (Information) PHE-CRS-17-03, 2017 Public Health Budget Approval (Information) 91 Regular Agenda Resumes 6. Information/Correspondence 6.1. Council Enquiries and Requests for Information Tracking List Other Business 8. Next Meeting January 9, Adjourn

4 4 4 Report: PHE-IDS Region of Waterloo Public Health and Emergency Services Infectious Diseases, Dental, and Sexual Health To: Chair Geoff Lorentz and Members of the Community Services Committee Date: File Code: P25-20 Subject: Harm Reduction and Opioid Response Update Recommendation: For information. Summary: At the November 1 st, 2017 Regional Council meeting, questions were raised about how Public Health and other Regional departments are responding to issues related to problematic substance use including the opioid crisis and its impact locally. In particular, there were questions about harm reduction programs and services including the Needle Syringe Program, needle disposal, and opioid overdose. Public Health and Emergency Services, as well as other departments, were asked to provide a report to Community Services Committee on December 5 th, 2017 outlining their work in this area. Public Health as well as other members of the Waterloo Region Integrated Drugs Strategy have been working together to respond to the opioid crisis in a timely and coordinated manner. Activities related to overdose education and awareness, overdose monitoring and reporting, overdose prevention campaigns, and planning related to expanding access to just in time treatment (i.e. rapid access medicine) have been implemented and expansion activities are underway. In addition, Public Health, on behalf of the Waterloo Region Integrated Drugs Strategy Steering Committee and in partnership with the Waterloo-Wellington Local Integrated Health Network (LIHN), has initiated a process to document the Waterloo Region Opioid Page 1 of 18

5 5 5 Report: PHE-IDS Response Plan as requested by the Ministry of Health & Long-Term Care. The plan will describe activities being led by various sectors to combat opioid issues locally. Public Health s role in responding to issues of substance use including the opioid crisis is defined by the Ontario Public Health Standards as well as new provincial requirements related to the Harm Reduction Program Enhancement. Activities related to the following areas are provided by Public Health to meet these requirements: Planning related to the creation of a Waterloo Region Opioid Response Plan Overdose education and awareness Overdose monitoring Overdose prevention including Needle Syringe Program, Naloxone Distribution program, needle recovery and disposal, and the Supervised Injection Services Feasibility Study This report is accompanied by a number of presentations including those from the Waterloo Region Integrated Drugs Strategy Steering Committee, Waterloo Region Police Services, the Waterloo-Wellington Local Integrated Health Network (LHIN), the Waterloo Region Crime Prevention Council, and Region of Waterloo Public Health and Paramedic Services. Together, they intend to provide a comprehensive update on our region s combined efforts to address the opioid crisis in Waterloo Region. While activities shared in this report are regionally-focused, highlights of work happening in Cambridge are also presented in a section of this report in response to Council inquiries. Report: Background At the November 1 st, 2017 Regional Council meeting, questions were raised about how Public Health, and other Regional and community partners are responding to the opioid crisis and its impact locally. In particular, questions related to harm reduction programs and services including the Needle Syringe Program, needle disposal, and opioid overdose were raised and a request was made for Public Health and Paramedic Services, as well as other departments, to follow up with a report to Community Services Committee on December 5 th, This report, which is accompanied by presentations from the Waterloo Region Integrated Drugs Strategy Steering Committee, Waterloo Region Police Services, the Waterloo-Wellington Local Integrated Health Network (LHIN), the Waterloo Region Crime Prevention Council, and Region of Waterloo Public Health and Paramedic Services, will provide an update on the strategy and our region s combined efforts to address the opioid crisis in Waterloo Region Page 2 of 18

6 6 6 Opioid crisis Report: PHE-IDS In a joint statement issued on November 19, 2019, the Federal Minister of Health and Ontario Minister of Health and Long-Term Care reported that Canada was facing a serious and growing opioid crisis marked by rising numbers of addiction, overdoses and deaths. The crisis is defined as a complex health and social issue requiring responses that are comprehensive, collaborative, compassionate and evidence-based. Opioids are a family of drugs which are typically used to treat acute and chronic pain. Over the past several years there has been increasing concern regarding the misuse of prescription opioids, including overprescribing, and the appearance of these medications in the illicit drug market. The presence of fentanyl in the illicit drug market is of particular concern at this time. Fentanyl is known to enter the market through either diversion of pharmaceutical fentanyl products in pill, powder or patch form, or through importation or smuggling of pharmaceutical grade fentanyl from abroad. In turn, this is used to create illicit products or is added to other substances such as cocaine and heroin. Individuals may use fentanyl intentionally or may use it unknowingly as a result of it being added to another substance. Because fentanyl is potent even in small doses, particularly for those with a low tolerance for opioids, it can be fatal. Nationwide, rates of opioid overdose have been increasing, particularly in British Columbia (B.C.) where the number of opioid related deaths increased by 79 per cent from 2015 to 2016 (2015 = 510, 2016 = 914) (CBC News, 2016). Fentanyl has been identified as a major factor responsible for the increase. Increases in the number of opioid related overdoses and deaths have also been seen in Ontario and Waterloo Region. The following data relates to Waterloo Region and comes from a variety of sources including proxy measures tracked through Waterloo Region s Overdose Monitoring Alert and Response System (or OMARS), as well as the Provincial Interactive Opioid Tool: Of 388 people surveyed in 2016 as part of the Waterloo Region Substance Use Study, almost one in ten (9%) people had personally experienced an overdose and one in five (19.4%) people reported knowing someone who overdosed (Region of Waterloo Public Health, 2017) Between 2015 and 2016, there was an 86% increase in the number of 911 overdose-related calls to Waterloo Region Paramedic Services (248 calls compared to 461 calls). From 2016 to 2017, this number increased by another 24% with 580 calls received between January and November (Waterloo Region Overdose Monitoring, Alert and Response System, November 2017). From January to September 2017, Waterloo Region Paramedic Services administered naloxone to 109 patients; representing a 101.9% increase Page 3 of 18

7 7 7 Report: PHE-IDS compared to the same period in 2016 and a 303.7% increase for the same period in 2015 (Waterloo Region Overdose Monitoring, Alert and Response System, November 2017). Geographic mapping of Region of Waterloo Emergency Services 911 calls by location has shown opioid use and overdose to be a region-wide issue (Refer to Attachment 1). While the map shows a clear concentration of overdose-related 911 in some areas, largely along the central corridor, overdose-related calls are received from across the Region. On October 24 th, 2017, Waterloo Region Police Services reported 55 suspected overdose deaths since the beginning of the year (Waterloo Region Overdose Monitoring, Alert and Response System, November 2017). Between 2015 and 2016, emergency department visits related to opioid overdose increased by 58% (146 visits vs. 241 visits). Between January and October in 2017, there have been 274 opioid overdose-related visits, representing a 18.6% increase from the whole of 2016 (National Ambulatory Care Reporting System and Canadian Institute for Health, November 2017 and Public Health Ontario, November 2017). Waterloo Region s Integrated Response In 2011, the Waterloo Region Integrated Drugs Strategy was developed by many agencies through a 26-member task force and sponsored by the Waterloo Region Crime Prevention Council. The strategy contains 99 recommendations that together represent a comprehensive community response to address problematic substance use and its effects in Waterloo Region through a four pillar approach: Prevention Recovery and Rehabilitation Harm Reduction Enforcement A fifth pillar, integration, is a foundational element of the model and is operationalized through the work of a multi-sectoral committee that oversees the implementation of the recommendations. Coordinating committees that align with the four pillars are tasked with identifying and implementing priorities among the recommendations. The context of substance use has changed since the creation of the plan with the rapid rise of intentional and unintentional opioid use and the appearance of bootleg fentanyl and its derivatives (e.g. carfentanil) in the illicit drug supply. The establishment of crystal methamphetamine as the main drug of use for some people has also changed the landscape of drug use in Waterloo Region Page 4 of 18

8 8 8 Report: PHE-IDS On June 6, 2017, two Community Services Committee reports provided data describing the burden of substance use and the opioid crisis in Waterloo Region as felt by service providers, first responders and community members including those who use substances or have friends or family-members struggling with addiction (refer to reports PHE-IDS and PHE-IDS-17-05). In response to trends related to substance use in Waterloo Region and growing concerns regarding opioid and injection drug use, in June of 2017, Community Services Committee endorsed the following recommendations from Public Health, on behalf of the Harm Reduction Coordinating Committee of the Waterloo Region Integrated Drugs Strategy, to enhance local harm reduction services: To explore the feasibility of supervised injection services in Waterloo Region; To work with health care providers to improve their knowledge of harm reduction and capacity to serve individuals who use substances; To identify and work with new community partners to provide harm reduction services; and To explore opportunities and funding to expand outreach/mobile initiatives in the community (e.g. peer programs and the Sanguen Van) to better reach priority populations and rural communities. Ministry of Health and Long-Term Care Harm Reduction Program Enhancement On June 12, 2017, the Minister of Health and Long-term Care announced that funding to hire more front-line workers would be provided to boards of health to expand existing harm reduction programs and services, and improve local opioid response capacity and initiatives. Correspondence received from Dr. Hoskins, Minister of Health & Long-Term Care on June 20 th indicated that Region of Waterloo Public Health would receive $250,000 in additional 100% base funding to support the addition of staff positions for these expanded local opioid response initiatives (refer to report PHE-IDS-17-06). The Ministry of Health and Long-Term Care defined the scope of work as falling into three areas: 1. Expanding and maintaining local opioid-related programming based on assessment of local data and community need (i.e. through a drug strategy or local opioid response plan); 2. Leading naloxone distribution to eligible community organizations to increase dissemination of naloxone kits to priority populations where individuals are already receiving services; and 3. Creating and/or sustaining early warning and surveillance systems that will allow for timely identification of, and response to, a surge in opioid overdoses Page 5 of 18

9 9 9 Report: PHE-IDS Action on the three areas of the Harm Reduction Program Enhancement will be described in the following sections of this report and will be organized by Region of Waterloo Public Health s opioid response activities to date: Planning related to the creation of a Waterloo Region Opioid Response Plan Overdose education and awareness Overdose monitoring Overdose prevention including Needle Syringe Program, Naloxone Distribution program, needle recovery and disposal, and the Supervised Injection Services Feasibility Study Creation of a Waterloo Region Opioid Response Plan In Waterloo Region, the Waterloo Region Integrated Drugs Strategy Steering Committee has been working to respond to the opioid crisis in a timely and coordinated manner. Along with coordination of many activities related to overdose education and awareness, overdose data monitoring and reporting, overdose prevention campaigns, planning related to expanding access to just in time treatment (i.e. rapid access medicine), and supporting planning related to harm reduction program enhancements, Public Health as part of the Waterloo Region Integrated Drugs Strategy Steering Committee and in partnership the Waterloo Wellington Local Integrated Health Network, have started a process to document our Waterloo Region Opioid Response Plan as requested by the Ministry of Health & Long-Term Care. While funding from the Ministry of Health and Long-Term care supports public health units to create opioid response plans, it is recognized that no single activity or sector alone can adequately address the complex issues surrounding substance use and the current opioid crisis. Problematic substance use is a complex community issue requiring comprehensive social determinants of health solutions, partnership across multiple sectors, and the involvement of people directly impacted by substance use and their communities. Recognizing this, the creation of the Waterloo Region Opioid Response Plan is being led by Public Health on behalf of the Waterloo Region Integrated Drugs Strategy Steering Committee, and in partnership with the Waterloo-Wellington Local Integrated Health Network, and will be organized according to the four pillars. A draft plan outlining current and planned activities is under development and will include a consultation component to gain feedback on the strategies and to identify gaps. Once final, the plan will act as an addendum to the existing Waterloo Region Integrated Drugs Strategy Page 6 of 18

10 10 10 Overdose education and awareness Report: PHE-IDS Requests for overdose education have vastly increased over the past year among the health care, social service, education, and private sector. Since 2016, Public Health as part of the Waterloo Region Integrated Drugs Strategy has focused efforts to provide education and training on the risks of opioid use. This includes overdose prevention training for youth, relatives of people who use substances, and service providers. Chaired by Region of Waterloo Public Health, the Overdose Prevention Work Group has provided or contributed to a number of overdose education and awareness initiatives and a number more are being planned. These include: International Overdose Awareness Day annual events (2016, 2017) Targeted education to festivals organizers on overdose recognition and response including the Good Samaritan Act (2016, 2017) Overdose awareness campaigns targeted to parents including educational events, letters to parents and guardians distributed through Waterloo Region District School Board and Waterloo Catholic District School Board (Refer to Attachment 2) (2017) Education sessions targeting health care clinicians on breastfeeding, pregnancy and substance use including methadone or Suboxone (to be provided in 2018) Substance use and overdose community education events (2017, 2018) Cross-sector partnership to develop of curriculum-based resources to support substance use prevention education and overdose awareness education (to be completed in 2018) Various social media campaigns targeted to the general public on overdose awareness and the Good Samaritan Act (i.e. calling 911) (2017) Region of Waterloo Public Heath has also partnered with a community member who has been impacted by overdose to provide overdose prevention training at Elmira Secondary School and the alternative schools in Waterloo Region. Program successes will be integrated into future curriculum support initiatives. Overdose monitoring Overdose surveillance and monitoring supports the identification of concerning substance use trends quickly, including the presence of toxic substances in the illicit drug market. This is important so that alerts can be issued to the community, including organizations and individuals who work with the populations most at risk. Currently provincial overdose monitoring systems report on visits to local emergency departments related to opioid poisoning (i.e. overdose) with a two-week lag period. Information Page 7 of 18

11 11 11 Report: PHE-IDS related to contaminated drugs needs to be timely to ensure warnings are received when risk is the highest. To meet this need, Region of Waterloo Public Health, Waterloo Region Police Services and Region of Waterloo Paramedic Services in support of the Waterloo Region Integrated Drugs Strategy, developed a made in Waterloo Region overdose monitoring and alert system called OMARS. OMARS (Overdose Monitoring, Alert, and Response System) is a collaborative community initiative to provide ongoing access to locally relevant, timely data on overdoses. Data is provided through a webbased interactive overdose monitor, bulletins created on a quarterly basis, and immediate alerts are issued when information to public is urgently needed. OMARS data sources include: Region of Waterloo Emergency Services 911 call data; Waterloo Region Police Services 911 call data; and Self-reported overdose community data via All OMARS resources are shared with a range of stakeholders including service providers who work with people who use substances, health care providers and community members. Attachments 3, 4 and 5 provide the link to the online overdose monitor, the most recent OMARS bulletin and the last alert issued in October Overdose prevention and harm reduction Overdoses can happen to anyone; however there are factors that may increase a person s risk. Increased risk is present for the following groups (WHO, 2014): people with opioid dependence, in particular following reduced tolerance (following detoxification, release from incarceration, cessation of treatment); people who inject opioids; people who use prescription opioids, in particular those taking higher doses; people who use opioids in combination with other sedating substances; people who use opioids and have medical conditions such as HIV, liver or lung disease or suffer from depression; household members of people in possession of opioids (including prescription opioids). Region of Waterloo Public Health along with various service providers deliver programs and services that aim to mitigate the health and social risks for people who use substances, including overdose. These are described in the sections below. a) Naloxone Distribution Program Naloxone is a life saving medication that is used to temporarily reverse the effects of an Page 8 of 18

12 12 12 Report: PHE-IDS overdose of opioid drugs. Previously, naloxone was available to residents through Region of Waterloo by Public Health, Sanguen Health Centre, Ontario Addiction and Treatment Centres, and select pharmacies in the region. As part of the Ministry of Health and Long-Term Care s Harm Reduction Program Enhancement, Region of Waterloo Public Health is expanding the Naloxone Distribution Program. Under the provincial program, as of September 1, 2017 the following types of community-based organizations became eligible to become naloxone distribution sites: Community Health Centres, including Aboriginal Health Access Centres; AIDS service organizations Shelters; Outreach programs; and Withdrawal management programs. Individuals are eligible to receive a naloxone kit if they use substances, have a history of substance use, or if they have a family member or friend who uses substances. In order to become a distribution site, organizations must sign a service agreement with Region of Waterloo Public Health, ensure their staff attend training provided by Public Health, and register as a naloxone distribution site with the online provincial program locator tool. In Phase 1 of the expansion, Public Health has worked with current partners of the Needle Syringe Program to become Naloxone Distribution Sites (Attachment 6 contains all Naloxone Distribution Sites in Waterloo Region as of December 1, 2017). Phase 2 will involve consulting with additional agencies to determine interest in distributing naloxone. Public Health has also partnered with Region of Waterloo Pharmacists Association and the University Of Waterloo School Of Pharmacy to assist with education and training initiatives as well as implementation of the naloxone program in pharmacies. b) Needle Syringe Program Public Health is mandated by the Ministry of Health and Long-Term Care to provide sterile needles to people who inject substances to prevent the spread of blood-borne infections such as HIV and hepatitis C. Needle Syringe Programs provide support for people in need health care and services, who might otherwise have limited access to mainstream supports. This includes ensuring people who inject drugs know the risks of overdose and how to decrease their risk, and have access to a naloxone kit. Through the Needle Syringe Program, all regions in Ontario provide access to sterile equipment to people who inject substances. Needle Syringe Services are provided at several locations in Waterloo Region on a Page 9 of 18

