For the sake of children, this ministry needs a reset

At the end of my work week last week, I hung up after my third phone call in one month to the Ministry of Children and Family Development’s child protection phone line.

This phone line is for professionals, for doctors like me, or teachers, nurses and others, to call when there is concern a child or youth requires some type of protection, usually from issues of neglect and harm.

This was my third call, for different children, in one month, and I am only one professional. Each time, I was on hold for 80 minutes.

I hate to think how long the “non-professional” phone line would have been. I hate to think who gives up and doesn’t report their concern at all.

This phone line wait is emblematic of the disconnection between the ministry system that says they exist to protect children from harm, and the system that exists.

Does it reflect a huge volume of calls, or being too short staffed for the need? Either way, it’s horrifying.

Each worker I spoke to said “I know, it’s bonkers around here, so busy with calls” or some variation.

Why is this not a headline, just like waitlists in the ER or for walk in care, or for orthopedic surgery? Why is the time on hold of a professional calling in of so little value?

Even a phone company asks after a call “How did we do? Rate us here.” But here is an important issue: with MCFD, there appear to be no benchmarks to reach, and no client feedback.

The mandate of the ministry is to support children and families to live in safe, healthy, and nurturing families. It’s important to emphasize “safe” when we think about what “unsafe” is when you are a child, and what level of “unsafe” is OK.

We have an idea of what a surgical waitlist is, and how long we should wait to see an urgent care doctor; the benchmarks for “unsafe children” appear murkier, yet are essential.

MCFD provides service lines across six service areas, including services to our most vulnerable children: like those in foster care, those with special needs, and those with mental health issues.

When the ministry evaluated themselves in 2017 to the legislature in a presentation, only three out of 41 performance indicators across the six service lines were ranked as “of concern” and all others were “unchanged” and “improving.” The Current Performance Barometer that MCFD used to rank itself was “improving.”

How satisfying. But as a version of a consumer of MCFD services, I see many areas of concern.

I wait on hold for literally hours to report that I think a child is unsafe and neglected. My other patients who require MCFD services, such as through the branches of Children and Youth with Special Needs, or Child and Youth Mental Health, will tell you, if you ask them, how inaccessible, opaque and convoluted the services are. But they are never asked.

What can be done?

The government could go back and find all the previous reviews and reports, the “new roadmaps” “new visions for mental health care” and not write another until they have read the ones already written, and accounted, in a public facing way, for how they have or have not met previous recommendations to improve access, to integrate ministries, to listen to schools and physicians and other professionals, and to be less reactive and more anticipatory.

They could increase frontline workers. The Ministry of Children and Family Development could have regular external reviews of benchmarks and quality measures. MCFD could be brought back under the Ministry of Health in areas such as children’s mental health to share goals and streamline care.

MCFD also needs to re-focus when it comes to children and youth with special needs. The medically frail children and youth need to be seen and their families brought in as patient partners for feedback that could be used as a measure of health care, insofar as Care Co-ordination and Care Close to Home is as explicit a benchmark as any surgical wait time.

There could be clear accountability for when the system fails in not addressing suffering, or for making families be marooned without explicit navigation.

MCFD could have researchers shadow families and clients through their care experience from the time of initial intake. Document that experience, just as learning happens about pathways from the ER to the OR, or surgical complications, and design streamlined, accountable, high-quality care.

MCFD and the government need to reflect deeply about who they see, and who is missing.

It was news to MCFD when I told them last week a certain young child hadn’t been at school for three months. Nobody seemed to know.

She was unseen by anyone, in the care of an unwell adult, and it took almost an hour and a half to get through to highlight how very, very concerning this is.

I am one of about 270 pediatricians in this province many with similar stories.

A rapid cycle of change for this ministry, with a re-set of its structure and systems, cannot come soon enough.