DECEMBER 2006 French Language Health Services Network of Eastern Ontario FRENCH-LANGUAGE HEALTH SERVICES IN ONTARIO S SOUTH EAST REGION Towards an Effective and Sensible Development for French-Language Health Services in Ontario s South East Region. En vue d un développement efficace et intelligent des services de santé en français dans la région du Sud-Est de l Ontario. LES SERVICES DE SANTÉ EN FRANÇAIS DANS LA RÉGION DU SUD-EST DE L ONTARIO DÉCEMBRE 2006 Réseau des services de santé en français de l Est de l Ontario
PREFACE The Association canadienne-française de l Ontario - Conseil régional des Mille-Îles (ACFO Mille-Îles) is pleased to present the results of a study conducted among South East region health service providers in an effort to depict the current state of French-language health services in the region. This study was conducted in close partnership with the French Language Health Services Network of Eastern Ontario (the Réseau) during 2006. We mandated the consulting firm of Ronald Bisson and Associates to carry out the study and we received the support of the South East Local Health Integration Network (South East LHIN) throughout the process. ACFO Mille-Îles wishes to thank the managers and staff members of agencies that answered the questionnaire, as well as all individuals who participated in the public consultations with the Francophone community, held in three different areas of the region. The summary is presented in two formats. The abridged version, Executive Summary, is intended for readers who wish to gain knowledge of the situation but lack the time to do an extensive reading of the report. The regular summary contains an outline of the process, key findings, as well as a series of recommendations concerning the planning and delivery of French-language health services and awareness-raising among the region s Francophone population. The information contained in this report sheds light on the current state of services from a Francophone standpoint, and takes a new meaning following the announcement of Kingston s designation under Ontario s French Language Services Act of 1986, to become effective May 1st, 2009. ACFO Mille-Îles is confident that this documented study will serve as a platform to support French-language health services planning efforts in the South East region. The Réseau and the South East LHIN, as planning organizations, will find herein basic information needed for their respective actions. ACFO Mille-Îles wishes to thank the Ontario Trillium Foundation (OTF) for the funding of this project. Without the OTF s support, this important study could not have been carried out 1. The summary of the study is available in English and French. The detailed French report is available by contacting ACFO Mille-Îles. 1 The Ontario Trillium Foundation, an agency of the Ministry of Culture, annually receives $100 million in government funding generated through Ontario s charity casino initiative. 1
EXECUTIVE SUMMARY The goal of this study is to depict a portrait of the state of French-language health services in Ontario s South East region: report on existing services, needs, gaps, health service priorities and potential models. A questionnaire was distributed to health care agencies and community consultations took place in three localities. Approximately 11,000 Francophones reside in this region, which is under the authority of the South East LHIN and the French Language Health Services Network of Eastern Ontario. The Réseau will soon become the primary contact for Francophones as a legal entity for health service planning in French for the Champlain LHIN region as well as the South East LHIN region. The questionnaire gathered data from 44 of 121 health service agencies, regarding their ability to provide French-language health services and their need for support in providing such services where necessary. Below are the key points of the analysis of the data provided by the agencies: Out of a total of 3,881 full-time equivalent employees, agencies identified approximately 59 who were capable of providing services in French and in English, 45 of which are health care professionals and 14 are administrators and employees offering various services. None of the positions are designated bilingual. Few agencies offer other French-language services, such as forms, informational brochures, interior and exterior signage, and few agencies have adopted measures to support the provision of French-language health services, such as hiring bilingual staff. The need for support in providing French-language health services is directly linked to the agency s perception regarding its possible designation in terms of offering French-language health services. Seventeen (17) agencies have expressed a high need for support, many of them expecting a potential designation, and 27 agencies stated having little or no need for support, as they do not expect to be designated. Below are the three key findings of the analysis of the data provided by the agencies: The offer of French-language health care services in the South East region is fragmented, uneven and random in nature. As it stands, a Francophone person who manages to obtain French-language health services in the region will do so through an element of chance rather than because these were planned services. This is understandable since the region is in the initial stages of the planning cycle regarding French-language health services. Agencies have shown a willingness to provide French-language services, but under certain conditions: agencies support the process if there is appropriate targeting, complementarity, a proper reference system; several agencies suggest that one organization act as a liaison ( focal point ) or as an information centre ( clearinghouse ); respondents believe that the agencies must above all know where to refer people, and not necessarily be able to directly provide all French-language health services. 2