13 13 13 Report: PHE-IDS confidential and non-judgmental basis in accordance with research-based best practices. Program statistics are monitored to ensure services meet the needs of the individuals who use the program and that Public Health and its partners adjust programs (e.g. hours of operation) as demand for services increases or decreases over time. In addition to provision of sterile intravenous drug use equipment, the Needle Syringe Program also collects used equipment for proper disposal. c) Needle Recovery and Disposal Region of Waterloo Public Health works with Needle Syringe Program partners to ensure individuals who inject drugs have access to needle disposal containers of various sizes ranging from discreet personal disposal units, to larger containers that can be used at home. Individuals are made aware that they can return their used sharps anywhere Needle Syringe Programs are provided. Region of Waterloo Public Health arranges for needles returned to Needle Syringe Program sites to be picked up and safely disposed. While many needles are returned through this process, improper needle disposal remains a concern across Waterloo Region. On November 1, 2016, a report to Community Services Committee described a needs assessment that was conducted to understand needle recovery and disposal needs in Waterloo Region (refer to report PHE-IDS-16-07). The assessment listed five activities that if implemented, would help address the community needs related to needle litter. These included: 1. Increasing disposal options by installing outdoor, tamper-proof disposal units in Cambridge, Kitchener, and Waterloo; 2. Exploring opportunities to enhance existing outreach services to increase education on safe disposal practices and to provide mobile disposal service; 3. Increasing awareness of disposal techniques and options available in Waterloo Region among individuals who use substances, service providers, and members of the public; 4. Increasing the number of agencies providing harm reduction disposal supplies (e.g. sharps containers) and education on proper disposal practices; and 5. Developing coordinated data collection measures to monitor inappropriate disposal of harm reduction equipment throughout Waterloo Region. The report shared that while, recommendation 1, 3 and 5 are either completed or in progress, implementation of recommendations 2 and 4 would be dependent upon funding. Since then, partnership between the Region of Waterloo Public Health, the City Page 10 of 18

14 14 14 Report: PHE-IDS of Cambridge and Sanguen Health Centre has begun to plan a pilot project aimed at needle recovery through a peer outreach model. Using a social enterprise philosophy, the pilot project would not only aim to remove needles from areas most impacted, through foot patrols and peer education, but at the same time, would provide employment and development opportunities for individuals with lived experience of substance use employed as peer workers. Partners aim to have the pilot project start in early Success of the pilot will be gauged using various metrics including the number of needles recovered through the program and the number of calls related to needles found in the community. d) Supervised Injection Services Feasibility Study Supervised injection services are legally-sanctioned, medically-supervised services where individuals can consume pre-obtained illicit drugs intravenously. Currently there are over 90 supervised injection service locations operating worldwide in the Netherlands, Germany, Switzerland, France, Spain, Luxembourg, Denmark, Norway, Australia, and Canada, including Vancouver but most recently in Ottawa and Toronto. The Ministry of Health and Long-Term Care established the supervised injection services program to complement and enhance existing harm reduction programming in response to growing public health concerns in Ontario related to opioid misuse and overdose. The Ministry lists the following impacts related to the establishment of supervised injection services (September 2017): Reduced overdose related morbidity Improved community safety by decreasing public injecting and discarded needles, and no increase in drug-related crime Increased referrals to health and social services including detoxification and drug treatment programs Reducing HIV and Hep C transmission as a result of lower rated of needle sharing and/or reusing On June 6, 2017, Community Services Committee endorsed Public Health s recommendation to enhance harm reduction services in Waterloo Region which included exploring the feasibility of supervised injection services (refer to Report PHE- IDS-17-04). A follow-up report to Community Service Committee was provided outlining the methodology for the feasibility study (refer to Report PHE-IDS-17-09). The methodology of the supervised injection services feasibility study, and its 2 phases, are described in Figure 1 below: Page 11 of 18

15 15 15 Report: PHE-IDS Figure 1: Supervised Injection Services feasibility study consultation phases Phase 1: Determining need and gaining broad community input (October to December 2018) In-person surveys with people who inject substances Key informant interviews with services providers Information and consultation sessions with groups with a vested interest in the community response to the opioid crisis A community-wide online survey Report to Community Service Committee - early 2018 Present findings of feasibility study and recommendations on community need (Assuming endorsement of Community Need by Regional Council) Phase 2: Consideration of potential locations and Council/Community consultation process (subsequent to Phase 1 in 2018) Report to Community Services Committee early Spring 2018 Present findings related to perceived concerns and benefits, mitigation strategies; seek endorsement to submit application Though approval to operate and fund Supervised Injections Services ultimately rests with the Federal and Provincial governments, respectively (see more below), if we proceed to the application stage, Public Health would seek Regional Council endorsement, as our Board of Health, before making an application. Federal Application for exemption To operate legally in Canada, supervised injection services require an exemption under Section 56 of the Controlled Drugs and Substances Act (CDSA), granted by the Federal Minister of Health. The application for exemption requires the applicant to provide information regarding the intended public health benefits of the site and any available information related to: Local conditions indicating a need for the site; The impact on crime rates; The administrative structure in place to support the facility; Page 12 of 18

16 16 16 Report: PHE-IDS Resources available to support its maintenance; and Community consultation report summarizing community support or opposition and steps to address concerns When an application is submitted, Health Canada conducts an initial screening to determine if it contains sufficient information to begin a review. Once the application has sufficient information to move to the review stage, Health Canada will notify the applicant and a detailed assessment of the application will be made. Health Canada will make a decision and either issue an exemption with appropriate terms and conditions; or issue an intent to refuse containing the reason for refusal. If an exemption is issued, Health Canada will conduct a site inspection before services to the public. The provincial application for funding requires similar information with additional emphasis on the funding and administrative sustainability of the proposed site. Opioid-related activities in Cambridge While the activities shared in this report are regionally focused, specific work in the City of Cambridge has been implemented. This includes: a) Cambridge Task Force and associated work groups Three Region of Waterloo senior staff have been involved in the Cambridge Task Force since it was initiated earlier this year. Staff are also involved in the associated work groups including the Social Service (poverty, mental health and addiction) work group, the Public Safety work group and the Resource allocation, Advocacy, Communication and Engagement work group. b) Substance use and overdose community education events Region of Waterloo Public Health and Waterloo Region Integrated Drugs Strategy members have participated or will be participating in various substance use and overdose community education events including: Substance Use in our Community, November 8 th, Trinity Anglican Church, 12 Blair Road, Cambridge Addictions and Mental Health Stakeholder Council Meeting: Local Response to the Opioid Crisis, November 2, 2017 at Cambridge Memorial Hospital Substance use and Opioid Response awareness event, December 13, 2017, Dunfield Theatre Overdose and Substance Use awareness Event, Saturday January 27 th, 2018 at St. Andrew s Presbyterian Church Page 13 of 18

17 17 17 Report: PHE-IDS c) International Overdose Awareness event Public Health in partnership with the Overdose Prevention Work Group held an International Overdose Awareness Day event at Dickson Park on August 21, Overdose Awareness Day is an international event held in August every year. The purpose of the event is to raise awareness about drug overdose, challenge stigma, and acknowledge individuals who have been impacted by overdose. In Cambridge, the event was very well received with the Cambridge Mayor and three Councillors in attendance. In addition, 48 people were trained for naloxone administration. Individuals who had lost a loved one to overdose were encouraged to create a prayer flag in their memory. d) Increased disposal Installation of, and ongoing disposal for, two outdoor sharps disposal kiosks which are accessible 24 hours a day, one at Bridges located at 26 Simcoe Street and one at Region of Waterloo Public Health at150 Main Street. As a result of these bins being so well-utilized by the community, the schedule for disposal has been increased at both of these locations. Outdoor sharps disposal options are being further enhanced and will include installation of four high-security wall mount sharps disposal units in outdoor locations in partnership with Bridges and the Cambridge Self-Help Food Bank. e) Peer outreach-based pilot project for needle recovery and disposal Public Health, in partnership with Sanguen Health Centre and the City of Cambridge will be initiating a pilot project aimed at needle recovery through a peer outreach model. Using a social enterprise philosophy, the pilot project would not only aim to remove needles from areas most impacted through the foot patrols and peer education, but would also provide employment and development opportunities for individuals with lived experience of substance use. f) Supervised Injection Services Feasibility Study Consultation Sessions As part of the Supervised Injection Services Feasibility Study, information and consultation sessions have been implemented with a number of groups specifically based in Cambridge. City of Cambridge staff For a Better Cambridge A Clean Cambridge Preston BIA Galt BIA It is also important to note that other sessions with individuals with a Regional focus Page 14 of 18

18 18 18 have also included individuals who work in Cambridge. Ontario Public Health Standards: Report: PHE-IDS Harm reduction planning, program and service provision relates to requirements 11 and 12 in Sexual Health, Sexually Transmitted Infections and Blood-borne Infections (including HIV) Standard. Corporate Strategic Plan: This report relates to strategic objective 4.4 (Promote and support healthy living and prevent disease and injury) in the Healthy, Safe and Inclusive Communities focus are in the Strategic Plan. Financial Implications: The Ministry of Health and Long-Term Care provides 100 per cent base funding of $125,000 annually for needle syringe programs; funding is used for the purchase of needles, syringes, related equipment and associated disposal costs. In 2017, an additional one-time allocation of $40,000 has been approved in response to a business case that was submitted by Region of Waterloo Public Health. As part of the provincial investment to battle the opioid crisis, the province is considering an enhancement to the funding of Needle Syringe Programs in public health that includes disposal costs. In 2017, an additional allocation of $250,000 in 100 percent base funding was introduced by the Ministry of Health and Long-Term care to support a Harm Reduction Program Enhancement. These funds support the department s local opioid response, naloxone distribution and training, and opioid overdose early warning and surveillance. Planning and other supports provided by Region of Waterloo Public Health are covered under the department s existing cost shared base budget for Public Health Mandatory Programs; the budgets are established by Regional Council (as the Board of Health) and are funded up to 75% by the province with the remainder funded by the local tax levy. Supplies for the Naloxone Distribution Program are provided free of charge by the Ontario Harm Reduction Distribution Program. Any supervised injection services which may be approved in the future in Waterloo Region would also be funded by the Ministry of Health and Long-Term Care Page 15 of 18

19 19 19 Other Department Consultations/Concurrence: Report: PHE-IDS Members of the Harm Reduction Coordinating Committee (see Attachment 1, pg. 26 for list of membership) contributed to, and were consulted on, the contents and finalization of this report. Attachments Attachment 1 Number of 911 Opioid Calls by Location Attachment 2 Letter to parents and caregivers regarding opioid-related drug overdoses and deaths Attachment 3 Waterloo Region Overdose Monitoring Report Attachment 4 Waterloo Region Overdose Bulletin v1-Waterloo_Region_Overdose_Bulletin_-_October_2017.pdf Attachment 5 OMARS alert (October 26, 2017) Attachment 6 Naloxone Distribution Sites in Waterloo Region Prepared By: Approved By: Grace Bermingham, Manager, Information, Planning and Harm Reduction Dr. Hsiu-Li Wang, Acting Medical Officer of Health Anne Schlorff, Acting Commissioner Page 16 of 18

20 20 20 Attachment 1 Number of 911 Opioid Calls by Location Report: PHE-IDS Page 17 of 18

21 21 21 Report: PHE-IDS Attachment 6 Naloxone Distribution Sites in Waterloo Region AIDS Committee of Cambridge, Kitchener, Waterloo and Area (ACCKWA) The Bridges Cambridge Shelter Corporation OneROOF Youth Services Region of Waterloo Public Health (Cambridge and Waterloo locations) Sanguen Health Centre Select Pharmacies Page 18 of 18

22 22 22 Region of Waterloo Community Services Housing Services Report: CSD-HOU To: Chair Geoff Lorentz and Members of the Community Services Committee Date: File Code: S13-40 Subject: Portable Home-Based Support Program Framework Recommendation: That the Regional Municipality of Waterloo approve the Portable Home-Based Support Program Framework as outlined in report CSD-HOU-17-26, dated. Summary: Developing the Portable Home-Based Support Program Framework (HBS Framework) builds on the success of the Supportive Housing Program Framework approved in 2014 (see SS ) and the Emergency Shelter Program Framework approved in early 2017 (see CSD-HOU-17-07). In anticipation of a successful proposal for new Home For Good funding (see CSD-HOU-17-15), the original timeline for development and approval of the HBS Framework was accelerated. The HBS Framework was informed by research, training, and practice in the area of Housing First locally, provincially, and across North America including results of local pilots and evaluation. The new policy direction calls for a region-wide, team-based approach. This aligns with current best practices and will allow for a more coordinated and consistent approach to service with a focus on both tenant quality of life and landlord satisfaction. The HBS Framework will inform a Request for Proposals (RFP) process to help determine the agency(s) for the HBS Team beginning in 2018/19. Home For Good funds will help to support implementation of the HBS Framework (see CSD-HOU-17-20). Report: 1.0 Introduction to the HBS Framework Developing the Portable Home-Based Support Program Framework (HBS Framework) builds on the success of the Supportive Housing Program Framework approved in 2014 (see SS ) and the Emergency Shelter Program Framework approved in early Page 1 of 9

23 23 23 Report: CSD-HOU (see CSD-HOU-17-07). The HBS Framework describes the shorter-term and longer-term Portable Home-Based Support Programs (HBS Programs) in the local Housing Stability System (HSS) 1. It also describes the region-wide, team-based approach of delivering these supports to people with greater depth of need who have transitioned from homelessness to housing and are living in rental units located across the community. 2.0 Development of HBS Framework Program development in the area of Housing First has been influenced by research and policy initiatives across North America over the last 25 years. Locally, Housing First programs have been available since 2008 (see SS and SS ). The approach has evolved significantly since that time with local pilots (see CSD-HOU-16-18), evaluation (see CSD-HOU-17-08) and through the influence of broader HSS redesign (see CSD-HOU-17-24). In the spring of 2017, the Province invited municipalities to submit proposals for new funding under an initiative called Home for Good. The purpose of Home for Good is to advance the Province s goal to end chronic homelessness 2 in Ontario by In anticipation of a successful proposal, the Region began an intensive period of consultation over the summer and fall of 2017 to develop new policy direction for HBS Programs (see section 3.0 below for more detail). In October, the Region was notified that the Home For Good proposal was successful (see CSD-HOU-17-20). 3.0 New Portable Home-Based Support Program Framework The HBS Framework describes HBS Programs, including their purpose, primary outcomes, core elements, and new policy direction. Highlights of the HBS Framework are described below. See Appendix A for the table of contents. The HBS Framework is available on-line. Purpose HBS Programs are designed to help people with lived experience of homelessness to stay housed. Shorter-term support of generally three to six months is provided to people with medium level of acuity. Longer-term support of generally 12 to 18 months is 1 The Housing Stability System (HSS) is a network of organizations, groups, and individuals that support people with housing issues in Waterloo Region. It includes service providers where at least fifty per cent of their time and/or activities are dedicated to the work of helping people find and keep a home. Often more than one community system is involved with supporting the same person or family with housing issues. 2 People, often with disabling conditions, who are currently homeless and have been homeless for six months or more in the past year (i.e. have spent more than 180 cumulative nights in a shelter or place not fit for human habitation) Page 2 of 9

24 24 24 Report: CSD-HOU provided to people with a higher level of acuity. As part of a Support Plan, staff broker or link participants with longer-term supports from other community systems as needed and desired (e.g., mental health and addiction, developmental, or health care supports). To be eligible for HBS Programs, people must: Be currently living without permanent housing; Have exhausted a market rent search; Have high or medium level of acuity (informed by the Service Prioritization and Decision Assistance Tool or SPDAT); Agree to in-home visits; Have lived in Waterloo Region for at least one year (currently or in the past)3; and Consent to service. Primary Outcomes HBS Programs focus on six primary outcomes. Five outcomes are specific to participants and inform the goal planning of Housing Support Coordination, with the ultimate purpose of reducing risk of future homelessness. The sixth outcome is specific to landlords, with the ultimate purpose of preserving positive landlord relationships. The six primary outcomes for the HBS program are: 1. Participants stay housed; 2. Participants maintain and/or increase their income stability; 3. Participants maintain and/or improve their physical and mental wellbeing; 4. Participants maintain and/or improve their social and community connections; 5. Participants are satisfied with the quality of the housing support; and 6. Landlords are satisfied with the quality of services provided. These outcomes are measured during regular case management sessions as well as other feedback or evaluation opportunities (e.g., landlord surveys). Core Elements HBS Programs have five core elements to program delivery: (1) Coordinated access; (2) Team-based approach; (3) Specialized staff roles; (4) Collaboration; and (5) Portable Home-Based Support tools and Program Standards. 3 Programs that support people with their application to HBS Programs through the Prioritized Access to Housing Support (PATHS) process verify residency. Applying for housing support is never the only step of service planning. It forms part of a more holistic Housing Plan and understanding housing history is part of this work. The purpose of residency requirements is to prioritize limited housing support spaces for people who are experiencing chronic homelessness in Waterloo Region Page 3 of 9

