regional municipality of waterloo community services ... car dated march 20, 2018. cs agenda - 2...

Media Release: Friday, March 16, 2018, 4:30 p.m.

Regional Municipality of Waterloo

Community Services Committee

Agenda

Tuesday, March 20, 2018

Approximately 11:00 a.m.

Immediately Following Administration and Finance Committee

Regional Council Chamber

150 Frederick Street, Kitchener, Ontario

1. Declarations of Pecuniary Interest under the Municipal Conflict Of InterestAct

2. Delegations

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.

3. Request to Remove Items from Consent Agenda

4. Motion to Approve Items or Receive for Information

4.1 PHE-PSV-18-02, Paramedic Services Performance Measurement Report January to December 2017 (year-end) (Information)

Page 6

Should you require an alternative format please contact the Regional Clerk at Tel.: 519-575-4400, TTY: 519-575-4605, or [email protected]

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4.2 PHE-CFH-18-01, Sleep and Your New Baby Session for New Parents in Waterloo Region (Information)

Page 14

4.3 PHE-HPI-18-02, Vector-Borne Disease Program Summary (Information) Page 19

4.4 CSD-CHS-18-05, Increased Staffing for Child Care Fee Subsidy Page 26

Recommendation:

That the Regional Municipality of Waterloo approve the addition of up to 3.0 permanent full time equivalent (FTE) child care subsidy caseworkers for Community Services/ Childrens Services to be funded by provincial subsidy at an annualized cost of $275,359 and $0 net levy, as outlined in report CSD-CHS18-05, dated March 20, 2018.

4.5 CSD-CHS-18-06, The Journey Together Child and Family Centre Service Provider

Page 29 Recommendation:

That the Regional Municipality of Waterloo take the following actions with respect to the Journey Together Initiative to create an Indigenous-led family and child centre, as outlined in Report CSD-CHS-18-06 dated March 20, 2018:

a) Approve entering into a service agreement for the period April 1, 2018to December 31, 2019 with Anishnabeg Outreach for the creation andprovision of an Indigenous-led child and family centre;

b) Approve operating funding of $300,000 to Anishnabeg Outreach basedon the Journey Together provincial allocations to the Region;

c) Approve one time funding of $167,500 to Anishnabeg Outreach for2018;

d) Authorize the Commissioner, Community Services, to execute suchagreements and documentation in a form satisfactory to the RegionalSolicitor, as may be required to advance the Journey Together funding.

4.6 CSD-HOU-18-08, Community Housing Waiting List Local Priorities and Status Policy Updates


That the Regional Municipality of Waterloo approve the recommended changes to Community Housing Program policies as outlined in report CSD-HOU-18-08, dated March 20, 2018.

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4.7 CSD-HOU-18-07, Social Housing Apartment Improvement Program (SHAIP) and GreenON Social Housing Program (GreenON)


That the Regional Municipality of Waterloo take the following actions with regard to the Social Housing Apartment Improvement Program (SHAIP) and GreenON Social Housing Program (GreenON), as described in Report CSD-HOU-18-07, dated March 20, 2018:

a) Authorize the submission of a Business Case and Program Delivery FiscalPlan for Years 2 - 4 of SHAIP as described in report CSD-HOU-18-07;

b) Authorize the submission of a Business Case for funding opportunities withthe GreenON program as described in report CSD-HOU-18-07;

c) Authorize the Commissioner, Community Services to execute suchagreements and documentation in a form satisfactory to the RegionalSolicitor, as may be required to advance funding for SHAIP and GreenON;

d) Authorize the Director of Housing Services to execute and deliver alldocumentation required by the Province of Ontario and the Region ofWaterloo for the purpose of implementing SHAIP and GreenON;

e) Authorize the Commissioner, Community Services to re-allocate any unspentallocation in accordance with program key outcomes and priority work;

f) increase the 2018 Operating Budget for Community Services / HousingServices by $27,610 gross and $0 net Regional Levy to be funded byprovincial grants for the Social Housing Apartment Improvement Program(SHAIP); and

g) increase the 2018 Capital Budget for Community Services / HousingServices by $699,252 gross and $0 net Regional levy to be funded byprovincial grants for the Social Housing Apartment Improvement Program(SHAIP).