It will be necessary to develop a plan to organize French-language health services, which will take the entire system into account across the territory and which will outline a process and overall action plan for developing and organizing health services geared to the Francophone population. Individual action plans to be developed by the different agencies will be required to fit into the overall process that will be coordinated by the South East LHIN and the French Language Health Services Network of Eastern Ontario. The LHIN and the Réseau, in conjunction with the local community, must therefore develop the overall plan that will guide agencies in developing their individual plans. Any other process would only increase the discontinuity in service and will not lead to a coherent development process that can ensure access, as well as the quality and durability of French-language health services in the region. Preliminary data gathered from agencies was presented during three public sessions held in Kingston, Trenton and Brockville, to which the Francophone community and its leaders had been invited. The sessions also gave the opportunity to review the Francophone health priority list (provided by the ACFO Mille-Îles health committee) and to validate possible recommendations. The study s recommendations, which serve as parameters for an action plan, are as follows: 1. It is recommended that the South East LHIN and the French Language Health Services Network of Eastern Ontario, within their respective mandates, develop a complete, detailed plan for French-language health services in the South East region, in conjunction with ACFO Mille-Îles, particularly as it pertains to the city of Kingston s new designation under the French Language Services Act of Ontario. This plan will serve as a guide for individual plans to be developed by health agencies. 2. It is recommended that ACFO Mille-Îles fully take part in the planning process aiming to ensure access to a wide range of French-language health care services in the South East region, and that it be recognized as the community respondent to that end by the Réseau and the South East LHIN. 3. It is recommended that a point of access to direct clinical French-language health services be created in the South East region. Whether this point of access is set up from an existing resource or whether a new structure is set up, it will specifically consist of a multi-service organization (providing different types of health services linking with social, educational and other such services) as well as a multidisciplinary one (including several types of health professionals, in order to provide the most comprehensive basic service that can meet the public s needs). This organization will directly provide a range of health services, notably primary health care services. It will also ensure a link, as well as coordination and progressive integration with other French-language health services already existing within the system and with those to be developed following implementation of the overall plan developed by the LHIN and the Réseau, in conjunction with agency plans. As part of its operating procedures, this point of access will need to plan for the provision of services particularly in Kingston, Brockville and Trenton. 4. It is recommended that ACFO play an important role in raising awareness within the community and disseminating information regarding French-language health services in the South East region. 3
SUMMARY OF THE STUDY Background, Objectives and Methodology Some 11,000 Francophones reside in the 5 communities that make up Southeastern Ontario, commonly known as the region of Kingston and the Thousand Islands. The local Francophone community has been seeking to have access to French-language health services for many years. Initial studies on this subject were published in 1991. In March 2004, ACFO Milles-Îles requested that the French Language Health Services Network of Eastern Ontario (the Réseau) include the region of Kingston and the Thousand Islands in the steps it will take to bring regional French-language health services to Eastern Ontario. ACFO Mille-Îles set up a health committee on January 24th, 2005. Its goal is to develop a strategy that will advance efforts on the issue of developing French-language health services in the region. The organization submitted a project request to the Ontario Trillium Foundation in June 2005, in conjunction with the Réseau. The organization was awarded a grant to conduct research aiming to obtain relevant information from agencies providing health services in the region. The specific outcome targeted by the research is: To present a portrait of the state of French-language health services in the Southeastern Ontario region: report on existing services, needs, gaps, health service priorities and potential models. Our firm has been commissioned to fulfill this mandate. A new type of player was recently created in the area of health: the Local Health Integration Networks (LHINs). The region of Kingston and the Thousand Islands is under the jurisdiction of the South East LHIN. As part of its integration plan released in October 2006, the South East LHIN lists French-language services as one of the seven (7) priorities in its Action Plan. The ACFO Mille-Îles health committee was consulted, and ACFO s Executive Director was part of the advisory committee for the South East LHIN s integrated plan. In order to develop a portrait of the situation, it was decided to proceed through means of a questionnaire that would give agencies the opportunity to transmit relevant information regarding their ability to provide French-language health services and their need for support in order to provide these services. The survey s covering letter explaining the background and requesting agencies to take part in the research was signed by Jeannine Proulx, Executive Director of ACFO Mille-Îles, and Paul Huras, Chief Executive Officer of the South East LHIN. 4