25 25 25 Report: CSD-HOU HBS Programs are delivered through a Portable Home-Based Support Team (HBS Team) that serves people across Waterloo Region. The HBS Team has specialized staff roles, including a Team Lead who provides strategic direction for the HBS Team and manages Housing Support Supervisors. Housing Support Supervisors directly supervise Housing Support Coordinators and Housing Support Coaches. Housing Support Coordinators are trained and skilled professionals that provide inhome housing support to participants. They support people using a person-centred, trauma-informed approach to meet goals within the three core components of housing stability: (1) Stabilizing housing; (2) Goal planning and moving forward with the next steps in a Support Plan; and (3) Connecting to the community and brokering for longerterm services. Housing Support Coordinators are specialized in their roles with designations related to supporting youth, single adults, families, and people who identify as First Nations, Metis or Inuit. Housing Support Coaches are most often people with lived experience of homelessness. They are trained and supported to help participants with the following: (1) Community participation/inclusion; (2) Life skill development/coaching; and (3) Belonging (feeling at home and/or included in a community of choice). The Housing Support Coach role is complementary yet distinct from the Housing Support Coordinator role. The Housing Support Coordinator develops and implements the Support Plan. The Housing Support Coach offers hand-on, practical assistance with parts of the Support Plan, as defined and overseen by the Housing Support Coordinator. New Policy Direction The HBS Framework is based on best practices and was informed by local piloting and evolution in coordinated access to housing support (the Prioritized Access to Housing Support or PATHS process). The new policy direction is outlined by a series of policy statements that spell IN-HOME SUPPORT (see Appendix B). These statements highlight key features of the support, including not only home visits but also structuring services around individualized Support Plans that focus on making the housing a home, brokering specialized services, eviction prevention, preserving positive landlord relationships, and community inclusion. The new policy direction calls for a region-wide, team-based approach to offering portable housing support. Within the team, support is coordinated for a range of people. This includes people with medium to high acuity; for youth, single adults, and families; and for people who identify as First Nations, Metis, and Inuit. In general, this approach will allow for a more coordinated and consistent approach to service. Advantages include better service for clients (e.g., with the consolidated Housing Support Coordinator role that serves people across the region; consistency in staff hiring practices, supervision, and training) and a more seamless, supported experience (e.g., engaging with people in a coordinated way with back-up on the team as needed; Page 4 of 9

26 26 26 Report: CSD-HOU allowing people to be supported by the same team even if they age out of youth services, become a family or return to single status). Strengthening relationships with landlords and other system partnerships will also be easier to facilitate with the consistent messaging and focused accountability inherent to a team-based approach. 4.0 Next Steps Services for people experiencing homelessness are exempt from the Region s purchasing by-law. As such, Housing Services is not required to complete a RFP. However, to support greater transparency and accountability to the public, following Council approval, Region staff will move forward with a Request for Proposals (RFP) process to help determine the agency(s) for the HBS Team, with the possibility of subcontracting specific components to other agencies. Proponent submissions will dictate the most appropriate structure for how to operate the HBS Team. Results of the RFP and an update on transition plans will be brought to Council for approval in spring Implementation of the HBS Framework will be supported through a consolidation of several funding sources including related 2017/18 Housing Services allocations (i.e., positions currently offering shorter-term or longer-term housing support) and new Home For Good funds (see CSD-HOU-17-20). See Attachment C for a summary of this information. Note that final budget amounts for the RFP are still being finalized between the PATHS Team and Portable Home-Based Support Team (see CSD-HOU-17-27). Relationship to Quality of Life Indicators: The Portable Home-Based Support Program Framework as described in this report aligns with Economic Well-Being (e.g., increased access to affordable housing); Social Inclusion and Equity (e.g., housing support will positively impact participants sense of belonging and community participation); Physical and Emotional Well-Being (e.g., housing support will positively impact participants daily functioning and how they feel about their life) and Relationships (e.g., increased access to housing support workers). Corporate Strategic Plan: Working to strengthen the housing stability system and build the community s capacity to address issues of housing instability and homelessness is consistent with the Region of Waterloo Corporate Strategic Plan, Focus Area 4: Healthy, Safe and Inclusive Communities; and specifically, Strategic Objective to Implement the Homelessness to Housing Stability Strategy and Strategic Objective 4.3 Increase the supply and range of affordable and supportive housing options. Financial Implications: NIL Page 5 of 9

27 27 27 Report: CSD-HOU Other Department Consultations/Concurrence: NIL Attachments: Attachment A: HBS Framework Table of Contents Attachment B: New Policy Statements for HBS Programs Attachment C: PATHS and Home-Based Support Program RFP Funding Sources Prepared By: Pat Fisher, Social Planning Associate, Housing Services Angela Pye, Manager, Housing Services Deb Schlichter, Director, Housing Services Approved By: Douglas Bartholomew-Saunders, Commissioner, Community Services Page 6 of 9

28 28 28 Section 1: Introduction Attachment A HBS Framework Table of Contents What is the Portable Home-Based Support Program Framework? Why was it developed? What does it include? How was it developed? Section 2: Policy Influences Regional policy shifts Provincial policy shifts Federal policy shifts Report: CSD-HOU Section 3: Portable Home-Based Support Programs & Portable Home-Based Support Team Purpose Primary outcomes Core elements New policy direction Section 4: Progressive Engagement in the Housing Stability System What is progressive engagement? Why use progressive engagement? Overview of the model Being data-informed through HIFIS and SPDAT Section 5: Next Steps Communicate release of the HBS Framework Implementation and transition plan Page 7 of 9

29 29 29 Attachment B New Policy Statements for HBS Programs Report: CSD-HOU The new policy direction for Portable Home-Based Support is summarized below using the phrase IN-HOME SUPPORT : Implement individualized Support Plans where people s service needs and preferences guide the work. Navigate other community systems to broker specialized services. Help people to make their housing a home. Offer shorter-term support for people with medium level acuity, longer-term support for people with high acuity, and services for all population groups on the same team to better coordinate services. Measure, monitor and share results to create a learning environment. Engage the whole community in the work to end chronic homelessness. Support connections to communities of choice. Use a team-based approach with specialized, mutually-reinforcing staff roles. Prevent evictions and preserve positive landlord relationships. Provide the right amount of support to stay housed, no more and no less. Offer a variety of tools to help people stay housed Housing Support Coordination, rent assistance, voluntary trusteeships, and other flexible funding options. Reduce risk of future homelessness by providing holistic support that builds on housing-related strengths. Tailor housing support to meet the unique needs of youth, single adults, families and people who identify as First Nations, Metis and Inuit Page 8 of 9

30 30 30 Attachment C Report: CSD-HOU PATHS and Home-Based Support Program RFP Funding Sources Note: Does not include Home For Good (approximately 1.5M) which will also support implementation of the PATHS Framework and Portable Home-Based Support Program Framework. Cambridge: Agency FTE and Staff Roles Funding Agreements Argus Residence for Young People Cambridge Self-Help Food Bank Cambridge Shelter Corporation Lutherwood 4 Agencies Kitchener-Waterloo: 2 Intensive Housing-Based Support Workers; 1.3 Housing Help Plus Workers 1 Intensive Housing-Based Support Worker; 2 Street-Based Outreach 2 Intensive Housing-Based Workers; 1 Housing Help Plus Worker; 1 Peer Support; 1 Trustee Admin; 0.5 Trustee Support Worker 1 Team Lead; Flex Fund; 2 Housing Liaisons; 2 Intensive Housing-Based Support Workers ~$180,000 2 ~$140,000 1 ~$340,000 4 ~$470, FTE $1,130,000 8 Agreements Agency FTE and Staff Roles Funding Agreements House of Friendship Lutherwood oneroof Working Centre YW 5 Agencies 1 Streets to Housing Stability Caseworker; 1 Shelters to Housing Stability Caseworker; 1 Housing Help Plus Worker 1 Housing Liaison/Supervisor; 1 Housing Help Plus Worker; 1 Families in Transition Advisor; 2 Tenant Transition Workers 1 STEP Home Worker; 2 Shelter/Streets to Housing Stability Workers 3.75 Streets to Housing Stability Workers; 0.8 Voluntary Trustee 2 Shelters/Streets to Home Support Workers; 0.5 Family STEP Home Worker; 1 Housing Help Plus Worker ~$180,000 2 ~$425,000 4 ~$120,000 2 ~$295,000 3 ~$270, FTE $1,290, Agreements Page 9 of 9

31 31 31 Report: CSD-HOU Region of Waterloo Community Services Housing Services To: Chair Geoff Lorentz and Members of the Community Services Committee Date: File Code: S13-40 Subject: Prioritized Access to Housing Support (PATHS) Framework Recommendation: That the Regional Municipality of Waterloo approve the Prioritized Access to Housing Support (PATHS) Framework as outlined in report CSD-HOU-17-27, dated December 5, Summary: Developing the Prioritized Access to Housing Support Framework (PATHS Framework) builds on the success of the Supportive Housing Program Framework approved in 2014 (see SS ) and the Emergency Shelter Program Framework approved in early 2017 (see CSD-HOU-17-07). In anticipation of a successful proposal for new Home For Good funding (see CSD-HOU-17-15), the original timeline for development and approval of the PATHS Framework was accelerated. The PATHS Framework was informed by an intensive consultation process over the summer and fall of 2017, as well as key best practices including the importance of having a shared goal and coordinating access to programs at the systems-level to achieve that goal. The new policy direction calls for a region-wide, team-based approach to support the PATHS process. This will allow for a more coordinated and consistent approach to service where progress with ending chronic homelessness can measured, monitored, and shared to adjust course as needed. The PATHS Framework will inform a Request for Proposals (RFP) process to help determine the agency(s) for the PATHS Team beginning in 2018/19. Home For Good funds will help to support implementation of the PATHS Framework (see CSD- HOU-17-20). Report: Page 1 of 10

32 Introduction to the PATHS Framework Report: CSD-HOU Developing the Prioritized Access to Housing Support Framework (PATHS Framework) builds on the success of the Supportive Housing Program Framework approved in 2014 (see SS ) and the Emergency Shelter Program Framework approved in early 2017 (see CSD-HOU-17-07). The PATHS Framework describes the role that the PATHS process plays in the local Housing Stability System (HSS) 1. More specifically, it outlines how access to housing support is coordinated for people experiencing homelessness that have a greater depth of need related to finding and keeping a home. 2.0 Development of the PATHS Framework The evolution of coordinated access to housing support began with local participation in the national 20,000 Homes Campaign (see CSD-HOU-15-13) and has continued since that time within the context of broader HSS redesign (see CSD-HOU-17-24). In the spring of 2017, the Province invited municipalities to submit proposals for new funding under an initiative called Home for Good. The purpose of Home for Good is to advance the Province s goal to end chronic homelessness 2 in Ontario by Development of the Home for Good proposal afforded an opportunity for the Region to begin a more formal review of its current coordinated access approach for people experiencing homelessness. In anticipation of a successful proposal, the Region began an intensive period of consultation over the summer and fall of 2017 to develop new policy direction for the PATHS process (see section 3.0 below for more detail). In October, the Region was notified that the Home For Good proposal was successful (see CSD-HOU-17-20). 3.0 New PATHS Framework The PATHS Framework describes the PATHS process, including its purpose, core components of quality, elements that support local processes, and new policy direction. Highlights of the PATHS Framework are described below. See Attachment A for the table of contents. The PATHS Framework is available on-line. Purpose 1 The Housing Stability System (HSS) is a network of organizations, groups, and individuals that support people with housing issues in Waterloo Region. It includes service providers where at least fifty per cent of their time and/or activities are dedicated to the work of helping people find and keep a home. Often more than one community system is involved with supporting the same person or family with housing issues. 2 People, often with disabling conditions, who are currently homeless and have been homeless for six months or more in the past year (i.e. have spent more than 180 cumulative nights in a shelter or place not fit for human habitation) Page 2 of 10

33 33 33 Report: CSD-HOU The PATHS process is designed to coordinate access to housing support for people experiencing homelessness that have a greater depth of need related to finding and keeping a home. Through the PATHS process, people are matched with the right housing support, at the right time. Three priority populations have been confirmed for the local HSS, informed by consultation and feedback sessions: (1) First Priority People with greater depth of need who are experiencing chronic homelessness. Prioritizing chronic homelessness is a policy direction from the Province. (2) Second Priority People who are highly vulnerable and have less ability to survive homelessness; defined as people with multiple disabilities (mental health, physical health, and substance use issues), people involved in higher risk and exploitive situations that put safety at risk (theirs and the safety of others) and/or people who have exhausted most of their sheltering options in Waterloo Region and have nowhere else to go that is safe and appropriate. (3) Third Priority People who have been living without housing the longest. Elements that Support Local Processes The four core elements to supporting the PATHS process in Waterloo Region are: (1) PATHS Team; (2) PATHS Partners; (3) Protocols; and (4) Leadership and Administration. The PATHS Team serves people across Waterloo Region. It includes a Team Lead who manages Service Navigators and Housing Liaisons. Service Navigators focus on helping people to move forward with the next steps in their Housing Plan, connect with programs with other community systems, and become offer-ready. Housing Liaisons specialize in finding new housing options for people and maintaining existing landlord relationships across the region. PATHS Partners include providers that serve people while they wait for an offer through the PATHS process, including helping them to develop and implement a Housing Plan. In the HSS, this includes Housing Resource Centres, Emergency Shelters, Street Outreach, the Community Housing Access Centre, and Transitional Housing funded through the Region. The PATHS process is led by the Region. In this role, the Region sets policy, develops and improves protocols, administers the list, and facilitates the PATHS Working Group. New Policy Direction The PATHS Framework is based on best practices, including the importance of having a shared goal and coordinating access to programs at the systems-level to achieve that goal. The new policy direction has been summarized into a phrase that spells OPEN Page 3 of 10

34 34 34 Report: CSD-HOU DOORS (combining nine interrelated policy statements; see Attachment B). The ultimate purpose of the PATHS process is to help open doors to housing for people experiencing homelessness that have greater depth of need. The new policy direction also calls for a region-wide, team-based approach to support the PATHS process (i.e., having a new PATHS Team). In general, this approach will allow for a more coordinated and consistent approach to service where progress with ending chronic homelessness can measured, monitored, and shared to adjust course as needed. Advantages include better service for clients (e.g., with the consolidated Service Navigator role that serves people across the region; consistency in staff hiring practices, supervision, and training), the ability to maximize rental opportunities (e.g., matching people with vacancies from all three cities and four townships), and a more seamless, supported experience (e.g., engaging with people in a coordinated way with back-up on the team as needed). Landlord networking and strengthening partnerships with other systems will also be easier to facilitate with the consistent messaging and focused accountability inherent to a team-based approach. 4.0 Next Steps Services for people experiencing homelessness are exempt from the Region s purchasing by-law. As such, Housing Services is not required to complete a RFP. However, to support greater transparency and accountability to the public, following Council approval, Region staff will move forward with a Request for Proposals (RFP) process to help determine the agency(s) for the PATHS Team, with the possibility of subcontracting specific components to other agencies. Proponent submissions will dictate the most appropriate structure for how to operate the PATHS Team. Results of the RFP and an update on transition plans will be brought to Council for approval in spring Implementation of the PATHS Framework will be supported through a consolidation of several funding sources, including Housing Allowance with Support funding (currently 104 spaces), related 2017/18 Housing Services allocations (i.e., positions currently supporting the PATHS process on an interim basis), and new Home For Good funds (see CSD-HOU-17-20). See Attachment C for a summary of this information. Note that final budget amounts for the RFP are still being finalized between the PATHS Team and Portable Home-Based Support Team (see CSD-HOU-17-26). Relationship to Quality of Life Indicators: The PATHS Framework aligns with Economic Well-Being (e.g., increased access to affordable housing); Social Inclusion and Equity (e.g., housing support positively impacts participants sense of belonging and community participation); Physical and Emotional Well-Being (e.g., housing support allows for meaningful daily activities including self-care and exercising daily living skills) and Relationships (e.g., through Page 4 of 10

35 35 35 Report: CSD-HOU access to navigation support and connection to workers that provide support). Corporate Strategic Plan: This report addresses the Region s Corporate Strategic Plan , Focus Area 4: Healthy, Safe and Inclusive Communities and Strategic Objective (to) increase the supply and range of affordable and supportive housing options as well as Focus Area 5: Responsive and Engaging Government Services and Strategic Objective 5.2 (to) provide excellent citizen-centered services. Financial Implications: Nil Other Department Consultations/Concurrence: Nil Attachments Attachment A: PATHS Framework Table of Contents Attachment B: New Policy Direction for the PATHS Process in Waterloo Region Attachment C: PATHS and Home-Based Support Program RFP Funding Sources Prepared By: Ashley Coleman, Social Planning Associate, Housing Services Angela Pye, Manager, Housing Services Mina Fayez-Bahgat, Manager, Housing Services Deb Schlichter, Director, Housing Services Approved By: Douglas Bartholomew-Saunders, Commissioner, Community Services Page 5 of 10

36 36 36 Section 1: Introduction What is the PATHS Framework? Why was it developed? What does it include? How was it developed? Attachment A PATHS Framework Table of Contents Section 2: Coordinated Access and the PATHS Process Reasons why coordinated access is important PATHS process overview Components of quality coordinated access to housing support Report: CSD-HOU Section 3: Background to the PATHS Process and New Policy Direction Local Housing Stability System assessment and redesign Evolution of the PATHS process up to spring 2017 PATHS Framework development in 2017 Other influencing factors New PATHS process policy direction Section 4: Progressive Engagement in the Housing Stability System What is progressive engagement? Why use progressive engagement? Overview of the model Being data-informed through HIFIS and SPDAT Section 5: Resources and Supportive Elements to the PATHS Process Resources accessed through PATHS Core elements for supporting the PATHS process Section 6: Next Steps Communicate release of the PATHS Framework Implementation plan Page 6 of 10