Regular Agenda Resumes

5. Reports Interdepartmental

5.1 CSD-HOU-18-09/COR-TRY-18-24, P2018-04 Housing Stability System: Prioritized Access to Housing Support (PATHS) Team Lead Agency (Presentation)


That the Regional Municipality of Waterloo accept the proposal of Lutherwood for the P2018-04 Prioritized Access to Housing Support (PATHS) Team Lead Agency for a two (2) year term starting April 1, 2018 and ending March 31, 2020

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at an estimated cost of $1,474,724.00 (estimated annual cost of $737,362) as outlined in Report CSD-HOU-18-09/COR-TRY-18-24 dated March 20, 2018;

And that the Regional Municipality of Waterloo authorize the Commissioner, Community Services to execute such agreements and documentation in a form satisfactory to the Regional Solicitor as may be required to process annual funding to Lutherwood;

And that the Regional Municipality of Waterloo approve transition funding not to exceed $10,000.00 to K-W Working Centre for the Unemployed for the period April 1, 2018 to September 30, 2018.

5.2 CSD-HOU-18-10/COR-TRY-18-25, P2018-01 Housing Stability System: Portable Home-Based Support (HBS) Team Lead Agency (Presentation)


That the Regional Municipality of Waterloo accept the proposal of Lutherwood for the P2018-01 Portable Home-Based Support (HBS) Team Lead Agency for a two (2) year term starting April 1, 2018 and ending March 31, 2020 at an estimated cost of $3,375,316.00 (estimated annual cost of $1,687,658.00) outlined in Report CSD-HOU-18-10/COR-TRY-18-25 dated March 20, 2018;

And that the Regional Municipality of Waterloo authorize the Commissioner, Community Services to execute such agreements and documentation in a form satisfactory to the Regional Solicitor as may be required to process annual funding to Lutherwood; and

And that the Regional Municipality of Waterloo approve transition funding not to exceed $634,712 to Argus Residence for Young People, Cambridge Self Help Food Bank, Cambridge Shelter Corporation, House of Friendship of Kitchener, KW Working Centre for the Unemployed, Kitchener-Waterloo Young Women's Christian Association and Reaching our Outdoor Friends (Kitchener) for the period April 1, 2018 to September 30, 2018.

Reports Chief Administrative Officer

5.3 CAO-SPL-18-01, Wellbeing Waterloo Region Page 69

Recommendation:

That the Regional Municipality of Waterloo endorse the Wellbeing Waterloo Region work to date and the proposed next steps, including undertaking a collaborative citizen survey, all as described in Report CAO-SPL-18-01, dated March 20, 2018.

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Reports Public Health and Emergency Services

5.4 PHE-IDS-18-05, Update on Opioid Data

6. Information/Correspondence

6.1 Council Enquiries and Requests for Information Tracking List Page 99

7. Other Business

8. Next Meeting

Public Input Meeting 6:30 p.m. March 21, 2018 - Regional Council Chamber

Public Input Meeting 6:30 p.m. April 4, 2018 Cambridge City Hall

Regular Meeting April 10, 2018 - Regional Council Chamber

9. Motion to go into Closed Session

That a closed meeting of the Planning and Works Committee be held on Tuesday, March 20, 2018 immediately following the Community Services Committee meeting in the Waterloo County Room in accordance with Section 239 of the Municipal Act, 2001, for the purposes of considering the following subject matters:

a) receiving of advice subject to solicitor-client privilege regarding the proposedor pending acquisition or disposition of land in the City of Cambridge

b) receiving of advice subject to solicitor-client privilege and proposed orpending acquisition of land in the City of Waterloo

c) receiving of advice subject to solicitor-client privilege and proposed orpending litigation on a matter before an administrative tribunal

d) receiving of advice subject to solicitor-client privilege in relation to aprocurement process and negotiations on behalf of the municipality

e) receiving of advice subject to solicitor-client privilege in relation to a matterbefore an administrative tribunal

10.Adjourn

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Report: PHE-PSV-18-02

Region of Waterloo

Public Health and Emergency Services

Paramedic Services

To: Chair Geoff Lorentz and Members of the Community Services Committee

Date: March 20, 2018 File Code: P05-80

Subject: Paramedic Services Performance Measurement Report January to December 2017 (year-end)

Recommendation:

For Information.

Summary:

The Paramedic Services Performance Measurement Report provides data and analysis of results and key indicators for the one-year period of January to December 2017. The Paramedic Services Master Plan guides decision making and planning; ongoing performance measurement and monitoring allows assessment of results in comparison to the plan and assists in ensuring quality performance and excellence in patient care.