The database developed from the lists provided by the South East LHIN includes 84 names (directors or designated officials) representing a total of 105 agencies. This list includes only agencies that are receiving transfer payments from the Ministry of Health and Long Term Care. At the request of the French Language Health Services Network of Eastern Ontario, 16 additional agencies (notably Family Health Teams) were added to that list. The final list therefore includes 121 agencies. At the time of writing of this report, December 10th, 2006, we have collected responses from 35 individuals representing 44 agencies. In addition, four other agencies indicated that the study did not seem to apply to them, since they do not offer any French-language services and do not expect to be offering any; these agencies declined the invitation to take part in the study. Report on Existing Services Bilingual Employees Of the 44 agencies that responded to the questionnaire, 18 reported having bilingual employees who were able to provide French-language services. 59.1 bilingual employees (full-time equivalent) were counted out of a grand total of 3881.9 paid employees (full-time equivalent), which amounts to slightly more than 1.5% of the workforce. Of the 59.1 bilingual employees who are able to provide French-language health services, 45 are health professionals. Of all the agencies that responded to the questionnaire, none reported having any designated bilingual positions. Approximately three quarters of the respondents indicated that they were aware of Kingston s designation regarding French-language services. Several institutional organizations in Kingston and its surrounding area indicated that they are expecting to be asked to formally designate bilingual positions; few community organizations are considering this possibility. Other Services Offered in French Area Number of Agencies Forms to be completed 5 Informational and promotional brochures 8 Correspondence with users 4 Automated call answering services 0 Website 2 Exterior signage 2 Interior signage 0 News releases 0 Public presentations 2 Other services 5 5
Other Measures to Support the Provision of French-language health services Area Number of positive answers Recruitment of bilingual staff 1 Internal statutes, regulations and policies regarding the 0 provision of French-language services Bilingual members on the board of directors 1 Human resources policies 2 A French-language services committee 0 Needs for Support for the Provision of French-language health services The goal of this question was to learn the agency s needs regarding support for the potential development of French-language services. Some agencies indicated that they have not been designated and that they would not be designated, and therefore had no needs in this area. Other agencies indicated that they have not been designated as of yet, but are expecting to someday be required to provide French-language services; they are anticipating a high need for support. Agencies were given the choice to respond on a scale of 1 to 5, where 1 indicates a low level of needs and 5 indicates a high level of needs. The average of the responses to this question for each agency is directly linked to the agency s perception regarding its potential obligation to provide French-language services. The median value on a scale of 1 to 5 is 3. Therefore, any average lower than 3 indicates a low level of needs and any average higher than 3 indicates a higher level of needs. The overall average for agency needs is 2.59 for the 6 elements analyzed. With this result being lower than 3, the average confirms that agencies in general do not see a great need for support regarding the potential provision of French-language services. Thus, they do not see the need to provide French-language health services as being very relevant to them. The following table illustrates the breakdown of responses by area of need, for all agencies. 6
Agencies levels of need relating to the provision of French-language services: breakdown of responses, by area of need Area of need Frequency of responses - level of need 1 low level 2 3 4 5 high level Average Knowledge of the agency s responsibility in providing French-language services Knowledge of the needs of the Francophone clientele Knowledge of best practices in providing French-language services (examples: recruitment, hiring, outreach work with the Francophone community) Support in developing an action plan to improve French-language services within the agency Support in setting up policies, procedures or mechanisms to further the provision of French-language services Support in recruiting bilingual health professionals 22 2 8 4 8 2,41 15 4 9 4 12 2,86 16 4 7 3 14 2,89 19 5 8 4 8 2,48 19 5 4 8 6 2,45 19 8 4 2 9 2,38 Level of need, all areas 110 28 40 26 57 2,59 A deeper analysis of the situation, however, shows that the breakdown of agency responses is bimodal. In total, 17 agencies indicated a high level of need for support in the potential implementation of French-language services (average of 3 or higher). The 17 agencies in question are listed below: Frontenac Community Mental Health Services (5.00) Heart of Hastings Hospice (5.00) Land O Lakes Community Services Corporation (5.00) Providence Continuing Care Centre - St. Mary s of the Lake Hospital (5.00) Providence Continuing Care Centre, Mental Health Services Site (5.00) Providence Continuing Care Centre - Providence Manor (5.00) Access Centre for Hastings & Prince Edward Counties (4.67) Victorian Order of Nurses for Canada - Greater Kingston (4.50) Victorian Order of Nurses for Canada - Hastings/Northumberland/Prince Edward (4.50) Hospice Kingston (4.00) Ontario March of Dimes (East Region Attendant Services) / Rehabilitation Foundation for the Disabled (4.00) 7