37 37 37 Report: CSD-HOU Attachment B New Policy Direction for the PATHS Process in Waterloo Region Policy Categories O Offer coordinated, people centred service P Prioritize access to limited housing resources. E Engage with people throughout the PATHS process. N Navigate a clear, short path from homelessness to housing. D Data from the PATHS process is used to inform dayto-day activities of staff. Policy Statements People no longer have to search for programs themselves, tell their story more than once, place themselves on multiple waiting lists or move from program to program before finding the right match. Next steps along a service pathway are informed by people s service needs and preferences. Processes are guided by region-wide protocols related to eligibility, matching, prioritization, and Housing Support Agreements. Match people with the resources that best meet their service needs and preferences. Then offer them to people with greater depth of need, first. People are fully informed of their options and coached along their service pathway. For some, this process is straightforward and can be completed within a short period of time. Others benefit from a wider circle of support, longer period of engagement, and longer transition period once housed Capacity is focused on supporting people. Customized use of technology reduces administrative burden and the time to process applications and fill vacancies People are supported to transition from homelessness to housing as quickly as possible. Access points to service are readily available to everyone who needs and wants housing support. Steps within the PATHS process are streamlined using shared, region-wide protocols. PATHS Partners and the PATHS Team use the PATHS List to focus staff activities. Working to get everyone offerready for housing is a top priority, every day. PATHS Partners and the PATHS Team take urgent action to find housing for everyone on the Offer-Ready List, every day Page 7 of 10

38 38 38 Report: CSD-HOU Policy Categories O Offer more resources in the context of progressive engagement. O Offer quality, coordinated access to programs. R Reduce pressure points in the system to speed up outflow from homelessness. Policy Statements Seeking access to housing support through the PATHS process is generally not the first step in a Housing Plan. It follows a period of engagement where people are supported with more limited service like shelter diversion, help through a Housing Resource Centre or a shelter stay to see if homelessness can be prevented or resolved without access to more intensive support. Being engaged in the PATHS process is never the only step of a Housing Plan. For example, PATHS Partners work to support people to access other safe and appropriate housing options while they wait for an offer of housing support. PATHS Partners, the PATHS Team, the Mobile Housing Support Team and Supportive Housing work together to offer seamless service for people across a system of care. Additional partnerships are secured to increase the supply of housing and/or support options access through the PATHS process. Based on a broader real-time list of everyone who is currently experiencing homelessness (By-Name List), maintain a real-time list of people who are eligible for more support (PATHS List) and a real-time list of people who are offer-ready and can be prioritized for housing support and move-in to new housing right away (Offer- Ready List). PATHS Partners and other system partners (e.g., hospitals, police or the mental health and addiction system) meet to generate new ideas and increase innovative solutions for improving service for people who are facing barriers or waiting for a longer time than others with a similar depth of need. Measure, monitor, and share outflow trends. Identify when households are waiting longer than average to be served and why. Work to close service gaps for everyone waiting for housing support. Collaborate with community partners to address unmet housing stability needs. Engage landlords in the PATHS process to increase the supply and range of affordable housing options Page 8 of 10

39 39 39 Report: CSD-HOU Policy Categories S Slow inflow to homelessness. Policy Statements Measure, monitor, and share inflow trends. Identify where, when, and why people are added to the By-Name List. Work to resolve housing issues (prevent homelessness) before people need to engage with the PATHS process to end their homelessness. Connect people with other community resources that can help with finding housing, including those that specialize in addressing complex issues Page 9 of 10

40 40 40 Appendix C Report: CSD-HOU PATHS and Portable Home-Based Support 2017/18 Staff Roles and Funding Note: Does not include Home For Good (approximately 1.5M) which will also support implementation of the PATHS Framework and Portable Home-Based Support Program Framework. Cambridge: Agency FTE and Staff Roles Funding Agreements Argus Residence for Young People Cambridge Self-Help Food Bank Cambridge Shelter Corporation Lutherwood 4 Agencies Kitchener-Waterloo: 2 Intensive Housing-Based Support Workers; 1.3 Housing Help Plus Workers 1 Intensive Housing-Based Support Worker; 2 Street-Based Outreach 2 Intensive Housing-Based Workers; 1 Housing Help Plus Worker; 1 Peer Support; 1 Trustee Admin; 0.5 Trustee Support Worker 1 Team Lead; Flex Fund; 2 Housing Liaisons; 2 Intensive Housing-Based Support Workers ~$180,000 2 ~$140,000 1 ~$340,000 4 ~$470, FTE $1,130,000 8 Agreements Agency FTE and Staff Roles Funding Agreements House of Friendship Lutherwood oneroof Working Centre YW 5 Agencies 1 Streets to Housing Stability Caseworker; 1 Shelters to Housing Stability Caseworker; 1 Housing Help Plus Worker 1 Housing Liaison/Supervisor; 1 Housing Help Plus Worker; 1 Families in Transition Advisor; 2 Tenant Transition Workers 1 STEP Home Worker; 2 Shelter/Streets to Housing Stability Workers 3.75 Streets to Housing Stability Workers; 0.8 Voluntary Trustee 2 Shelters/Streets to Home Support Workers; 0.5 Family STEP Home Worker; 1 Housing Help Plus Worker ~$180,000 2 ~$425,000 4 ~$120,000 2 ~$295,000 3 ~$270, FTE $1,290, Agreements Page 10 of 10

41 41 41 Region of Waterloo Community Services Employment & Income Support Report: CSD-EIS To: Chair Geoff Lorentz and Members of the Community Services Committee Date: File Code: S08-01 Subject: Provincial Income Security Report Recommendation: That the Regional Municipality of Waterloo send correspondence to Ontario Premier Kathleen Wynne and the Ministry of Community and Social Services indicating support for the direction outlined in the Income Security: A Roadmap for Change report, as summarized in the community services report Provincial Income Security Report CSD EIS , dated. Summary: Three working groups were invited by the Province of Ontario to recommend a ten year roadmap for income security reform. Their report is titled Income Security: A Roadmap for Change. The report advocates for sweeping changes to Ontario s income security system over the next ten years in order to transform the system into one that provides equitable access to a comprehensive and accountable system of income and in-kind support that provides an adequate level of financial assistance and promotes economic and social inclusion, with particular attention to the needs and experience of Indigenous peoples. The report outlines its recommendations through a series of immediate actions and subsequent reforms over the next ten years (concluding in 2028). The actions and recommendations can be grouped within the following focus areas: Achieving Income Adequacy Engage the Whole Income Security System Transforming Social Assistance Helping Those in Deepest Poverty Page 1 of 10

42 42 42 Report: CSD-EIS The roadmap report was released on November 2 nd. The Ministry of Community and Social Services is inviting the public to provide feedback within sixty days of the report being released. Report: Introduction Three provincial working groups were tasked by the Province of Ontario to recommend a ten year roadmap for income security reform in Ontario. The three working groups are: The Income Security Reform Working Group, the First Nations Income Security Reform Working Group, and the Urban Indigenous Table on Income Security Reform. These working groups produced a report called Income Security: A Roadmap for Change. Ontario s income security system is made up of a network of benefits, programs, and services that support health, well-being, and community inclusion while ensuring that no individual or family falls below a certain income level. The income security system provides income and in-kind benefits to individuals who are often connecting or reconnecting to jobs. Examples of income security programs and benefits include the Working Income Tax Benefit, the Ontario Child Benefit, Ontario Works (OW) and the Ontario Disability Support Program (ODSP), and Employment Ontario program. The need to modernize and transform Ontario s income security system stems from several factors: The income security system was designed for the workforce of the past, where many people had long-term, well-paying jobs; Many people experience systemic obstacles to work and social inclusion due to intergenerational poverty, a history of mental health or addiction issues, and a history of colonialism; Poverty and living with low-income are negatively impacting people s health and well-being, with an estimated cost of $32 billion per year in Ontario. The working groups are clear that a mere tweaking of the system is not an option, and that the report s recommendations should not be taken as standalone or as a menu of options. The report presents a clear, staged approach to income security reform that sets out concrete steps over multiple years with the goal being a modern, responsive and effective system. Roadmap Themes The working groups present their roadmap for income security reforms under three overarching themes: Page 2 of 10

43 43 43 Report: CSD-EIS ) Investing in People: The current income security system needs to evolve from one that focuses on transactional activities and the enforcement of rules, to one that connects people to a network of supports that meet the needs of a diverse range of needs and experiences. 2) Addressing Adequacy: Financial investments and legislative commitments are required to ensure that within ten years there is a minimum income standard below which no one should fall. 3) Recognizing the Experience of Indigenous Peoples: Income security reform must support commitments to reconciliation and provide opportunities for First Nations communities to develop and control their own social service programs. Roadmap Focus Areas The roadmap report for income security reform presented by the working groups is comprehensive, with 98 recommendations over 178 pages. The recommendations outlined in the roadmap are grouped into four key action areas: Achieving Income Adequacy Adopt a definition of income adequacy and make a public commitment to achieve that goal over ten years. Engage the Whole Income Security System Leverage the whole income security system so that programs work together to help all low-income people to achieve social and economic inclusion. Transforming Social Assistance Make social assistance simpler and eliminate coercive rules and policies. Focus on helping people overcome barriers to moving out of poverty and fully participating in society. Helping Those in Deepest Poverty Take early and concrete action to increase the level of income support available to people living in deepest poverty. The remainder of this report outlines some of the individual recommendations within each focus area. Achieving Income Adequacy Objective: Adopt a standard of income adequacy to be achieved by The roadmap s first recommendation is for the Province of Ontario to adopt a minimum income standard in Ontario below which no one should fall. The goal would be for the Page 3 of 10

44 44 44 Report: CSD-EIS minimum income standard to be met by The minimum income standard would be supported through the entire income security system (i.e., social assistance programs and individual/family tax benefits). A commitment to the minimum income standard would ensure an adequate standard of living for all Ontarians. In order to measure progress towards the minimum income standard, the roadmap recommends the development of a made in Ontario Market Basket Measure. This measure would be used to monitor and evaluate the progress on income security reforms. Engage the Whole Income Security System Objective: Transform the whole income security system so that programs work together to help all people achieve social and economic inclusion. The income security system in Ontario is made up of a collection of programs and services both within and separate from social assistance (i.e. Ontario Works and Ontario Disability Support Program). Offering targeted programs and services outside of social assistance ensures that a broad range of people living with low-income can access supports, regardless of whether or not they are in receipt of social assistance. It is recommended that partners from different Provincial Ministries, Municipal staff, and persons with lived experience will need to be engaged in the co-design and implementation of the creation of new, and the redevelopment of existing, income security programs. The roadmap report recommends the following actions to transform the whole income security system: Design and implement a universal, income tested portable housing benefit to all renters living with low income. o The benefit will begin at 25% coverage of the affordability gap; meaning it will cover 25% of the difference between actual rent and an affordability standard (affordability standard is 30% of household income spent on housing). Expand existing and introduce new health benefits for all low-income adults over the next ten years, including: o Expanding Healthy Smiles Ontario to adults and add dentures. o Designing/implementing new vision and hearing benefits. o Expanding access to medical transportation benefits. Provide bridging child supplements within social assistance as social assistance payments are transformed to flat rates. Provide denture coverage (initial and follow up fittings) for all social assistance recipients. Shift the amounts paid in children s needs through current social assistance rates Page 4 of 10

45 45 45 Report: CSD-EIS to the Ontario Child Benefit, as a supplement to the lowest-income families. Expand existing health benefits through Ontario Drug Benefit Program. Redesign Temporary Care Assistance to focus on child well-being, increase the amount provided to care givers (to align with foster care levels), and provide clear flexibility for OW administrators to determine when and where it is best accessed. Request that the Federal government enhance the Working Income Tax Benefit. Review the level of earnings at which an individual begins and ends receiving the benefit, as well as how the benefit is adjusted as income increases. Co-design an assured income approach to income security for persons with disabilities, providing lifelong eligibility to benefits and supports. This assured income approach would be income tested only (not asset test) and would adhere to a tax based definition of income (would not include financial help from family or friends). Transform Social Assistance Objective: Fundamentally change the approach, culture, and legislation within social assistance. Some of the most significant recommendations within the roadmap report come within the transformation of social assistance focus area. The working groups are recommending sweeping, transformative changes to the approach, legislation, and delivery of social assistance. Some of the key recommendations with regard to social assistance transformation include: Implement Standard Flat Rate and Standard Flat Rate Disability rates for OW and ODSP. o These rates do not distinguish between basic needs and shelter costs. o Adults with disabilities would receive higher flat rates in recognition of the additional costs of living with a disability. o Flat rates do not include amounts for children. o Enhancements made through the Ontario Child Benefit program will support families with children. Fundamentally change the culture of social assistance: o Introduce new approach to serving people receiving OW/ODSP that prioritizes trust, collaboration and problem solving, uses a trauma informed lens, and supports quality of life outcomes. o A single view of case management across OW/ODSP. Direct service staff become case collaborators whose primary role focuses on barriers to social and economic inclusion rather than program eligibility. Develop and introduce new legislation to govern and rebrand OW. Within first year of reform, draft and publicly consult on new purpose statement for OW that Page 5 of 10

46 46 46 Report: CSD-EIS recognizes and reinforces: o individual choice and well-being. o diverse needs and a goal of social and economic inclusion for all. The introduction of a Standard Flat Rate structure to social assistance will eliminate the rent scales used for those receiving social assistance. Municipal housing services managers will be required to invest the increased revenues resulting from elimination of rent-geared-to-income scales into local housing and homelessness projects. Changes are being proposed to processes and policy within the Ontario Works program in order to move the program from one of policing and monitoring to one that allows direct service staff to focus on building positive relationships and acting as system navigators. These changes include: Redesign the existing employment benefits available through OW into one benefit; give consideration to whether the benefit is mandatory or discretionary. Redesign OW discretionary benefits as other recommendations are implemented (e.g., making core health benefits and help with funeral and burial costs mandatory) and consider making them available to broader low income population. Align the definition of spouse under social assistance with Family Law Act (i.e., deemed spouse after three years cohabitation). Reduce the wait period for OW employment earning exemptions to one month (from current three). Introduce a comprehensive assessment tool to identify needs and barriers to social an economic inclusion. Exempt assets held in tax free savings accounts (TFSA) and all forms of registered retirement savings plans (RRSP). Provide First Nations with opportunity to develop and implement their own community based models of income assistance under provincial legislation. Helping Those in Deepest Poverty Objective: Take early urgent steps to increase the level of income for people living in deepest poverty. Throughout the roadmap report its authors reflect that that immediate action is long overdue; the current approaches and rules within social assistance programs contribute to keeping people trapped in a cycle of poverty. The authors discuss that restructuring social assistance rates, realigning health and child benefits, and the introduction of a portable housing benefit are transformative, and insufficient. Immediate and significant increases to social assistance rates are needed in order to reach the breath of people who have been left furthest behind Page 6 of 10

47 47 47 Report: CSD-EIS The roadmap report recommends that flat rate structures be increased over the next three years by 22% for Ontario works and 15% for the Ontario Disability Support Program. Single Non-Disabled Person (Ontario Works) Fall 2017 Year 1 (2018) Year 2 (2019) Year 3 (2020) 0% +10% +7% +5% $721/month $794/month $850/month $893/month Single Disabled Person (Ontario Disability Support Program) Fall 2017 Year 1 (2018) Year 2 (2019) Year 3 (2020) 0% +5% +5% +5% $1,151/month $1,209/month $1,270/month $1,334/month Income support available through OW/ODSP will continue to increase until the minimum income standard is achieved (with support from other income security components) by Indigenous and First Nations Objectives: Transform social services into programs and supports that are determined and controlled by First Nations The authors of the roadmap report acknowledge that the incredibly negative impacts of historical colonialism on First Nations people. The authors also recognize that income security reform must support the Province s commitments to reconciliation. In acknowledging that reform must respect First Nation s right to self-governance and respond to the unique needs and perspectives of all indigenous peoples, the report recommends the following actions: Provide First Nations with opportunity to develop and implement their own community based models of income assistance under provincial legislation. Designate First Nations OW delivery agents to administer Employment Ontario. Simplify processes and provide tools for a more holistic, individualized approach that offers wrap-around services. Broaden program outcomes to encompass social inclusion. Respect First Nations autonomy and work with First Nations to develop an opt Page 7 of 10

48 48 48 Timelines Report: CSD-EIS out clause that explicitly recognizes their right to opt out of provisions in OW legislation in favour of their own models. The roadmap outlines a strategic progression of the recommendations to be implemented over the next ten years. The first years of the roadmap are focused on helping individuals deepest in poverty by significantly increasing social assistance rates, transforming the social assistance rate structures, and making changes to social assistance rules regarding earnings and assets. Year 1 o Social assistance Standard Flat Rate transformation. o Earnings and asset rule changes. o Begin development of Minimum Income Standard and made-in-ontario Market Basket Measure. o Preparation of details of portable housing benefit, move remaining children s benefits outside social assistance. Year 2 o Increase in Standard Flat Rates. o Introduce Ontario Housing Benefit. o Expand core health benefits. o Changes made to Temporary Care Assistance. o New approach to intensive, collaborative case management implemented. Year 3 o Increase in Standard Flat Rates. o Increase in Ontario Housing Benefit. o Continuation of new approaches to child supplements, Temporary Care Assistance. Year 4-10 o Increase portable Housing Benefit. o Discretionary benefits fully redesigned. o OW program rebranded based on improved culture and approach to service. o Implementation of new low income health benefits, starting with further enhancing eligibility for drug coverage for low income adults. Summary The roadmap report presents a ten year plan for income security system reform, with the most substantial changes prioritized for the first three years. The recommendations outlined in the report stand to fundamentally change Ontario s income security system. The numerous recommendations in the report come together to form a transformational Page 8 of 10