Call Volumes

The 52,771 vehicle responses provided by Paramedic Services in 2017 is the highest yearly total to date. It also represents the largest year-over-year growth, both in absolute and relative terms (4,194 or 8.6 per cent additional vehicles responses compared to 2016), in the services history. The number of vehicle responses provided in 2017 exceeded the Paramedic Services Master Plan projection for 2017 by 3,918 (8.0 per cent).

Offload Delays

Compared to 2016, offload delay more than doubled in 2017 resulting in the loss of 101 additional ambulance days. An average of 16.0 ambulance days per month was lost to offload delay in 2017.

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Response Times

For 2017, response times were slightly faster (improved 2.8 per cent), and compliance to the Response Time Performance Plan incrementally improved across all categories.

Unit Utilization

The addition of three 12-hour ambulances in July 2017 helped to offset the continued growth in call volumes and the impact of offload delay. Following the introduction of the three additional ambulance units in July 2017, unit utilization improved from 41.3 per cent in the first half of the year to 37.3 per cent in the second half of 2017. Improvements in this range are typical when ambulance units are added in July. Overall, the 12 month moving average for unit utilization was 39.3 per cent at the end of 2017; slightly higher (worse) than the 38.8 achieved at year-end 2016. It is anticipated that the additional ambulance units added in February 2018 (as per the Paramedic Services Master Plan), will continue to help address the increasing call volumes and improve unit utilization.

Report:

The report contains four indicator categories: 1. Volume and Service Level (How much did we do?) 2. Compliance and Quality Assurance (How well did we do it?) 3. Efficiency (How efficiently did we do it?) 4. Service and Quality Impact (How well is the service being performed?)

To produce this report, and the indicators included in it, a number of data sources were used. Due to the nature of Paramedic Services, the Region of Waterloo relies on a joint effort with external parties to access accurate and reliable data in as timely a fashion as possible. The Ambulance Dispatch Reporting System (ADRS), Central Ambulance Communications Centre (CACC), and St. Marys Hospital are sources of data for a number of indicators. For the remaining indicators, data values have been pulled from the Paramedic Services TabletPCR (an internal tool used to track information and data relevant to calls and patient care reporting). The Paramedic Services Performance Measurement Report will continue to undergo additional refinement in the future as new key indicators are identified and existing measures refined.

Note, a 12-hour ambulance was added in each year in July of 2011, 2012, 2013, 2015, and an emergency response unit was added in 2014. Changes in 2016 included two 12hour ambulances added in July 2016 as well as a scheduling adjustment at the end of September 2016. Three additional 12-hour ambulances were added in July 2017. As part of the 2018 budget process two additional 12-hour ambulances were authorized for service beginning in early 2018. The effects of these two 12-hour ambulances, added February 18, 2018, one on a shift of 06:00 to 17:59, and the other on a shift of 18:00 to 05:59, are not reflected in this report as they are outside of the 2017 reporting period.

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Performance Highlights for January to December 2017 include:

Volume and Service Level For 2017, Paramedic Services responded to 45,621 calls resulting in 52,771

vehicle responses; an 8.6 per cent increase in vehicle responses compared to 2016.

2017 was the largest year-over-year growth in the services history with a total of 4,194 additional vehicle responses, or 12 additional vehicle responses per day, compared to 2016.

The rate of vehicle responses for every 1,000 people increased 7.1 per cent compared to 2016

Following the introduction of three additional ambulance units in July 2017, unit utilization, the percentage of an hour that ambulances are actively engaged in responding to calls as opposed to waiting for calls, improved, from 41.3 per cent in the first half of the year to 37.3 per cent in the second half of 2017.

Improvements in this range are typical when ambulance units are added in July. Overall, the 12 month moving average for unit utilization was 39.3 per cent at the end of 2017; slightly higher (worse) than the 38.8 achieved at year-end 2016. It is anticipated that the additional ambulance units to be brought on in February 2018 (as per the Paramedic Services Master Plan), will continue to help address the increasing call volumes and improve unit utilization.

o Unit utilization by time of day: Overnight period (00:00-05:59) = 34.5 per cent Morning period (06:00-11:59) = 39.8 per cent Afternoon period (12:00-17:59) = 38.2 per cent Evening period (18:00-23:59) = 42.8 per cent

For 2017, a typical day consisted of, o Four hours of each day meeting the master plan benchmark unit utilization

of 35 per cent or lower. o Ten hours of each day unit utilization is more than 35 per cent to 40 per

cent or less. o Ten hours of each day unit utilization is above 40 per cent.