Kingston, Frontenac, Lennox & Addington Public Health (3.83) Merrickville District Community Health Centre and Services Centre (3.67) Kingston, Frontenac, Lennox & Addington Community Care Access Centre (3.00) Addictions Centre (Hastings/Prince Edward Counties) - Mental Health (3.00) Addictions Centre (Hastings/Prince Edward Counties) - Substance Abuse (3.00) Options for Change: Community Addictions Treatment Services (3.00) Suggestions for Improving the Continuum of French-Language Health Care Services This section of the questionnaire quoted the description of the five steps of the continuum of health care developed by the French Language Health Services Network of Eastern Ontario; it then asked respondents to provide any suggestions for improvement they may have for each step. Comments given by the 32 agencies having made some 41 suggestions for improvement can be grouped into the five following themes: The need to assess the requirements of the Francophone population at each step of the continuum; The need to have access to human resources that can provide French-language health services, on the employee level as well as the volunteer level; The need for a coordinated approach for the entire territory due to the impossibility of developing bilingual services in all agencies; The importance of ensuring service in French at the system s point of entry; The need to promote available resources in French to the Francophone community (general campaigns to promote the entire system, agency-specific campaigns, brochures, etc.). Agency Interest in the Follow-up to This Study Responses given by the 32 agencies having made some 26 comments (some comments were repeated) can be grouped into the five following themes: Agencies awaiting potential designation want to respect the law and want to collaborate with any organization able to help them develop and implement their plan. Le niveau de connaissance des besoins de la communauté francophone de la région est peu élevé; les agences expriment qu elles apprécient le travail de sensibilisation de l ACFO régionale et que cette sensibilisation doit se poursuivre; elles veulent augmenter leurs connaissances concernant la populatio francophone à desservir; cette connaissance de la réalité francophone sera particulièrement utile pour les organismes de planification régionaux. The knowledge level of the needs of the Francophone community in the region is low; agencies state that they appreciate the awareness-raising work done by the regional ACFO and this awareness-raising must continue; they want to increase their knowledge of the Francophone population to whom they must provide service; this knowledge of the Francophone reality will be particularly useful to regional planning bodies. 8
Agencies want to be kept informed of future steps regarding this issue; among other things, they want to be made aware of the results of this research. Some agencies have indicated they would like to provide French-language services, whether they are designated agencies or not, since providing services to their entire clientele is part of their mission. It will be necessary to raise awareness among the general public regarding the Francophone community s presence in the region and its French-language health service needs. Research Findings The analysis of the questionnaire data leads to the following findings: Agencies demonstrated a willingness to offer French-language services (as indicated both in their responses and by their attitudes), but under certain conditions: agencies support the process if there is appropriate targeting, complementarity, a suitable referral system; some suggest that agencies act as a liaison ( focal point ) or that one agency act as an information centre ( clearinghouse ); respondents believe that the agencies must above all know where to refer individuals, and not necessarily be able to directly provide all French-language health services. The vast majority of agencies report that they have no staff members who can provide French-language services; the research did not formally assess the linguistic ability of the employees. In agencies that do have such staff members, this is seen as a happy coincidence : the positions are not designated bilingual and the ability to speak French has no impact on the recruiting process, apart from two or three cases (who consider French to be an additional asset, albeit secondary, in candidates). The majority of agencies have not adopted formal measures to support the provision of French-language services. The majority of agencies believe their support needs to be low pertaining to developing French services as matters currently stand, but should their agency be required to play an active role, their needs would then be high. They do not anticipate developing any formal mechanisms or bilingual capacities. However, if they had obligations in terms of French-language health services, they would want to respect those obligations and would like to have support. Seventeen (17) agencies expressed a high need for support, particularly in terms of furthering their knowledge of the needs of the Francophone clientele and their knowledge of best practices in providing