49 49 49 Report: CSD-EIS income security system that addresses income adequacy by ensuring that there is a minimum income standard below which no individual or family will fall. The implementation of these reforms will be beneficial for all Ontarians living with low income, especially those in deepest poverty who access social assistance through Ontario Works and the Ontario Disability Support Program. The Ministry of Community and Social Services is inviting members of the public to submit feedback on the roadmap report via , mail, or fax, by January 5 th, Based on the potential for change and improvement in quality of life associated with this report staff recommend that the Regional Municipality of Waterloo send correspondence to Ontario Premier Kathleen Wynne, the Ministry of Community and Social Services, the Ontario Municipal Social Services Association (OMSSA), The Association of Municipalities of Ontario (AMMO), Ontario Non-Profit Housing Association (ONPHA), and local area MPs & MPPs indicating support for the direction outlined in the Income Security: A Roadmap for Change report. Relation to Quality of Life Indicators: The recommendations made in the roadmap for change address all five quality of life indicators: - Economic well-being: increasing social assistance rates and access to income tax benefits - Social inclusion and equity: redesigning social assistance s outcomes to explicitly include social inclusion - Physical and emotional well-being: enhancing access to health services and supports - Relationships: refocusing direct services staff to become case collaborators - Skills development: ensuring direct service staff have skills in social work and trauma informed approaches to practice to be successful in their new roles as system navigators Corporate Strategic Plan: This report addresses the Region s Corporate Strategic Plan , Focus Area 4: Healthy, Safe and Inclusive Communities and Strategic Objective 4.2: Mobilize efforts to reduce poverty and the impacts it has on Waterloo Region residents. Financial Implications: Nil Page 9 of 10

50 50 50 Other Department Consultations/Concurrence: Nil Attachments Nil Report: CSD-EIS Prepared By: Chris McEvoy, Supervisor, Employment & Income Support Carolyn Schoenfeldt, Director, Employment & Income Support Approved By: Douglas Bartholomew-Saunders, Commissioner, Community Services Page 10 of 10

51 51 51 Region of Waterloo Community Services Housing Services Report: CSD-HOU To: Chair Geoff Lorentz and Members of the Community Services Committee Date: File Code: D26-04 Subject: Community Housing Review System Update Recommendation: For Information Summary: The Housing Services Act requires each Service Manager to have a system in place to allow community housing applicants and tenants to appeal any of five decisions that have been made regarding their housing situation. In November 2012, (P ) Regional Council approved the formation of a body and process to review these appeals called the Community Housing Review System (Review System). This report provides an update on the Review System including some changes that have recently been made to the Review Committee membership. Report: Since 2013, Housing Services has had a system in place to allow community housing applicants and tenants to appeal any of five decisions that have been made regarding their housing situation. The five decisions that can be appealed are: eligibility for Rent Geared to Income (RGI); eligibility for priority or status on the central wait list; eligibility for size and type of unit; RGI calculation the amount of rent they must pay; and withdrawal of their subsidy. The appeals are to be heard by an independent body whose decision is then final. The body is independent in the sense that, even though the members are all working within Page 1 of 5

52 52 52 Report: CSD-HOU the housing stability system, they have not had any involvement with the original decision that is being reviewed. This report provides an update on the Review System by describing the process of holding a review, the membership on the review committee, the results of the past years reviews, and the impacts of the Review System. Process In 2013, community partners and housing providers were consulted to determine how best to structure a review process and who should be on the Review Committee. It was clear that community membership on the Review Committee was important. When the review process was first established, it was intentionally flexible and responsive to allow for modifications and improvements along the way. Tenants and applicants are made aware of their right to appeal a decision. If they choose to appeal, they send a written request to Housing Services administration. The original decision maker (either a community housing provider or Regional staff) is made aware of the appeal request. The community housing providers and regional staff are always encouraged to make another attempt to resolve prior to the appeal hearing date being scheduled. A date is set for the appeal hearing where both sides are invited to explain their reason for making the decision or disagreeing with the decision. The Review Committee hears both sides and makes their final decision. The results are communicated to the appellant and original decision maker. Many decisions that are reviewed will highlight improvements in processes or communication that can be made. Documentation of each review includes suggestions for improvement which are followed up on by Regional staff. As such, the review process is an important part of ensuring that community housing providers and regional staff are following due process and communicating well with tenants and applicants. Membership In 2013, the members of the Review Committee were appointed by the Commissioner of the then Planning, Housing, and Community Services Department. Membership consisted of a total of seven members; three community housing provider representatives, the Manager of Client Services and Waterloo Region Housing, the Supervisor of New Supply Initiatives, the Supervisor of the Community Housing Access Centre, and the Supervisor of Assisted and Affordable Housing Programs. The initial community housing provider representatives each fulfilled three one year terms. Currently there are three new community housing provider representatives. As a result of the move of Housing Services to the Community Services Department and the subsequent Housing Services re-organization, the membership on the Review Committee required adjustment. The Commissioner of Community Services has Page 2 of 5

53 53 53 Report: CSD-HOU recently approved a revised membership structure effective November The recent changes include adding another community housing provider and two Regional Housing Services supervisors, and removing the Manager of Client Services and Waterloo Region Housing. The updated review committee will consist of a total of eight members; the five supervisors in Housing Services and four community housing representatives. The changes are detailed in the chart below. Position Previous Committee Current Committee Manager, Client Services and WRH Supervisor, Assisted and Affordable Housing Programs Supervisor, Housing Supply Initiatives Supervisor, Access and Income Testing Supervisor, Tenancy Management (Previous title Supervisor, Area Operations) Supervisor, Community Housing and Housing Stability Member Member Member Member Not a member Not a member - position did not exist Removed Member revised title Supervisor, Rent Assistance Member revised title Supervisor, Housing Program Initiatives Member revised title Supervisor, Housing Access Added to membership Added to membership Community Housing Provider Representatives 3 Housing Providers 4 Housing Providers Results In the years of 2014, 2015, and 2016, 336 requests for review were received. Of the five reviewable decisions, the one most frequently appealed is whether or not someone is eligible for Special Priority Program (SPP as a victim of domestic violence) or Urgent Status on the Community Housing Wait List. The pie chart below illustrates all five types of decisions, showing there are requests for reviews for all types on a consistent basis Page 3 of 5

54 54 54 Report: CSD-HOU Decision Being Reviewed 2% 16% 14% 30% Requesting Priorty Status (SPP or Urgent Status) Subsidy Withdrawal Size and Type of Unit Eligibility for RGI 18% 20% RGI calculation Not reviewable Almost half (46%) of the decisions made are upheld after the review has taken place. The next largest category is requests that are withdrawn by the appellant before the review stage once the policy behind the decision is understood by the appellant through pre-review discussions. This indicates that the majority of original decisions (69%) align with legislative requirements and local policies. Another 16% of applications are withdrawn by the appellant before the review because the original decision maker grants the appellant s request, often due to new information submitted as part of review preparation. Seven (7%) per cent of decisions are overturned after a review has taken place. For these reviews, some new information may have come forward or the Review Committee has concluded that the original decision maker erred in the decision or interpretation of the relevant policies. In these cases, the original decision maker is advised of the issue, offered training or required to follow up directly with region staff to address the issue. A very small number of reviews result in decisions that are revised or closed if the appellant does not proceed. The pie chart below shows these outcomes of the reviews. 16% 7% Outcome of Review 4% 4% 46% Upheld Withdrawn-understood Withdrawn - awarded Overturned Revised Closed 23% Page 4 of 5

55 55 55 Impacts Report: CSD-HOU Following reviews each month, the Review Committee makes recommendations to housing providers on how to improve decision making and communication of decisions. In addition, Housing Services staff review the local policies and processes in place that contributed to the review, the committee decision, and the rationale put forward by the appellant. This process has contributed to the development of more standard templates, letters, and process charts to assist community housing providers in their decision making processes. Some examples include notifications of unauthorized guests and overhoused status. The Review System meets the criteria of an administrative body that ensures a duty of fairness is applied to appellants. Relation to Quality of Life Indicators: The Review System is an important part of enabling a higher quality of life for community housing tenants or applicants. It enables them to address concerns which may affect their economic wellbeing such as the amount of rent that they pay. It promotes their social inclusion by valuing their perspective on decisions that have been made. Lastly, presenting their case before a review committee may allow some tenants and applicants to improve their advocacy skills. Corporate Strategic Plan: This report addresses the Region s Corporate Strategic Plan , Focus Area 5: Responsive and Engaging Government Services 5.1 Enhance opportunities for public engagement, input, and involvement in Regional decision making. Financial Implications: Nil Other Department Consultations/Concurrence: Nil Attachments Nil Prepared By: Judy Maan Miedema, Principal Planner (Housing) Approved By: Douglas Bartholomew-Saunders, Commissioner, Community Services Page 5 of 5

56 56 56 Region of Waterloo Community Services Housing Services Report: CSD-HOU To: Chair Geoff Lorentz and Members of the Community Services Committee Date: File Code: D26-01 Subject: Waterloo Region Housing Tenant Engagement Summary Recommendation: For information. Summary: Waterloo Region Housing (WRH) provides safe and affordable housing to over 2,700 individuals and families living in 62 different housing communities across Waterloo Region. Within WRH housing communities, there are very diverse tenants with a sense of commitment to the places where they live. A Tenant Engagement Strategy will provide tenants with meaningful opportunities to collaborate with WRH to create better homes and build better neighbourhoods. Tenant engagement is a community-based approach to managing and operating community housing. It goes beyond informing tenants about changes being made to their housing, and takes a proactive approach to engage tenants to influence meaningful changes in the communities where they live. In 2017 staff launched a Tenant Engagement Strategy (see Report CSD-HOU-17-01) that enhanced the competency of all WRH in supporting tenants in a more meaningful and impactful way. This new approach saw staff focused on considerable community capacity-building, neighbourhood-based collaboration and creating trust-based leadership. The Tenant Engagement strategy was accompanied by ongoing staff training and development to ensure staff has the necessary skills and knowledge to effectively implement all the engagement programs and initiatives. Staff completed three full-day training modules that focused on cultural intelligence, de-escalation and customer service Page 1 of 5

57 57 57 Report: Report: CSC-HOU The goal of the Waterloo Region Housing (WRH) Tenant Engagement Strategy is to create better homes and build better neighbourhoods, using five approaches. These methods are being measured by four key performance indicators of success: (1) the total number of community meetings hosted by WRH; (2) the total number of tenants referred to support agencies; (3) the total number of evictions prevented through enhanced engagement; and (4) increased level of client satisfaction. In 2017 WRH has successfully implemented various forms of community engagement initiatives. Staff focused on the implementation of new programs that created numerous opportunities for tenant to participate with WRH on issues that matter; in a positive and meaningful way. These different projects and initiatives allowed staff to learn from tenants lived experiences. WRH has worked to ensure that a broad range of tenants participated and engaged in many different ways, using five tenant engagement methods: 1) Participation and input into decision-making of capital programs; 2) The Waterloo Region Housing Tenant Advisory Committee; 3) Economic development and employment programs like YouthForce ; 4) A region wide tenant newsletter What s Up ; and 5) Local Tenant Councils. 1. Participation and Input into Decision-making During the summer WRH began plans to replace 575 kitchens throughout its portfolio and resulted in the participation of 575 households. Understanding that this would have a significant impact on its communities; WRH used participatory decision-making as a tool for tenants to have a say in what their kitchens looked like. Participatory decisionmaking is a tangible way for tenants to collaborate with WRH and to participate in how their housing and homes are managed and operated. WRH Community Relation Workers and the Capital Planning team hosted 14 different barbeques for the communities that where scheduled to have their kitchens replaced. Tenants used a dot-mocracy process to tell WRH which colour scheme they preferred for their new kitchens. The colour scheme that was chosen by the most tenants was used for the kitchen renovations in that complex. When tenants have had input into some of the decisions for these upcoming kitchen renovation projects, the feedback received was overwhelmingly positive. 2. Tenant Advisory Committee In May of 2017 a modified WRH tenant advisory body was launched to allow tenants to have input into decision-making processes within Waterloo Region Housing communities. This Advisory Committee consisted of 12 tenants from across the Region. The Advisory Committee has representation from all key demographics including Page 2 of 5

58 58 58 Report: CSC-HOU seniors, youth, single family households and single adults. Moreover, the committee also was compromised of tenants living in the townships and three municipalities where WRH has communities. The Advisory Committee met five times in 2017 and covered a vast array of issues and topics. Specifically, the Advisory Committee took the opportunity to identify and advocate for needed resources. This region-wide tenant advisory body established its own terms of reference and was consulted twice on the development of the WRH Master Plan. The Advisory Committee 2017 accomplishments facilitated greater autonomy in overall tenant input into decision-making. 3. Economic Development and Employment Programs Creating opportunities for tenants to improve their economic circumstances is an integral component of providing better homes and building better neighbourhoods. One of the goals of the WRH is to promote the economic resiliency of the residents living in WRH communities as a means of breaking the cycle of poverty and contributing to the creation of healthy communities and better neighbourhoods. In the summer of 2017, WRH launched its second year of the YouthForce program across all of its properties in Waterloo Region. This was in collaboration with Region of Waterloo Employment and Income Support, Facilities Management, and five community centers, including: Greenway Chaplin, Langs, Carizon, House of Friendship and Kinbridge. The program is an integral component of the Region of Waterloo commitment to the economic and skill development of youth. The YouthForce program focused on employing young people in the months of July and August in various small scale labour jobs including: community clean ups, beautification (weed pulling, basic shrub pruning), cleaning signs, cleaning lobby windows, conducting unit inspections and completing flyer drop offs. There were two streams of youth engaged: youth aged as team members and youth aged as site leads. For the eight weeks in the summer of 2017, 27 youth (tenants) were employed in the YouthForce program attended eight personal development and career workshops. These workshops were facilitated by the Region of Waterloo Employment Services team. At the end of the summer WRH properties were cleaned over 500 times and 3500 unit inspections were completed. The YouthForce program has not only grown in size but it used a newly designed online form that was created by the Region of Waterloo s Human Resources and Citizen Service Division. Finally, 2017 saw the YouthForce program expand its services beyond WRH communities. YouthForce successfully completed over 700 units for Kitchener Housing Inc. and KW Urban Native Wigwam Project Page 3 of 5

59 Newsletter Report: CSC-HOU The Waterloo Housing Acting Together Supporting and Understanding People (WHATS UP) newsletter was relaunched in February of The updated newsletter is a collaboration between Waterloo Region Housing staff and tenants. Produced twice a year and distributed to all 2700 units, the newsletter provides a forum for both tenants and staff to communicate important information. The online version of the newsletter will be launched in December 2017 and will utilize the newly formed partnership with Rogers Canada as a method to have a broader reach to the communities. In September 2017 WRH launched the Rogers Connected for Success program. Through the Rogers Community Foundation, tenants at WRH now have access to affordable internet services for 9.99 per month along with an account. Currently 70 tenants have registered from three communities. In 2018 WRH will roll the program out to all its communities. The ability for WRH to now have a growing tenant list allows it to distribute the What s Up newsletter electronically for the first time. 5. Tenant Councils In 2017 WRH continued to implement its local tenant council initiative. Tenant councils have proven to maintain a higher level of consistency and accountability in terms of community development, property management matters, financial practices, and overall local resident decision making. Generally, Tenant Councils have dedicated positions (e.g. Tenant Co-Chair, Secretary, Treasurer) to work with and represent ongoing tenant issues and concerns. Through tenant councils WRH was able to plan and host over 320 local community events across the region. These events included tax clinics, barbeques, building meetings, community clean ups and back to school events. Key Performance Indicator Results: WRH clearly has increased the number of engaged tenants in its community through its Tenant Engagement Strategy. Specifically, WRH has measured its Tenant Engagement Strategy through three key performance indicators: (1) WRH hosted a total number of 327 community meetings (33% increase from 2016); (2) WRH referred a total of 278 tenants to 29 different support agencies (66% increase from 2016); (3) WRH prevented 17 evictions through enhanced engagement; and (4) Client satisfaction has increased as tenants have been surveyed within the different engagement opportunities they have participated in. Over 100 tenants completed the same survey that was used in the integrated team pilot project. On average tenants had a 4.5/5 in terms of their level of satisfaction with WRH services Page 4 of 5