The inability for the current triage tool to differentiate call priorities means that growth remains quickest in calls assigned higher priority at dispatch; urgent calls cannot be deferred.

o In the past five years, Urgent (code 4) vehicle responses have increased 40 per cent. Prompt (code 3) vehicle responses have increased 15 per cent. Scheduled (code 2) vehicle responses have decreased 60 per cent. Deferrable (code 1) vehicle responses have decreased 90 per cent.

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Compliance and Quality Assurance The regional 80th percentile response time to emergency calls quickened

(improved) by 16 seconds, or 2.8 per cent, to 9 minutes and 21 seconds in 2017 compared to 9 minutes 37 seconds in 2016.

Despite the growth in call response volume throughout 2017, response times improved, in part due to three 12-hour ambulances added in July 2017.

Across all acuity levels Paramedic Services improved its compliance and response times. Response Time Performance Plan compliance was achieved for CTAS 1 through 5, and nearly achieved for sudden cardiac arrest (SCA).

Efficiency Indicators For 2017, 192.5 ambulance days were lost to offload delay; more than double the

number lost in 2016. An average of 16.0 ambulance days per month is being lost to offload delay.

o Paramedic Services continues to work with area Emergency Departments to maximize the effect of the allocated funding and partially offset our offload delay losses. For example, Regional Councils advocacy on behalf of Paramedic Services in

November 2017 to the Ministry of Health and Long-term Care to, immediately increase funding to the dedicated offload nurse program, to a level proportionate with the degree of offload delay in our local Emergency departments and, that this increase to ongoing base funding be effective immediately.

Using strategies to release crews to respond to the next 911 call being received (e.g. offloading patients to the waiting room, doubling of patients, etc.).

Shifting offload nursing hours to periods of greater demand from periods of reduced demand. For example, in 2017 most offload delay occurred:

o In January (15.6 per cent), or o Monday to Friday (78.4 per cent), or o Afternoons, 12:00 to 17:59 (45.2 per cent).

Code yellow occurs when Region of Waterloo Paramedic Services is at minimum coverage of three vehicles or less.

o For 2017, 10.5 per cent of time, the equivalent of 35.8 days, was spent in code yellow compared to 9.9 per cent of time (37.7 days) in 2016. There were 97 fewer code yellow events in 2017 compared to 2016.

o Code yellows are occurring less frequently, but when they are occurring, they are, on average, longer in duration.

Code red occurs when no local ambulances are available to respond to the next emergency call and no out of town services are immediately available to assist.

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o For 2017, 0.6 per cent of time, the equivalent of 2.3 days, was spent in code red which was the same as in 2016 (0.6 per cent). There were 17 more code red events in 2017 compared to 2016.

o Code reds are occurring more frequently, but when they are occurring, they are, on average, shorter in duration.

The fewer number of code yellows events, but more code red events that occurred in 2017 indicate that, in general, ambulance availability experienced more, sharper (higher) peaks, and fewer, broad plateaus of reduced availability or complete unavailability.

Service and Quality Impact Service type indicators tend to fluctuate around the average over time,

particularly when a small number of cases are involved. Currently all indicators are within acceptable ranges.

The percentage of stroke patients taken to stroke facilities was 3.3 per cent higher in 2017 compared to the same time period in 2016.

Any return of spontaneous circulation (ROSC) is deemed positive. The service remains in an acceptable range relative to the historical average (variation is normal due to a small numbers of cases).

Corporate Strategic Plan:

Strategic Plan Focus Area 4 .4 Promote and support healthy living and prevent disease and injury

Strategic Plan Focus Area 5.4 Ensure regional programs and services are efficient, effective and provide value for money

Financial Implications:

Paramedic Services budgets are funded 50% by the Ministry of Health and Long Term Care and 50% through the local tax levy.

Other Department Consultations/Concurrence:

Information Technology staff from the Corporate Services Department collaborated with Public Health and Emergency Services staff on the production of this report.

Attachments

Appendix A: Paramedic Services Performance Measurement Report, for the period of January December 2017 (year-end), produced February 12, 2018, Summary.