French-language health services. The majority of agencies state that they have never or have rarely received requests for French-language health services; they say the community has not shown any signs of need in that respect. Respondents are more and more sensitive to the issue in general, but they do not believe that their agency is directly required to act on it, since historically it has never had to deal with such requests. Les répondants sont de plus en plus sensibles à la problématique en général, mais ils ne sentent pas que leur agence est interpellée directement parce que, historiquement, elle n a pas eu à faire face à de telles demandes. Several respondents also believe that the Francophone population has relatively moderate needs in terms of health, due to its profile (individuals in the military or in university, along with their families, generally young and healthy, with higher levels of education and income). Some respondents mention that the demand is sometimes more apparent with other languages (Portuguese, Mandarin for example) than with French. 9
Agencies believe that they must adapt to Francophones needs, but within reason (efficiency as far as devoting efforts and resources, in agencies individually as well as in the system in general). Respondents gave several suggestions for improvement in terms of the five steps of the health care continuum (how the Francophone individual navigates through the health care system); in particular, these suggestions involved the need to assess the requirements of the Francophone population at each step of the continuum, the need to have access to human resources that can provide services, and the need for a coordinated approach on the entire territory. There is a great deal of interest in learning research results, from the agencies (the supply ) and, most of all, the demand for French-language services. Findings of the Analysis of the Data Provided by the Agencies The results of the research confirm positive elements on which it is possible to build: open-mindedness on the part of those responsible, the presence of bilingual employees, and suggestions to facilitate referrals and liaison services in order to improve the provision of French-language services. The results also confirm the need to develop a plan to organize French-language health care services that takes the entire system into account across the territory, and that outlines a process and an overall, comprehensive action plan for developing and organizing health services geared to the Francophone population. Data regarding the availability of bilingual staff, as well as French-language materials and services confirms that the provision of French-language health care services in the South East region is fragmented, uneven and random in nature. As it stands, a Francophone who manages to access French-language health services in the region will do so through chance rather than because these were planned services. This is understandable since the region is in the initial stages of the planning cycle regarding French-language health services. This plan to organize French-language health services must integrate the Francophone community s priorities and needs on one hand, and develop an approach to providing services efficiently and effectively on the other. It appears obvious that the 121 agencies will not all be able to provide bilingual services. As several agencies have suggested, services must therefore be organized in such a way that they cover the entire territory, that they provide Francophones with a point of entry to the French system, and that they subsequently provide a service that allows Francophones to navigate through the various steps of the health care services continuum in French. This finding has a very significant impact. Individual action plans to be developed by the different agencies will be required to fit into the overall process that will be coordinated by the South East LHIN and the French Language Health Services Network of Eastern Ontario. The LHIN, in conjunction with the Réseau and the local community, must therefore develop the overall plan that will guide agencies in developing their individual plans. Any other process would only increase the discontinuity in service and will not allow for a coherent development process that will ensure access, as well as the quality and durability of French-language health services in the region. 10
Community Validation In order to achieve the objectives set out in this research, the firm also held three community consultation meetings in the communities of Brockville (November 16, 2006), Kingston (November 21, 2006) and Trenton (November 22, 2006). Approximately 20 people accepted the invitation made by the regional ACFO. These were community organization leaders, as well as individuals who work in the health care field and residents who were interested in receiving French-language health services. The firm presented the results of the research conducted with the agencies. Individuals were asked to give their opinions on the community s priority needs, and on approaches that can meet these needs. The majority of participants experienced significant difficulty when seeking French-language health care services, which they deem essential to obtain in their mother tongue (for example, French-language mental health services were obtained only by making frequent trips to Ottawa, the inability for the elderly to access French-language long term care). In the three centres, there was a common thread in participants views regarding priority needs that should be addressed by an action plan. Individuals understand that it will be impossible for 121 agencies to provide fully bilingual services. Participants