60 60 60 Report: CSC-HOU Accordingly, 2017 has seen positive outcomes for both staff and tenants through the implementation of the WRH Tenant Engagement Strategy. Relation to Quality of Life Indicators: The Tenant Engagement System is an important part of enabling a higher quality of life for WRH tenants. It enables tenants to have input into decision-making that may improve their economic and social wellbeing. It promotes their social inclusion by valuing their perspective on decisions that have been made. Finally, tenant engagement allows WRH to create healthier homes and neighbourhoods. Corporate Strategic Plan: The Waterloo Region Housing Tenant Engagement Strategy aligns with the Corporate Strategic Plan Focus Area 5: Responsive and Engaging Government Services, and specifically 5.1 Enhance opportunities for public engagement, input and involvement in Regional decision making, and 5.2 Provide excellent citizen-centered services. Financial Implications: Nil Other Department Consultations/Concurrence: Nil Attachments Nil Prepared By: Mina Fayez-Bahgat, Manager, Waterloo Region Housing Approved By: Douglas Bartholomew-Saunders, Commissioner, Community Services Page 5 of 5

61 61 61 Region of Waterloo Community Services Housing Services Report: CSD-HOU To: Chair Geoff Lorentz and Members of the Community Services Committee Date: File Code: S13-40 Subject: Homelessness Update Recommendation: For information. Summary: In November 2017, the local redesign of the Housing Stability System (HSS) was outlined (CSD-HOU-17-24). The current report builds on this information by describing the current state of homelessness in Waterloo Region within the context of the HSS Redesign. It answers the following key questions: (1) what is homelessness; (2) why do people experience homelessness; (3) how is homelessness measured; (4) how do programs work together to serve people with housing issues; (5) what help is available for people experiencing homelessness; (6) what is the history of local shelters and what role do they currently play; and (7) what s next for HSS Redesign. Report: 1.0 What is homelessness? In the Province s Long-Term Affordable Housing Strategy Update (LTAHS Update), homelessness is described as the situation of a person or family without stable, permanent, appropriate housing, or the immediate prospect, means, and ability of acquiring it. Homelessness is also described as a range of housing circumstances, with people being without shelter at one end, and being insecurely housed at the other. Within this context, people experiencing homelessness fall into one of four main groups: Unsheltered (living on the streets or in places not intended for human habitation); Emergency Sheltered (staying overnight in Emergency Shelter); Provisionally Accommodated (staying in temporary accommodation that lacks Page 1 of 16

62 62 62 Report: CSD-HOU security of tenure); or At-Risk (people with precarious economic and/or housing situations that do not meet public health or safety standards). Within these four groups, there are additional factors to consider namely, how long someone has been homeless (chronicity) and their depth of need related to housing stability (acuity) 1. According to the Federal Homelessness Partnering Strategy (HPS), people who have been homeless for six months or more in the last year are considered chronically homeless. They often have higher acuity because of disabling conditions (like physical and mental health issues or addictions) and may require more intensive support to find and keep a home. This is in contrast to people who quickly self-resolve their housing issues and never experience homelessness again. Typically, people who are able to self-resolve their homelessness have lower acuity than people experiencing chronic homelessness. 2.0 Why do people experience homelessness? People who are at-risk of homelessness often have fewer resources to buffer them from the impact of their housing problems. Exclusion and deep poverty make matters worse by intensifying already difficult circumstances. During times of crises, having someone to call on for help (like family, friends or a supportive neighbour) and/or having other resources to draw from (e.g., paid time-off from work or savings) helps people to avoid homelessness. If people have depleted all of their assets, and no additional help is made readily available, homelessness can happen and people may need to access emergency shelter. Some issues that create problems with housing stability happen suddenly and can overwhelm households within a short period of time (e.g., homelessness following a catastrophic event like a house fire, car accident, relationship breakdown, illness or job loss). Other issues can build over a longer period of time, slowly eroding housing stability up to a breaking point (e.g., homelessness following a build-up of increasing debt, arrears and/or personal issues). There are countless factors that can impact housing stability. While every story is unique, issues tend to fall into a few categories. Some are more personal in nature (e.g., money management or health problems), while others are connected to a 1 Locally, depth of need is measured using the Service Prioritization and Decision Assistance Tool (SPDAT). This tool supports an evidence-informed approach to assessing strengths and vulnerabilities in five areas of life that impact housing stability: (1) homelessness and housing history; (2) wellness (e.g., trauma, substance use, mental health, physical health); (3) risks (e.g., interaction with emergency services); (4) socialization and daily functions (e.g., social network, self-care); and (5) family dynamics (e.g., age, number of children). There is a pre-screen and full assessment, both of which are tailored to youth, single adults, and families Page 2 of 16

63 63 63 Report: CSD-HOU person s living environment (e.g., unsafe housing or neighbourhood), financial insecurity (e.g., precarious employment), or relational challenges (e.g., social isolation and domestic violence). Issues can also be rooted in system-level barriers (e.g., inadequate discharge planning, discriminatory policies or lack of cultural competency) or structural factors (e.g., cost of living or lack of affordable housing). Homelessness prevention initiatives are most effective when they tackle one or more of these underlying factors. 3.0 How is homelessness measured? Three sources of data inform the extent of homelessness in Waterloo Region: (i) homelessness enumeration; (ii) Emergency Shelter data; and (iii) the Prioritized Access to Housing Support (PATHS) List of people waiting for housing support. These data sources suggest that between people are homeless at any point in time in the region. Each data source is further described below. i) Homelessness Enumeration Service Managers are required to conduct homelessness enumeration every two years beginning in the spring of 2018, selecting from a variety of approved methodologies (see CSD-HOU-17-09). The Federal Government is coordinating a national homelessness enumeration using a Point-in-Time count method around the same time. The Region has received funding to lead enumeration for Waterloo Region (see CSD- HOU-17-15) through the Count Me In event, which will take place on April 23, It will be a combined Point-in-Time count (surveys done in shelter and through outreach over a 24 hour period) and Registry Week event (as the survey will include questions about service needs). This means that data will both enumerate homelessness using non-identifying information (meeting Provincial requirements and contributing to the national Point-in-Time count) and also identify those who wish to be considered for other services after the event (e.g., through the PATHS process). Count Me In will be the second local enumeration event, building on the success of the 20,000 Homes Campaign Registry Week that took place in December 2014 (see CSD- HOU-15-13). Through the 2014 Registry Week, 295 individuals (not including families) were found to be experiencing homelessness. About half had the highest level of acuity and nearly two-thirds were experiencing chronic homelessness. The average length of time that people had lived without housing was three and a half years. Most people had either a mental health issue (85 percent), substance use issue (82 percent) or both (72 percent). Results of the 2018 Count Me In event are expected in early May. A summary will be prepared that compares data between 2014 and 2018 to inform local progress with ending chronic homelessness, among other key benchmarks Page 3 of 16

64 64 64 Report: CSD-HOU Implementation of the new web-based database called the Homeless Individuals and Families Information System (HIFIS 4) over 2018 will streamline future enumeration efforts within the Housing Stability System (HSS) 2. With HIFIS 4, real-time data about service use will be available every day of the year from every Region-funded program. ii) Emergency Shelter Data Shelter use is another way to measure homelessness. The 2016/17 Housing Stability Data Summary includes information about a number of shelter-related trends, including: Demographics (e.g., men 69 percent); Bed nights 3 (78,787); People served (2,726); and Stays o First time accessing shelter 51 percent; o Returning to shelter within the year 28 percent; o Staying six months or more less than 3 percent; and o Average length of stay for singles 29 days or families 43 days. There are 245 spaces in seven Region-funded emergency shelters across Waterloo Region, plus motel beds for overflow needs. Motel overflow is used on nights when more than 245 people require access to shelter across the region (i.e., capacity has been reached at all seven shelters) and when there is a need for special accommodations (e.g., when an individual or family needs access to an off-site option because of accessibility, health or safety issues). Based on bed night data across the region, shelter use stabilized between 2015/16 and 2016/17 after declining almost six percent since 2014/15. Between April 2015 and September 2017, nightly occupancy was 89 percent. Over this time, the average number of beds occupied each night across the region was 216 (it ranged from a low of 146 to a high of 274). In September 2017, the average number of beds occupied each night across the region was 221 (it ranged from a low of 190 to a high of 241). See Attachment A for region-wide shelter trends and a breakdown for shelters in Cambridge and Kitchener. iii) PATHS List The number of people waiting to access housing support is the third source of information used to help estimate the extent of homelessness. Access to housing support for people with lived experience of homelessness is prioritized in Regionally- 2 The HSS is a network of organizations, groups, and individuals that support people with housing issues in Waterloo Region. It includes providers where at least fifty percent of their time and/or activities are dedicated to helping people find and keep a home. 3 Bed nights refer to the number of beds occupied each night Page 4 of 16

65 65 65 Report: CSD-HOU funded spaces for people with the greatest depth of need who have been homeless the longest 4. Data is collected through the PATHS process which includes a centralized, real-time waiting list. Everyone who is eligible for housing support applies through the same process that is administered by the Region. To stay on the list, people must be actively homeless if they haven t had contact with the HSS in the last ninety days, they are removed. As of November 23, 2017 there were 241 households with high acuity waiting to access housing support (197 single adults, 34 youth, and 10 families). Ninety percent are chronically homeless. Most people have expressed interest in finding housing anywhere across the region. 4.0 How do programs work together to serve people with housing issues? The HSS includes ten Region-funded Housing Stability Programs that work together as an integrated system of care for people with housing issues. These programs are listed in Attachment C. Program providers are unified through a shared approach where everyone works toward common goals. A new HSS Program Delivery Framework is anticipated in fall 2018 that will explain how the various parts of the system fit together to reinforce the three main goals of increasing housing affordability, preventing homelessness, and ending chronic homelessness 5 as identified in the local 10 Year Housing and Homelessness Plan (10 Year Plan 6 ). A refresh of the 10 Year Plan is being developed at the same time. It will set revised targets for the second five-year span ( ) of the current commitment. Reaching these goals within the HSS is a shared responsibility. All orders of government, businesses, not-for-profits, groups, landlords, and residents have a role to play. Organizations, groups, and individuals in the HSS are leading the way forward. The Region s role includes responsibilities in the areas of system and program planning, program delivery, resource allocation and accountability, as well as quality assurance. Housing Services now has a dedicated team responsible for leading the 10 Year Plan and coordinating efforts across the region. Often more than one community system is involved with supporting the same person or family experiencing housing instability. Given this intersection, other community systems and partners are encouraged to do their part to support implementation of the 4 A new region-wide PATHS Team will support the PATHS process beginning in 2018/19 (see CSD-HOU-17-27). 5 The LTAHS set a goal to end chronic homelessness in Ontario by The National Housing Strategy set a goal to reduce chronic homelessness in Canada by fifty percent. 6 The current version of the 10 Year Plan (see P-14-42/SS-14-16) merges the 2012 Homelessness to Housing Stability Strategy (with its focus on ending homelessness) and the 2014 Waterloo Region s Housing Action Plan (with its focus on addressing the housing needs of low to moderate income households) Page 5 of 16

66 66 66 Report: CSD-HOU Year Plan. Some of these community systems are also identified in Attachment C. 5.0 What help is available for people experiencing homelessness? People experiencing homelessness are eligible for five Region-funded Housing Stability Programs: 1) Housing Resource Centres: Help with a housing plan during business hours (see the HSS Pocket Card for access information); 2) Emergency Shelters: Help with a housing plan and resources to meet basic needs when people have no other safe and appropriate place to stay (see the HSS Pocket Card for access information); and 3) Street Outreach: Help with linking and engagement for people who are streetinvolved (see the HSS Pocket Card for access information); 4) Community Housing: Rent assistance to make housing more affordable (see the Access Centres for application information); and 5) Transitional Housing: On-site support with a time-limited stay (includes Marillac Place for youth who are pregnant, parenting or trying to regain custody of a young child; people can access the program by phoning or dropping by). As identified in section 3.0, if people experiencing homelessness have a need for more support to help them find and keep a home, they can apply to access Portable Home- Based Support 7 or Supportive Housing 8 through the PATHS process. A specialized position called Service Navigators will be part of the new region-wide PATHS Team beginning in 2018/19. This role will be able to assist people to engage with the PATHS process if they are not otherwise connected to one of the five Housing Stability Programs listed directly above. As noted in section 4.0, many community systems intersect with the HSS by serving the same people. Some of the programs within these other community systems are more directly connected with helping people experiencing homelessness than others because of their mandate to serve people living with very low (or no) income. Some examples of these are listed below. Basic income: Ontario Works and the Ontario Disability Support Program Child care: Child care subsidies (administered by the Region) Disabilities (developmental, mental health/addictions, physical): Developmental Services Resource Centre, Here 24/7, Independent Living Centre of Waterloo Region, or Traverse Independence Families: Family Outreach Program and Family and Children s Services 7 A new region-wide Portable Home-Based Support Team will deliver shorter-term and longer-term support starting in 2018/19 (see CSD-HOU-17-26). 8 Supportive Housing for people with lived experience of homelessness was redesigned in 2016 (see SS ) Page 6 of 16

67 67 67 Report: CSD-HOU Food insecurity: Drop-in meal programs and the FoodBank of Waterloo Region Health care: Community health centres (Kitchener Downtown Community Health Centre and Langs), urgent care clinics, hospitals, and Waterloo-Wellington Community Care Access Centre Settlement: Kitchener-Waterloo Multicultural Centre, Reception House, YMCA Immigrant & Employment Services or Welcome Home Women and families fleeing abuse: Women s Crisis Services of Waterloo Region Again, these are just some examples of the many programs that help people experiencing homelessness in Waterloo Region, working in partnership with the HSS. 6.0 What is the history of local shelters and what role do they currently play? The Emergency Shelter program in Waterloo Region has grown based on a local, community-based response to meeting the need for this type of service over time. Various not-for-profits have been providing shelter options to people experiencing homelessness for decades, some since the early and mid-1900s. The Region also has a long history of funding shelters; some service Agreements date back to Up until the introduction of the Provincial Community Homelessness Prevention Initiative (CHPI) in 2013, shelters were funded through a per diem that was cost-shared 80/20 between the Province and the Region. Shelters accommodated people up to the maximum number they can serve based on fire code regulations. They only received payment for a person s stay if the person was eligible for Ontario Works (OW). In situations where OW eligibility was not secured (e.g., because people did not apply or were denied), costs for a stay were paid through other sources (e.g., fundraising) at the discretion of the shelter provider. The Region has never been the sole funder of shelters in Waterloo Region. Other funding is secured through United Way, grants, fundraising events, and charitable donations to meet the full costs of the program. CHPI had a significant and immediate impact on emergency shelters. For example, stays are no longer tied to OW eligibility and funding is no longer tied to occupancy. Instead, funding is available under the Emergency Shelter Solutions CHPI service category and annual reporting on outcomes is required through a set of housingfocused performance indicators. Locally, the Region began to grant-fund emergency shelters in At that time, the overall CHPI budget for local shelters was set at the current allocation level (about 3.5M including motel overflow funds) and work began with developing a new funding model to determine the specific funding amounts for each shelter (which came into effect in 2015/16). See Attachment B for more information about this process and Regional allocations over the last few years. In March 2017, the Emergency Shelter Program Framework was approved by Regional Council (see CSD-HOU-17-07); a short summary was released at the same time. The Page 7 of 16

68 68 68 Report: CSD-HOU framework provides a detailed review of the history of local shelters for people experiencing homelessness. It also outlines the purpose, description, and policy direction for the program going forward. The new policy direction for the Emergency Shelter program puts a renewed focus on coordinated access across the region. This approach has a few steps. It begins with shelter diversion a supportive conversation to explore where else people can stay that is safe and appropriate, even for a few days. Only people who have no other options are offered a shelter stay. Shelter participants may be referred to another site in the region as needed, either at intake or at any point during their stay. The purpose of these referrals is to maximize use of all grant-funded sheltering options (all 245 spaces across the region) before using the more costly option of overflow to motels. Shelter capacity is outlined in the Service Agreement with the Region. With the new capacity-based funding model beginning 2015/16, shelters receive a funding allocation based on their total capacity to serve for the year (regardless of occupancy). When internal capacity has been reached at one shelter site on a given night, providers are expected to refer to other locations in the region. Then, when internal capacity has been reached across the entire system, providers shift referrals to motels (at additional cost to the Region). For more information about this process, see Attachment D (a flowchart) and Attachment E (shelter referral protocol highlights). Implementation of the Emergency Shelter Program Framework is underway. A number of new and revised protocols are being developed to clarify service expectations in priority areas (e.g., harm reduction practices). Also, in partnership with the new regionwide PATHS Team, work will continue related to supporting Critical Safety Plans 9 for people experiencing homelessness with a demonstrated, elevated level of risk. 7.0 What s next for HSS Redesign? In partnership with a variety of community agencies, the Region has been redesigning the local HSS to create a more coordinated approach to service for people with housing issues. New policy directions related to HSS Redesign are being documented in a series of frameworks and Waterloo Region Housing Master Plan (see CSD-HOU-17-24). Waterloo Region continues to be an active participant in the 20,000 Homes Campaign and has recommitted to the initiative as part of a revised, national goal to end chronic homelessness in twenty communities across Canada by July Critical Safety Plans identify the sheltering options available to people while they wait for more support. People are added to the Critical Safety List if they have exhausted most sheltering options in community; have service restrictions from most or all shelters; and/or are at an elevated risk of death (i.e., reduced capacity to survive homelessness) Page 8 of 16