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The detailed January December 2017 (year-end) report is distributed separately for Councillors and is available online at the following link:

January December 2017 (year-end): https://www.regionofwaterloo.ca/en/regional-government/resources/ReportsPlans--Data/Public-Health-and-EmergencyServices/ParamedicServices_PerformanceMeasurement_Q4_2017.pdf

Prepared By: Stephen Van Valkenburg, Director/Chief Paramedic Services Stephen Drew, Health Data Analyst

Approved By: Dr. Hsiu-Li Wang, Acting Medical Officer of Health Anne Schlorff, Acting Commissioner

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https://www.regionofwaterloo.ca/en/regional-government/resources/Reports-Plans--Data/Public-Health-and-Emergency-Services/ParamedicServices_PerformanceMeasurement_Q4_2017.pdfhttps://www.regionofwaterloo.ca/en/regional-government/resources/Reports-Plans--Data/Public-Health-and-Emergency-Services/ParamedicServices_PerformanceMeasurement_Q4_2017.pdfhttps://www.regionofwaterloo.ca/en/regional-government/resources/Reports-Plans--Data/Public-Health-and-Emergency-Services/ParamedicServices_PerformanceMeasurement_Q4_2017.pdf


Appendix A Paramedic Services Performance Measurement Report, for the period of January December 2017 (year-end), Produced February 12, 2018, Summary.

A. Volume and Service Level Indicators1

Indicator Year-end

2016 Year-end

2017 Per cent change

Number of vehicle responses* 48,577 52,771 +8.6%

Rate of vehicle responses per 1,000 population*

83.3 89.1 +7.1%

Unit utilization* 38.8% 39.3% 1.2%

B. Compliance and Quality Assurance Indicators2

Indicator Year-end

2016 Year-end


Paramedic Services response time to emergency calls 9min 37sec 9min 21sec -2.8%

Response Time Performance Plan compliance resuscitation calls (CTAS1)* 71.7% 73.8% +2.9%

Response Time Performance Plan compliance emergent calls (CTAS2)* 79.0% 81.6% +3.3%

C. Efficiency Indicators3

Indicator Year-end

2016 Year-end


Offload delay measurement (Number of 24 hour ambulance days)* 91.6 days 192.5 days +110.1%

Code yellow status (per cent of total time) 10.5% 9.9% -5.6%

Code red status (per cent of total time) 0.6% 0.6% 0.0%

1 Volume and service level indicators can be forecasted, but do not necessarily require

targets. They are monitored to identify trends to inform action as relevant to address the changing demands on the service. 2 Compliance and Quality Assurance indicators do have targets, and Paramedic Services strives to continually improve reporting period over reporting period, understanding variances and taking appropriate action. 3 Efficiency indicators provide tracking mechanisms to see overall system status/health. The target is to continually improve reporting period over reporting period, understanding variances and taking appropriate action.

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D. Service and Quality Impact Indicators4

Indicator Year-end

2016 Year-end


Stroke patient to stroke facility* 86.9% 89.7% +3.3%

Return of spontaneous circulation* 13.5% 14.1% 4.7%

Heart attack (STEMI) protocol* 58.4% 64.4% +10.2%

*Indicator is captured in a similar fashion (with some variation in measurement) within a portion of the MBNCanada (formerly OMBI) reporting process.

4 Service and Quality Impact indicators tend to fluctuate around averages, due to the shared nature of responsibility among multiple parties. They are monitored over time for trending to understand possible patterns and improvement opportunities.

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Report: PHE-CFH-18-01

Region of Waterloo


Child and Family Health



Subject: Sleep and Your New Baby Session for New Parents in Waterloo Region

Recommendation:

For information

Summary:

The first five years of life build the brains structure and foundation for learning throughout life. This report provides an overview of a Sleep and Your New Baby session that is available through local EarlyON Child and Family Centres in Waterloo Region to help parents of infants 0-3 months of age recognize the importance of the early months in their childs life. Staff at the EarlyON Child and Family Centres deliver the session, with development, training and consultation support from Public Health staff. . The Sleep and Your New Baby sessions contribute to the Healthy Growth and Development, and the Chronic Disease Prevention and Wellbeing requirements of the 2018 Ontario Public Health Standards. All parents of newborns in the Region have an opportunity to register and attend a session.

Report:

Experiences in the first 5 years of life build the brains structure and foundation for learning that will stay with a child for their entire lifetime, as outlined in The Big Bang: The First 2000 Days council report (April, 2015). However, research shows that many parents have a knowledge gap around the importance of these early months in their childs life. The Sleep and Your New Baby session is designed to help address this knowledge gap.

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http://www.regionofwaterloo.ca/en/regionalgovernment/resources/cs/sa2015-0414.pdfhttp://www.regionofwaterloo.ca/en/regionalgovernment/resources/cs/sa2015-0414.pdf

15 15March 20, 2018 Report: PHE-CFH-18-01

The newborn period may be the intervention point par excellence across the lifespan1 to influence the development of parent- infant relationships. This is important for building healthy brain architecture for learning and also for forming self-regulatory behaviours such as sleep.