state that if a point of access to French-language health services were to be established, this would make an excellent starting point. As well as providing French-language services, this point of access could allow Francophones to be referred to French services in other agencies in order to receive French-language services, and within reasonable timeframes. It should have the necessary tools and information to accomplish these tasks (for example, listing of available services, agreements made with other resources providing French-language services in the system, etc). This point of access cannot be located exclusively in Kingston. Points of access must also be set up in Trenton and Brockville. There are large distances between the three and people will not be able to travel to get to one sole point of access in Kingston. It is uniformly agreed that ACFO plays a very important role in advancing services to the community. People indicate that ACFO provides a link to all Francophones in all areas. They accept that ACFO must play an important role in the approaches to follow, in conjunction with the French Language Health Services Network of Eastern Ontario. ACFO is not nor will it ever be a health care agency. ACFO s processes must focus on the political level, where it can act as a community spokesperson, and on the level of implementation of community engagement strategies, in conjunction with the Réseau. RECOMMENDATIONS Recommendations for Planning French-Language Health Care Services The main responsibility in terms of planning lies with the LHIN. The LHIN must see to developing Frenchlanguage services for its region and work closely with the Francophone community, given that community engagement is a key factor in changing the health care system. The Local Health System Integration Act, 2006 forecasts that the LHIN will engage Francophone communities through local French-language health planning entities. French-language health networks have been identified to perform this task. 2 2 Article 16, paragraph 4, clause b): In carrying out community engagement under subsection (1), the local health integration network shall engage the French language health planning entity for the geographic area of the network that is prescribed. 11
Recommendation 1: It is recommended that the South East LHIN and the French Language Health Services Network of Eastern Ontario, within their respective mandates, develop a complete, detailed plan for French-language services in the South East region in cooperation with ACFO Mille-Îles. As well, approaches will need to be taken to raise awareness among the region s health agencies regarding their health service obligations. Recommendation 2: It is recommended that ACFO Mille-Îles fully take part in the planning process aiming to ensure access to a wide range of French-language health care services in the South East region, and that it be recognized as the community respondent to that end by the Réseau and the South East LHIN. Recommendation for Providing French-Language Health Services Recommendation 3: It is recommended that a point of access to direct clinical French-language health services be created in the South East region. Whether this point of access is set up from an existing resource or by setting up a new structure, it will specifically be a multi-service organization (providing different types of health services linking with social, educational and other such services) as well as a multidisciplinary one (including several types of health professionals, in order to provide the most comprehensive basic service that can meet the public s needs). Occupying a physical space of which the community will be aware, this organization will directly provide a range of health services, notably primary health services. It will also ensure a link, as well as coordination and integration with other French-language health services already in place in the system and with those to be developed following implementation of the LHIN s overall plan. It is reminded that this overall plan will include potential designations of agencies or programs that are to provide French-language services and that these agencies and programs must also develop their plans for providing French-language health services. This organization will play an important role in providing French-language health services throughout the entire South East region. As part of its operating procedures, this point of access will plan for the provision of services particularly in Kingston, Brockville and Trenton. The specific model for this point of access remains to be developed. Recommendation for Raising the Francophone Community s Awareness Recommendation 4: It is recommended that ACFO play an important role in raising awareness within the community and disseminating information regarding French-language health services in the South East region. 12
This study was conducted in collaboration with the French Language Health Services Network of Eastern Ontario. www.rssfe.on.ca This study was prepared and written by Ronald Bisson and Associates, Management Consulting, Ottawa. Coordination: Jeannine Proulx, Executive Director Translation: Allset Inc., Ste-Catherines Graphic design: Denis Langlois, Belleville Note: The detailed French report Situation Assessment: French-Language Health Services in Ontario s South-East Region is available by contacting ACFO Mille-Iles at 613-546-7863 or by e-mail at info@acfomi.org. ACFO Mille-Îles, Fall 2007. Reproduction of this publication with reference to the source is permitted. Contact information: R.R.2, 760 Hwy 15, Kingston, Ontario, K7L 5H6 Telephone: 613-546-7863 Toll free: 1-800-561-4695 Fax: 613-546-7918 E-mail: info@acfomi.org Web Site: www.acfomi.org