69 69 69 Report: CSD-HOU Plans for 2018 include strengthening the regional systems-based approach developed through the HSS Redesign. A number of activities will support this objective, as outlined below. Continue implementation of the Supportive Housing and Emergency Shelter Frameworks; Finalize the Waterloo Region Master Plan and move forward with next steps; Finalize the HSS Program Delivery Framework and release a five-year refresh on the local 10 Year Plan that sets revised targets (e.g., through leveraging strategic partnerships); Launch HIFIS 4; and Release a series of HSS fact sheets, brochures and FAQ documents. Relationship to Quality of Life Indicators: Addressing homelessness aligns with Economic Well-Being (e.g., increased access to affordable housing); Social Inclusion and Equity (e.g., housing support positively impacts participants sense of belonging and community participation); Physical and Emotional Well-Being (e.g., housing support positively impacts participants daily functioning and how they feel about their life) and Relationships (e.g., through access to housing stability workers that provide support). Corporate Strategic Plan: Working to strengthen the HSS and build the community s capacity to address issues of housing instability is consistent with the Region of Waterloo Corporate Strategic Plan, Focus Area 4: Healthy, Safe and Inclusive Communities; and specifically, Strategic Objective to Implement the Homelessness to Housing Stability Strategy. Financial Implications: NIL Other Department Consultations/Concurrence: NIL Attachments Attachment A: Emergency Shelter Trends Attachment B: Emergency Shelter Funding Allocations through the Region Attachment C: Community Systems that Support Housing Stability Attachment D: Emergency Shelter Referral Flowchart Page 9 of 16

70 70 70 Attachment E: Emergency Shelter Referral Protocols Prepared By: Angela Pye, Manager, Housing Services Mina Fayez-Bahgat, Manager, Housing Services Deb Schlichter, Director, Housing Services Report: CSD-HOU Approved By: Douglas Bartholomew-Saunders, Commissioner, Community Services Page 10 of 16

71 71 71 Report: CSD-HOU Attachment A: Emergency Shelter Trends 1) Waterloo Region Nightly Occupancy April 2015 to September 2017 Seven Region-funded shelter sites across Waterloo Region Capacity line set at current level of 245 beds each night (plus motel overflow) Average nightly occupancy: 216 bed nights (89 percent of capacity) Range 146 bed nights to 274 bed nights Occupancy (Bed Nights) ) Cambridge Nightly Occupancy April 2015 to September 2017 Two Region-funded shelter sites in Cambridge: Argus and Cambridge Shelter Capacity line set at current level of 99 beds each night (plus motel overflow) Average nightly occupancy: 77 bed nights (78 percent of capacity) Range 40 bed nights to 116 bed nights Occupancy (Bed Nights) Page 11 of 16

72 72 72 Report: CSD-HOU ) Kitchener Nightly Occupancy April 2015 to September 2017 Five Region-funded shelter sites in Kitchener: House of Friendship, Lutherwood, oneroof, The Working Centre Bunkies, and YW Capacity line set at current level of 146 beds each night (plus motel overflow) Average nightly occupancy: 133 bed nights (91 percent of capacity) Range: 84 bed nights to 175 bed nights Occupancy (Bed Nights) ) Waterloo Region Participants and Occupancy April 2014 to September 2017 Seven Region-funded shelter sites across Waterloo Region Periods with fewer participants where bed nights remain high indicate longer lengths of stay for each individual or family 25,000 1,000 20, Bed nights 15,000 10, Participants 5, Q1 14/15 Q2 14/15 Q3 14/15 Q4 14/15 Q1 15/16 Q2 15/16 Q3 15/16 Q4 15/16 Q1 16/17 Q2 16/17 Q3 16/17 Q4 16/17 Q1 17/18 Q2 17/18 Bednights Participants Page 12 of

73 73 73 Report: CSD-HOU Attachment B: Emergency Shelter Funding Allocations through the Region The last year of per diem funding was In 2013/14, the Region shifted to fiscal allocations. Part of the new Emergency Shelter Program Framework included a new capacity-based funding model. Beginning in 2016/17, each shelter receives the same amount per bed (about $14,000) and shelters smaller than 25 beds receive an additional top-up. Note that the Cambridge Shelter, House of Friendship and YW sites had non-shelter staff positions (previously included in shelter budgets) funded through another Agreement beginning in 2016/17. Additional, temporary investments in shelter have included the following: o Intensive Shelter Workers; o Cambridge STEP Home shelter-based support; o Overnight and motel overflow support; and o Increase shelter bed capacity. Budget for motel overflow is currently about $250,000 (shared across the region). After the three-year transition period, the new funding model will be evaluated. $4,000,000 $3,500,000 $3,000,000 Annual Allocation $2,500,000 $2,000,000 $1,500,000 $1,000,000 $500,000 $- 2014/ / / /18 Argus $270,813 $320,600 $322,028 $342,165 Cambridge Shelter $942,966 $942,966 $971,574 $1,089,067 House of Friendship $623,388 $723,388 $662,982 $772,218 Lutherwood $46,542 $46,542 $64,757 $73,055 oneroof $240,450 $240,450 $253,056 $321,834 The Working Centre $27,982 $27,982 YW $1,487,077 $1,447,010 $1,112,255 $1,082,940 Total $3,611,236 $3,720,956 $3,414,634 $3,709, Page 13 of 16

74 74 74 Report: CSD-HOU Attachment C: Community Systems that Support Housing Stability Region-Funded Housing Stability Program General Description 1) Housing Resource Centres Help with a housing plan during business hours 2) Emergency Shelter Help with a housing plan and resources to meet basic needs during a shelter stay 3) Street Outreach Help with linking and engagement for people who are street-involved; fixed-site and drop-in options 4) Community Housing Rent assistance; fixed-site and portable options 5) Affordable Home Ownership Funds to support the transition to home ownership 6) Ontario Renovates Funds for repairs, renovations, and accessibility 7) Transitional Housing On-site support with a time-limited stay 8) Portable Home-Based Support Shorter-Term 9) Portable Home-Based Support Longer-Term 10) Supportive Housing Support for people with medium acuity living in rental units across the community (~3-6 months) Support for people with high acuity living in rental units across the community (~12-18 months) Support for people with high acuity that is on-site of permanent housing; shared living setting Page 14 of 16

75 75 75 Attachment D: Emergency Shelter Referral Flowchart Report: CSD-HOU-17-xx Page 15 of 16

76 76 76 Attachment E: Emergency Shelter Referral Protocols Report: CSD-HOU There are five reasons why participants may be referred to a different shelter site: 1) Capacity pressures (e.g., referral avoids or reduces motel overflow costs); 2) To accommodate people s accessibility, health or safety needs; 3) Due to a change in circumstances (e.g., to reunite with family); 4) As part of a Housing Plan (e.g., to find housing closer to another site); and 5) Service restrictions. There are six reasons why people may be service restricted: 1) Damage to the shelter; 2) Theft; 3) Weapons on-site; 4) Drug dealing on-site; 5) Harassment, bullying, threats, or violence; and 6) Substance use on-site. A service restriction means that people cannot access overnight service. Service restrictions should not be longer than 14 days and the time limit on accessing overnight shelter begins immediately. Most are much shorter than two weeks, typically one night to a week (i.e., it is a suspension not a permanent ban). When considering referrals to another shelter site, five things are explored: 1) Shelter service mandate (e.g., age, gender-identity or household type); 2) Existing supports (e.g., close to schools, specialized services or family); 3) Existing employment (e.g., closer to job site); 4) Specific transportation needs (e.g., if the person can use transit); and 5) Housing Plan (e.g., where people want to settle). If people want to settle in another community, they may be referred to appropriate shelter options that can help to facilitate this transition Page 16 of 16

77 77 77 Region of Waterloo Community Services Employment & Income Support Report: CSD-EIS To: Chair Geoff Lorentz and Members of the Community Services Committee Date: File Code: S09-80 Subject: Ontario Works Caseload: July - September 2017 Recommendation: For Information. Report: This report provides an update on the Ontario Works (OW) caseload for the third quarter of 2017 (July - September). Employment & Income Support (EIS) in Community Services, along with Treasury Services/Corporate Services, monitor the caseloads on a monthly basis and provide a report to Council quarterly. OW is an employment-focused program that provides citizens of Waterloo Region with employment, financial, and social supports for improved quality of life by: Working with the clients to create an employment or self-sufficiency plan in order to assist them to achieve their potential and an improved quality of life; Engaging with employers and the labour market to ensure there are jobs to which to refer clients; and Collaborating with internal partners and community to support client needs across service sectors, such as health, housing and education. Caseload numbers are influenced by external factors such as education levels and the local economy. Table 1 is the total OW caseload for the third quarter (July - September 2017) with comparisons to the second quarter (April - June 2017) and the third quarter in the previous year (July - September 2016) Page 1 of 4

78 78 78 Report: CSD-EIS Table 1: Caseload Size Caseload Size* Third Quarter 2017 Second Quarter 2017 Third Quarter 2016 % of Change Second to Third Quarter 2017 % of Change Third Quarter 2016 to Third 2017 ROW OW 9,253 9,240 8, % % Caseload Ontario - OW Caseload 257, , , % -0.7 % *As reported in September 2017 Social Assistance Operations Performance Reports. Numbers are an average of the three months in the quarter. Table 2 provides information on the four indicators related to employment that are tracked to show how many clients were employed and compares the Region to the Province. Thirteen per cent of clients continue to receive OW supports while earning money from employment because their earnings have not reached the threshold level for ineligibility. (see #3 and #5). Low earnings from employment are not enough to live on but can indicate a positive connection to the community and more job experience which may lead to a better quality of life and better job opportunities. Table 2: OW and Employment OW and Employment* Third Quarter 2017 Third Quarter ROW - Number of cases with Employment Earnings 1,220 1, Ontario - Number of cases with Employment Earnings 31,414 29, ROW - % of caseload with employment earnings 13.30% 13.18% 4. Ontario - % of caseload with employment earnings 13.06% 12.26% 5. ROW - Average monthly employment earnings per $791 $756 case 6. Ontario - Average monthly employment earnings per $806 $770 case 7. ROW - % of terminations exiting to employment % 13.47% 8. Ontario - % of terminations exiting to employment 15.80% 16.46% 9. ROW - % of caseload exiting to employment % 0.75% 10. Ontario - % of caseload exiting to employment 0.84% 0.95% 11. ROW Number of exits to employment Ontario Number of exits to employment 2,015 2,307 1 % of terminations to employment means the per cent of OW cases that left OW because they were beginning to earn enough employment income that they were no longer eligible for the program or clients who have asked to have their OW case closed as a result of beginning employment. 2 The percent of cases exiting to employment from the total current caseload. 3 The total number of cases that exited either due to employment income making them ineligible or as a request to exit because they have achieved employment Page 2 of 4

79 79 79 Report: CSD-EIS *As reported in the September 2017 Social Assistance Operations Performance Reports. Numbers are an average of the three months in the quarter. Table 2 also shows the number of times a case was closed (a termination) for an individual or family because someone in the family began earning income above the eligibility thresholds, or they voluntarily requested to exit the program because they are working. The challenge with this measurement is that often clients get jobs and no longer need OW supports but do not tell their caseworker, making it difficult to classify the reason for the exit / termination. As part of modernization efforts, EIS is reviewing processes to be able to minimize hidden exits to employment and ensure numbers are as accurate as possible. To understand the broader economic context within which OW functions, Table 3 provides the unemployment rates for the second quarter of 2017 with comparisons to the third quarter of 2016 and second quarter of While these numbers suggest that it should be easier to find employment in Waterloo Region relative to Ontario as a whole, there is often a lack of alignment between OW participants education and / or skill level relative to the jobs available (e.g. advanced manufacturing and tech sectors). Table 3: Unemployment Rates Seasonally Adjusted* Area Third Quarter 2017 Second Quarter 2017 Third Quarter 2016 Waterloo Region 4.5% 5.2% 5.6% Ontario 6.1% 6.2% 6.5% *As revised by Statistics Canada. Numbers are an average of the three months in the quarter. Lastly, a brief update on the Ontario Disability Supports Program (ODSP) is provided in Table 4. ODSP is provincially funded and operated; however, there is inter-dependence between these programs. OW is often the intake point for clients who are then referred to ODSP once they are deemed eligible as a result of a disability. ODSP clients may be referred to OW employment programs and are eligible for supports through the OW Discretionary Benefits program Page 3 of 4

80 80 80 Report: CSD-EIS Table 4: December Ontario Disability Supports Program Caseload* Area Waterloo Region Third Quarter 2017 Second Quarter 2017 Third Quarter 2016 % Change Second to Third Quarter 2017 % Change Third Quarter 2016 to Third Quarter ,954 11,888 11, % + 4.3% *As reported in the September 2017 Social Assistance Operations Performance Reports. Numbers are an average of the three months in the quarter. In summary, the tables demonstrate that for Waterloo Region the caseload numbers for both OW and ODSP have risen over the last year and have increased slightly from the second to third quarter of Relation to Quality of Life Indicators: OW is an employment-focused program that provides citizens of Waterloo Region with employment, financial, and social supports which improve quality of life by increasing Economic Well-Being, Social Inclusion and Equity, Physical and Emotional Well-Being, Skills Development, and Relationships. Corporate Strategic Plan: This report addresses the Region s Corporate Strategic Plan , Focus Area 4: Healthy, Safe and Inclusive Communities and Strategic Objective 4.2: Mobilize efforts to reduce poverty and the impacts it has on Waterloo Region residents. Financial Implications: Costs related to the Ontario Works program are cost shared with the Province. In 2017, the cost sharing ratio was 97.2%/2.8%. The cost sharing upload will be completed in 2018 at which time the Region s obligation to contribute to program costs will terminate. Costs related to the ODSP caseload are the sole responsibility of the Province. Other Department Consultations/Concurrence: Corporate Services / Treasury Services was consulted in the preparation of this report. Prepared By: Nina Bailey-Dick, Social Planning Associate, Employment and Income Support Carolyn Schoenfeldt, Director, Employment and Income Support Approved By: Douglas Bartholomew-Saunders, Commissioner, Community Services Page 4 of 4

81 81 81 Region of Waterloo Crime Prevention Council Report: CPC To: Chair Geoff Lorentz and Members of the Community Services Committee Date: File Code: C06-60 Subject: Waterloo Region Area Survey Recommendation: For information Summary: Nil Report: The Waterloo Regional Area Survey (WRAS) is an annual survey run out the Research Data Centre at the University of Waterloo. The WRAS was launched in early 2017 and 404 responses were collected using both telephone and online methods. Respondents from all cities and townships within the Region were selected for the survey, allowing for a representative sample. One section of the WRAS included several questions developed by the Waterloo Region Crime Prevention Council (WRCPC) research team related to trust, perceptions of community safety and crime, perceptions of the downtown core, frequency of visits to the downtown, and understanding of the phrase Smart on Crime. Analysis of the WRAS Data was completed by research staff at the Waterloo Region Crime Prevention Council in the summer and fall of Once this analysis was complete, two reports were presented to the Waterloo Region Crime Prevention Council: a long-version comprehensive report of all questions included in the analysis, and a short version intended as a community report which includes highlights and key findings. Waterloo Region Area Survey Summary of Results: Fifty-four percent of the respondents were female; 46% male. The age range for Page 1 of 4

82 82 82 Report: CPC respondents was 19 to 92; the average age was Given that the average age of adults over 19 in Waterloo Region is 47.8 years, statistical adjustments were applied to the survey data in order to provide results that better represent the wider population. Trust in the Waterloo Region is on the rise. When asked about trust, 76% of respondents chose the option most people can be trusted. Results were not consistent across gender male respondents reported to be more trusting than female nor were they consistent across city/township, though these differences did not prove statistically significant. Looking at trends over time, this 76% overall result is a significant increase over results reported in previous years and represents a 16% increase from the 2013 WRAS results. This indicates a potentially positive shift in attitudes in the Waterloo Region over the past 4 years. Additionally, results reveal that 91% of respondents feel either very safe or reasonably safe from crime when walking alone in their area after dark. Trends over time show that feelings of safety are steadily going up, despite consistent population growth. Comparative analysis by city and township indicate some differences in perceptions of safety, particularly between the townships (where 97% of respondents report feeling safe after dark), and the three major cities (where 90% of respondents report feeling safe after dark). Results also show that men feel significantly safer than women (95% for male; 87% for female). These results tend to mirror studies of this nature in other communities. When asked about feelings of safety in the downtown core at night, overall results for this question show a marked difference in feelings of safety between the downtown cores and respondents own neighborhoods: 62 % of respondents reported feeling either very safe or somewhat safe in their downtown at night (Cambridge-Kitchener- Waterloo only), compared with the 91% of respondents who report feeling safe in their own area at night. Gender differences were also seen in the results for this question: 52% of women report feeling safe in their downtown at night as compared with 79% of men. The more often people visit the downtown at night, the safer they perceive the downtown to be at night OR the safer people perceive the downtown to be at night, the more often they will visit at night. Either way, there is a direct relationship between frequency of visits to the downtown at night and feelings of safety in the downtown at night. Overall, 62% of survey respondents reported that they feel either very safe or somewhat safe, and 38% of respondents reported that they feel either somewhat or very unsafe in their downtown at night Page 2 of 4