Infants have very minimal self-regulation skills at birth; however these skills are learned and developed through positive parent-infant interactions. Research suggests that the most rapid period for the consolidation of night time sleep regulation occurs in the first four months of life.

The Sleep and Your New Baby session was developed, by adapting, with permission, content from the NCAST (Nursing Child Assessment Satellite Training) Keys to Caregiving Program of NCAST Programs, University of Washington. The NCAST Keys to Caregiving program is an evidence based program that, until recently, has only been provided in home-visit settings with high risk families. The program material has been adapted for a group setting and is now universally available to all parents of infants up to 3 months of age throughout Waterloo Region.

The session helps parents know about:

Their babys cues, how it is a language that babies communicate with, and how parents can respond to their childs cues

The sleep-wake cycle and how parents can help their child move through each stage

Strategies they can use to promote sleep for their child Community resources and services

Parents attending the session are encouraged to bring a support person and/or an interpreter.

What Participants are saying:

Since its launch in January 2016 to December 2017, 665 parents have attended Sleep and Your New Baby sessions. Evaluations completed by 481 participants indicate that goals for the program are being reached with the vast majority of feedback survey respondents stating they:

learned something new from the session would refer someone else to the session, and would continue to access the EarlyON Child and Family Centres

Parents attending the session have also commented that:

1 Nugent, J. (2015). The newborn behavioural observations system as a form of intervention and support for new parents. Zero to Three, 36(1), 2-10. 2454736 Page 2 of 5

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they appreciate that the course is delivered in a compassionate way their parenting struggles are validated and normalized they feel supported to share their experiences every parent should attend

A Partnership Model:

Region of Waterloo Public Health and Emergency Services provides expertise in content development, training and evaluation of Sleep and Your New Baby sessions; while the EarlyON Child and Family Centres provide staff to facilitate the sessions.

Delivering the Sleep and your New Baby sessions at EarlyON Child and Family Centres introduces parents to the EarlyON Centres and the local early years system. The Early Years system provides families with access to referrals, information and programs for families with children up to 6 years of age.

There is a commitment in this partnership to offer the Sleep and Your New Baby sessions throughout the Region, working together to ensure that the sessions are available in various formats, locations and languages, as needed.

Current Relevance

The Sleep and Your New Baby session contributes to the requirements in two areas of the 2018 Ontario Public Health Standards. The Healthy Growth and Development Standard requires consultation and collaboration with local stakeholders to address needs related to growth and development and positive parenting. As well, the Chronic Disease Prevention and Wellbeing Standard has sleep listed as a topic to be considered in responding to local needs for Public Health interventions.

Recommendations put forward by the Ministry of Education related to the transformation of the Ontario Early Years system emphasizes programming that involves parents interacting with their children. The delivery format of the Sleep and Your New Baby session which encourages parents to bring and engage with their baby during the session aligns with these recommendations and aligns with the principles of familycentred service delivery.


This report relates to Focus Area 4 in the 2015-2018 Corporate Strategic Plan: Healthy, Safe and Inclusive Communities; addressing strategic objective 4.1: Support early learning and child development.


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budgets are established by the Board of Health and are funded up to 75% by the province, with the remainder funded by the local tax levy.


Sleep and your New Baby sessions are being conducted in EarlyON Child and Family Centre settings, in consultation with Childrens Services Division of Community Services Department.

Attachments

Appendix A: Sleep and Your New Baby Session Poster

Prepared By: Sheryl Wilk, Public Health Nurse, Child and Family Health Deborah Azim Fleming, Manager, Child and Family Health


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Appendix A: Sleep and Your New Baby Session Poster

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Report: PHE-HPI-18-02

Region of Waterloo


Health Protection and Investigation



Subject: Vector-Borne Disease Program Summary

Recommendation:

For information.

Summary:

To reduce the risk of vector-borne diseases, including West Nile Virus and Lyme disease, Public Health conducts human case and vector surveillance, vector control, and provides public education on personal protective measures.

In 2017, there were three human cases of West Nile Virus (confirmed and probable) reported in Waterloo Region, one of which was locally acquired. This was a slight rise compared to 2015 (1 case) and 2016 (0 cases). A similar increase was seen across the province, with 158 cases in Ontario in 2017, compared to 56 in 2016.* Public Health will continue to conduct mosquito surveillance and control efforts in 2018, with the following operational adjustments: (1) alter routine municipal catch basin larviciding from three to two treatments across Waterloo Region to better align with evidence supported by literature and local surveillance, retaining the option to conduct a targeted third round of treatment around West Nile Virus hot spots, up to a full round of Region-wide treatment, if necessary; (2) allocate potential savings to support other vector-borne disease program needs, such as enhanced public education for the prevention of Lyme disease.

Seven human cases of Lyme disease, all acquired outside the Region, were reported to Public Health in 2017. * Seven black-legged ticks, also acquired outside the Region,

* Ontario and Waterloo Region data for 2017 should be considered preliminary and subject to future revisions. 2587250

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were submitted to Public Health for identification and testing, and tested positive for the bacterium that causes Lyme disease. At the present time, Waterloo Region is not an endemic area for the black-legged tick, and the risk of acquiring Lyme disease locally is low. However, Lyme disease is on the rise in Ontario in endemic regions, with 967 cases reported in 2017. * This is more than double the number of human cases seen in previous years. Public Health will continue to conduct Lyme disease surveillance in 2018.

Report:

Vectors, like mosquitoes and ticks, can transmit diseases from one animal to another, including humans. In Ontario, the vector-borne diseases of significance are West Nile Virus and Lyme disease. Public Health conducts surveillance and works to minimize the risk of vector-borne disease in Waterloo Region.

West Nile Virus

West Nile Virus is primarily a disease of birds, but can be spread to humans through the bite of an infected mosquito. While most people infected with West Nile Virus have no symptoms, about one in five will develop mild flu-like symptoms, and one in 150 infected individuals will develop serious neurological symptoms.

Three human cases of West Nile Virus were reported to Public Health in 2017, while provincially there were 154 cases in humans.* These numbers are within the expected normal seasonal fluctuations. Historically, Waterloo Region has experienced low West Nile Virus activity. In the past 10 years, there have been seven locally acquired human cases, plus two travel-related cases, for an average rate of 0.2 cases per 100,000 population. This rate is lower than the average rate for Ontario (0.5 per 100,000) and similar to, or lower than, the rate for adjacent health units. Human case surveillance will continue in 2018 to monitor disease trends.

In 2017 there were 16 mosquito trapping sites in the cities and rural areas across the region. Trapping provides timely information on West Nile Virus activity within the mosquito population across the region, and is an important source of surveillance data. Three pools of mosquitoes tested positive for the virus in 2017, which is slightly higher than previous years but remains within the expected seasonal fluctuations. Since 2007, very few mosquito pools have tested positive for the presence of West Nile Virus in Waterloo Region, a total of only 18 out of almost 6000 pools tested. The low number of positive pools aligns with other surveillance evidence indicating an overall low risk of acquiring West Nile Virus in Waterloo Region. Public Health will continue to conduct adult mosquito trapping throughout the Region, and respond to any locations with identified West Nile Virus activity as needed.

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Only adult female mosquitoes of certain species are capable of carrying and transmitting West Nile Virus to humans. The preferred habitat of these vector mosquito species is artificial pools of standing water typically found in urban areas, rather than naturally occurring pools that are found in rural areas. Therefore, catch basins, or storm drains, are important points to target for vector control. Larvicide is designed to prevent larvae from developing into adult mosquitoes.

Catch basin larvicide treatments were applied to about 55,000 municipal catch basins in Waterloo Region in three treatment rounds in 2017. Monitoring of mosquito breeding sites, including natural sites, ditches and storm water management ponds resulted in the additional treatment of 3.87 hectares of standing water. In 2017, standing water complaints regarding privately owned sites were referred to area municipalities with standing water by-laws (City of Kitchener, City of Waterloo). Where standing water complaints could not be referred, Public Health staff undertook on-site investigation and followed-up in person with property owners to ensure that standing water was remediated to reduce mosquito breeding grounds and thereby supress vector mosquito populations. Public Health received nine standing water complaints in 2017, resulting in five site visits and four referrals to the appropriate municipality.

Historically, Public Health has conducted three rounds of municipal catch basin larvicide treatment annually, taking place in the months of June, July and August. A recent review of research evidence indicates that two rounds of larviciding during periods of peak development among mosquitoes (late June and late July) should be sufficient, on a routine basis, to provide protection for residents against West Nile Virus. Larviciding in late June and late July reduces the vector mosquito population developing in catch basins during key periods of reproduction. By mid- to late-August, adult vector mosquitoes are generally no longer seeking a blood meal which means they would not be biting and transmitting the virus to humans. The female mosquitoes go into a state known as diapause which prepares them to survive the winter.1 Therefore, vector mosquitoes emerging in late August and September would no longer be viable transmitters of West Nile Virus, and generally would not require an application of larvicide to prevent their development.