83 83 83 Report: CPC For those who perceive the downtown as very safe at night, 90% report that they visit the downtown at night at least a few times per year, whereas for those who perceive the downtown as very unsafe at night, 51% report that they never go downtown at night. When asked to elaborate on the specific characteristics that make up a safe downtown, the top responses were: lights/street lights/area being well lit, having people around, police presence, stores being open, car traffic, and having no history or experience with crime. Respondents were asked in your own words, what does being smart on crime mean? Open-ended responses provided for this question varied considerably, though the most frequently cited definition for smart on crime was being vigilant and/or aware of either surroundings or people, with 49% of the total responses in this category. Beyond this, other responses included: taking safety measures such as locking doors/car/home or traveling in groups; focusing on crime prevention or root causes of crime; avoiding dangerous or criminal areas; being or remaining educated on crime; utilizing a strong police presence; and focusing on community rehabilitation and supports. Despite the variation in these responses, the Smart on Crime message by the Waterloo Region Crime Prevention Council which comprises a focus on prevention, root causes and education is to some extend reflected in the responses. Corporate Strategic Plan: Healthy, Safe and Inclusive Communities, 4.5 Enhance community safety and crime prevention Financial Implications: Nil Other Department Consultations/Concurrence: Some analysis generated from the Waterloo Region Area Survey was also used in the Central Transit Corridor monitoring report 2017 prepared by Margaret Parkin, Manager, Planning Research and Analytics, Region of Waterloo. Attachments 1. WRAS Community Report 2017, Docs# WRAS Summary of Results 2017, Docs# Prepared By: Elin Moorlag Silk, Coordinator, Community Development & Research, Waterloo Region Crime Prevention Council Approved By: Christiane Sadeler, Executive Director, Waterloo Region Crime Page 3 of 4

84 84 84 Prevention Council Report: CPC Shayne Turner, Chair, Waterloo Region Crime Prevention Council Douglas Bartholomew-Saunders, Commissioner, Community Services Page 4 of 4

85 85 85 Report: CPC Region of Waterloo Crime Prevention Council To: Chair Geoff Lorentz and Members of the Community Services Committee Date: File Code: C06-70 Subject: Good Samaritan Drug Overdose Act Recommendation: For information Summary: Research conducted by the Waterloo Region Crime Prevention Council has formed the basis for a new national law that seeks to improve 911 call rates at overdose emergencies. Bill C-224 (Good Samaritan Drug Overdose Act) was drafted by MP Ron McKinnon in 2016, passed First Reading in February 2016 and received Royal Assent on May 4, The Waterloo Region Crime Prevention Council together with collaborating partners, primarily the Canadian HIV/Aids Legal Network, have filled a gap by creating materials to support knowledge exchange and operationalization of the Act for citizens, agencies and governments. The materials are posted at overdose prevention resources. Report: An opioid overdose is a medical emergency and victims are unable to seek or administer emergency care to them, leaving victims dependent on the actions of bystanders or Good Samaritans. Seconds can mean the difference between life and death and between a lifetime of disability or a successful recovery. The best medical advice always includes calling 911 for emergency assistance. In September 2008, the Waterloo Region Crime Prevention Council (WRCPC) released two overdose reports. A First Portrait of Drug-Related Overdoses in Waterloo Region provided the first glimpse of the extent and typology of overdoses across Waterloo region and Saving Lives: Overdose Prevention and Intervention in Select North American Cities illuminated the key characteristics of lifesaving naloxone programs Page 1 of 4

86 86 86 Report: CPC The latter report recommended the establishment of naloxone programs and, anticipating the bootleg fentanyl crisis, a real time monitoring system. Additionally, the research revealed that the number of overdose victims treated at area hospitals exceeded patients delivered by Waterloo Region Emergency Medical Services. The finding suggested there may be barriers to calling 911 at the scene of an overdose emergency where illicit substances have been consumed. In 2012, the WRCPC undertook research to determine A First Portrait of Drug-Related Overdoses Barriers to Calling 911 at an (illicit) overdose emergency. The research was the first study in Canada on this issue. The report contains an analysis of the international literature and results of personal surveys with 450 people who used drugs at the time or who were engaged in opioid agonist treatment. The researchers conducted the interviews in Waterloo region, Guelph and Wellington County and the data revealed several findings, among them: At the last witnessed overdose, 911 was called 46% of the time. By comparison, 911 calls for cardiac arrest emergencies are above 90%. 83% of those surveyed thought they would probably or maybe be charged with a criminal offense if 911 was called during an overdose emergency. The likelihood of calling 911 and waiting with the victim was lowest amongst the youngest cohort (16-24 years of age). The primary barrier to calling 911 and waiting with the victim was fear of becoming entangled with the criminal justice system via police presence at the overdose scene. Following the release of the report, WRCPC struck an ad hoc working group to consider policy options. Comprised of area first responders, community agencies and citizens the working group recommended: the establishment of overdose prevention programs with naloxone; and the establishment of a national Good Samaritan Law. In 2016, MP Ron McKinnon introduced Bill C-224 (The Good Samaritan Drug Overdose Act) based on WRCPC s research and concern for the surge in overdose fatalities. The purpose of Bill C-224 was to improve 911 call rates by providing limited immunity from possession charges for persons at the scene of an overdose emergency. The Good Samaritan Drug Overdose Act received Royal assent on May 4, Private members Bills are not permitted to have supporting resources attached to the Bill. Thus the knowledge dissemination necessary for appropriate application and Page 2 of 4

87 87 87 Report: CPC operationalization of the Act was an anticipated gap. The WRCPC together with collaborating partners subsequently undertook a design workshop and with the Canadian HIV/Aids Legal Network, multiple focus groups were held in Waterloo region and Toronto to develop a fact sheet and a wallet card. Funding was procured from Law Foundation of Ontario to reproduce 50,000 laminated wallet cards and two organizations the Legal Aid Ontario and the Law Society Referral Service - are providing additional assistance as needed via toll-free phone numbers. The Fact Sheet and wallet cards have been endorsed by the Ontario Association of Chiefs of Police. The materials are available free of charge while supplies last and have been offered to the Ministry of Health and Long Term Care for inclusion into Ontario s naloxone kits. The Fact Sheet and the wallet card will be made available at the WRCPC website Since the WRCPC began releasing overdose reports in 2008, Ontario s fatal opioid-related overdoses have continued to rise. The contamination of the black market by the bootleg fentanyls, as anticipated in an advisory issued by WRCPC and enforcement partners in 2013 and 2016, is unfolding across Canada. The high toxicity of the bootleg fentanyls and/or unintentional consumption by opioid-naïve citizens increases the need to receive urgent hospital care, regardless of naloxone administration outside of hospital settings thus making this legislation timely. Ontario s 16 year trend of record-setting opioid-related overdose fatalities reached a rate of 1 death every 10 hours in 2016, almost double the fatalities on Ontario s roadways. In Waterloo region, fatal opioid-related overdoses climbed from 23 victims in 2015 to 38 victims in Waterloo Region Police Services report 58 suspected opioid-related overdoses as of November 14, The bootleg fentanyls are cited for the escalation of deaths locally and beyond. Against this backdrop, the Good Samaritan Drug Overdose Act aims to improve 911 call rates and improve health outcomes. The Fact Sheet and Wallet Card will assist in ensuring that citizens, service providers and government agencies are aware of and able to operationalize this legislation. The WRCPC s collaborative efforts to establish and expand naloxone access in Ontario together with the Good Samaritan Drug Overdose Act becoming law completes two key recommendations contained in A First Portrait of Drug-Related Overdoses in Waterloo Region (2008), The Waterloo Region Integrated Drugs Strategy (2011), Oxy to Oxy: Impacts and Recommendations Forum (2012), Between Life and Death: The Barriers to Calling 911 During an Overdose Emergency (2012) and Prescription For Life (2015) Page 3 of 4

88 88 88 Report: CPC WRCPC remains grateful for the contributions of citizens and collaborating partners to achieve these initiatives. Corporate Strategic Plan: This report relates to strategic objective 4.4 (Promote and support healthy living and prevent disease and injury) in the Healthy, Safe and Inclusive Communities focus area in the Strategic Plan. Financial Implications: Nil Other Department Consultations/Concurrence: Nil Attachments Fact Sheet and Wallet Card Prepared By: Michael Parkinson, Community Engagement Coordinator Approved By: Christiane Sadeler, Executive Director, Waterloo Region Crime Prevention Council Shayne Turner, Chair, Waterloo Region Crime Prevention Council Douglas Bartholomew-Saunders, Commissioner, Community Services Page 4 of 4

89 89 89 Good News For Good Samaritans! On May 4, 2017, the Good Samaritan Drug Overdose Act became law in Canada. The purpose of the Act, introduced by Member of Parliament Ron McKinnon, is to improve 911 call-rates at overdose emergencies and encourage witnesses to continue assisting the victim(s) until medical assistance arrives. [1] An overdose is a medical emergency. Overdose victims cannot save themselves and are dependent on witnesses or good samaritans for emergency medical care. Across Canada, the best medical advice always includes calling 911. However, research from the Waterloo Region Crime Prevention Council in 2012 demonstrated that multiple barriers exist that prevent witnesses from calling 911, primarily fear of police presence and potential involvement with the criminal justice system. [2] The Good Samaritan Drug Overdose Act amends the Controlled Drugs and Substances Act ( CDSA ) to exempt both victim(s) and witnesses from being charged or convicted of the offence of simple possession of drugs [3] when emergency help is sought for an overdose, if the evidence in support of the offence was obtained or discovered as a result of seeking assistance or remaining at the scene. Seeking emergency help could include calling 911, leaving the scene to call 911 or leaving the scene to locate emergency medical assistance. An individual who calls 911 but leaves before emergency services arrive has the same exemption. [4] Exemption from charge and conviction for drug possession is granted by the Good Samaritan Drug Overdose Act for both the overdose victim(s) and witnesses at the scene of the overdose when emergency assistance is sought. This exemption is further extended to overdose victims and witnesses who violate conditions of: a pre-trial release, a probation order, parole or a conditional sentence related to a drug possession offence under Section 4(1) of the CDSA. While local police services have some operational discretion (e.g. thresholds for trafficking vs possession charges) and policy discretion (e.g. routine non-attendance at overdose emergencies), the Act does not grant exemptions for any other Criminal Code or CDSA offences or for outstanding arrest warrants. For more information visit: ADVANCE DRAFT [1] The Good Samaritan Drug Overdose Act defines an overdose in Section 4.1(1) of the Act as a physiological event induced by the introduction of a controlled substance into the body of a person that results in a life-threatening situation and that a reasonable person would believe requires emergency medical or law enforcement assistance. [2] Between Life and Death: The Barriers to Calling 911 During an Overdose Emergency. Waterloo Region Crime Prevention Council, [3] Section 4(1) of the Controlled Drugs and Substances Act. [4] About the Good Samaritan Overdose Act. Government of Canada. Retrieved June 22,

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91 91 91 Region of Waterloo Public Health and Emergency Services Central Resources Report: PHE-CRS To: Chair Geoff Lorentz and Members of the Community Services Committee Date: File Code: F11-01 Subject: 2017 Public Health Budget Approval Recommendation: For information Summary: Correspondence has recently been received confirming the Ministry of Health and Long Term Care s approved 2017 funding allocation for Region of Waterloo Public Health program based grants. The Ministry of Health and Long Term Care s 2017 funding allocations for Region of Waterloo Public Health programs include $23,463,600 in annual base funding and $297,600 in one time funding; the total ministry approval of $23,761,200 is a combination of 100% and cost shared funding. Region of Waterloo Public Health will operate within the approved provincial and Regional base and one-time funding allocations for Since 2011, Boards of Health in the province of Ontario have been expected to enter into agreements that identify the requirements for the accountability of the board of health and the management of the health unit. As per routine practice, the Chair of the Board of Health (the Regional Chair) has signed a revised accountability agreement with the updated financial information included. Report: Correspondence has recently been received confirming the Ministry of Health and Long Term Care s approved 2017 funding allocation for Region of Waterloo Public Health s Page 1 of 9

92 92 92 Report: PHE-CRS program based grants. The correspondence details both base and one time funding envelopes for mandatory and related public health programs and services; the ministry funding is a combination of 100% funding and cost shared funding (up to 75% provincial). Provincial Budget Approval for Public Health Programs The correspondence received from the Ministry of Health & Long Term Care (MOHLTC) confirms Waterloo Region s 2017 allocation of funding to support the provision of mandatory and related public health services (Attachment 1). The provision of provincial funding is in accordance with section 76 of the Health Protection and Promotion Act. The 2017 base approval is $23,463,600 and includes $250,000 for 100% Harm Reduction Enhancement to support a local opioid response; the enhanced harm reduction funding was announced previously and reported to Regional Council at the end of June. In addition, the correspondence confirms one time approvals of $297,600 for a total of $23,761,200. Further details of the funding are provided in Schedule A-4 Program-Based Grants (Attachment 2). For specifics of the various funding envelopes and information about how the approved allocations represent funding shortfalls or additional resources to those in the Region s 2017 budget assumptions, see the Financial Implications section of this report. Accountability Agreement Public Health Programs Since 2011, Boards of Health in the province of Ontario have been expected to enter into agreements that identify the requirements for the accountability of the board of health and the management of the health unit. The Accountability Agreements for Public Health were designed to Demonstrate to government the effective use of public funds value for money Demonstrate clear movement on government priorities; Demonstrate general compliance with Ontario Public Health (OPHS) and Organizational Standards; and Address public health unit specific performance issues. The funding for mandatory and related programs (described above) is subject to the Public Health Accountability Agreement which sets out the obligations of the Ministries of Health and Long Term Care and the Boards of Health. As per routine practice since 2011, the Chair of the Board of Health (the Regional Chair) has signed a revised accountability agreement with the updated financial information included Page 2 of 9

93 93 93 Ontario Public Health Standards: Report: PHE-CRS Under the Health Protection and Promotion Act, Region of Waterloo Council serves as Waterloo Region s Board of Health. Boards of Health are expected to adhere to the Ontario Public Health Standards which outline the expectation for providing public health programs and services and the Ontario Public Health Organizational Standards which outline the expectations for the effective governance of boards of health and effective management of public health units. This report provides information related to provincial funding approvals for 2017 for mandatory and related public health programs. Corporate Strategic Plan: Provincial funding for Public Health enables the delivery of programs and services which contribute to the corporate strategic plan. For the corporate strategic plan, Public Health s work aligns most significantly with the following focus areas: Healthy, Safe and Inclusive Communities Responsive and Engaging Government Services Financial Implications: The 2017 base approval for public health programs totals $23,463,600. The following table compares the 2017 approved Regional budget for provincial funding to the actual provincial approval for Public Health as confirmed in recent correspondence from the Ministry of Health and Long Term Care. Base Funding: Cost Sharing % 2017 Approved Regional Budget Provincial Approval Difference Mandatory Programs 75% $20,114,160 $20,139,100 $24,940 Chief Nursing Officer Initiative 100% 126, ,500 (4,833) Enhanced Food Safety 100% 61,286 59,100 (2,186) Enhanced Safe Water 100% 41,266 40,400 (866) Healthy Smiles Ontario 100% 981, , Page 3 of 9

94 94 94 Report: PHE-CRS Infection Prevention and Control Nurses Initiative 100% 94,381 90,100 (4,281) Infectious Diseases Control Initiative 100% 581, ,600 (25,809) MOH/AMOH Compensation Initiative 100% 114, ,500 27,799 Needle Exchange Program 100% 125, ,000 0 Vector Borne Diseases Program 75% 234, ,000 (5,363) Small Drinking Water Systems 75% 27,196 23,600 (3,596) Social Determinants of Health Nursing Initiative 100% 183, ,500 (3,176) Smoke-Free Ontario Strategy 100% 536, ,700 (42,653) Electronic Cigarettes Act 100% 32,500 32,500 0 Total Base Funding $23,253,624 $23,213,600 ($40,024) In addition to base funding, one time funding of $297,600 (100% provincial funding) has been approved for 2017 to support the Workstation Upgrades, Healthy Menu choices Act, 2015 Enforcement, HPV Vaccine Program, Needle Exchange Program, purchase of new vaccine refrigeration equipment and implementation of the Panorama Immunization Solution technology. One Time Funding Approvals (to March 31, 2018): Provincial Approval PHI Workstation Upgrade 100% $40,000 Healthy Menu Choices Act Enforcement 100% 36,000 Human Papillomaviris Vaccine Program 100% 25, Page 4 of 9

95 95 95 Report: PHE-CRS Needle Exchange Program Initiative 100% 40,000 New Purpose Built Vaccine Refrigerators 100% 18,600 Panorama Immunization Solution 100% 138,000 $297,600 The Public Health Department will operate within the approved envelopes of provincial and Regional base and one-time funding allocations The 2017 provincial approval has formed the basis of preparation for the 2018 regional budget for Public Health. Other Department Consultations/Concurrence: Corporate Services / Treasury Services staff was involved in the preparation of the 2017 Public Health budget as well as the funding request submissions to the Province and have reviewed this report. Similarly, Treasury Services staff are involved in the preparation of the 2018 regional budget which will reflect the impacts of the new funding approvals. Attachments Attachment 1: The correspondence received from the Ministry of Health & Long Term Care (MOHLTC), dated November 15, 2017 Attachment 2: Schedule A-4 Program-Based Grants Prepared By: Approved By: Anne Schlorff, Director, Central Resources Dr. Hsiu-Li Wang, Acting Medical Officer of Health Anne Schlorff, Acting Commissioner Page 5 of 9

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