Public Health Ontario has been consulted, and confirmed that operational adjustments to Waterloo Regions larviciding program could be considered, based on a risk assessment which reviewed evidence from recent literature, and local surveillance data collected since the program began in 2002.

As our current service provider contract expired at the end of 2017, Public Health has issued a Request for Proposals for the contract for larval surveillance and control. The

1 Public Health Ontario. (2013). Guide for public health units: considerations for adult mosquito control. Retrieved December 1, 2017 from https://www.publichealthontario.ca/en/eRepository/Guide_Considerations_Mosquito_Control_2013.pdf 2587250 Page 3 of 7

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Request for Proposals requires two rounds of routine larviciding, and retains the option to conduct a third round of treatment, if required. A targeted, or region-wide, third round of treatment could be applied, based on a risk assessment that considers the presence of positive pools, human cases, or weather conditions favourable for accelerating the rate of mosquito reproduction. Larval surveillance and standing water treatment will continue as in previous years. Any potential savings will be available to support other vector-borne disease program needs, such as enhanced public education for the prevention of Lyme disease.

Lyme disease

In Ontario, Lyme disease can be transmitted to humans through the bite of a black-legged tick or deer tick carrying the Borrelia burgdoferi bacterium. A circular rash, referred to as a bulls-eye rash at the site of the tick attachment could be one of the earliest signs of Lyme disease infection. Antibiotics can be effective in preventing longterm neurological, rheumatological, and cardiac complications, especially if taken in the early stages of infection.

The Lyme disease vector, the black-legged tick, is not currently established in Waterloo Region. It is regularly found along the north shores of Lake Erie, Lake Ontario and the St. Lawrence Seaway. Black-legged ticks are also endemic to Wainfleet Bog, Pinery Provincial Park and the Ottawa area.2 Occasionally, migratory birds or other warm-blood mammals may transport black-legged ticks into Waterloo Region from endemic areas. This can lead to the sporadic reporting of black-legged ticks in Waterloo Region; however, black-legged ticks are not endemic in our region and the overall risk remains low. Public Health encourages residents to submit tick specimens for laboratory testing for monitoring purposes, if they have been bitten by a tick. The purpose of tick surveillance is to monitor the type of ticks found in Waterloo Region, identify any geographic areas that may have established black-legged tick populations, and determine if any black-legged ticks are infected with Lyme disease. When a tick is submitted, a Public Health Inspector will attempt to identify the tick species. For common dog ticks that do not carry Lyme disease and pose no risk to humans, no further testing is done. The majority of ticks acquired within Waterloo Region are dog ticks. If a Public Health Inspector cannot identify the species, or suspects the tick is a black-legged tick, the tick is sent to the lab for identification, regardless of whether the tick was acquired within the Region or from travel elsewhere in the province. In 2017, Public Health submitted 113 tick specimens for laboratory testing and, of those, 46 were identified as black-legged ticks. Seven black-legged ticks, none of which were acquired in Waterloo Region, tested positive for the bacterium Borrelia burgdoferi. Ten black-legged ticks were possibly acquired in Waterloo Region, based on self-reporting at time of submission to Public Health. No geographic patterns were identified within Waterloo

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Region for the locally acquired black-legged ticks. To date, no black-legged ticks potentially acquired in Waterloo Region have tested positive for Lyme disease. These findings support that the overall risk remains low in our region. Tick surveillance by Public Health will continue.

There have been no reported cases of Lyme disease acquired within Waterloo Region and the risk of acquiring Lyme disease locally remains low. Seven cases of Lyme disease (confirmed or probable) were reported to Public Health in 2017, which is within the expected natural fluctuations from year to year.* All were acquired outside Waterloo Region. Provincially, there were 967 confirmed or probable cases of Lyme disease in 2017.* This is a significant increase over the number of cases seen previously in Ontario. The rate of Lyme disease in Waterloo Region has been lower than the rate for Ontario for the past five years. Human case surveillance will continue in 2018 to monitor disease trends.

Public Education

The Fight the Bite public education campaign provides general health information, risk factors and recommends personal protective measures to minimize risk of exposure to West Nile Virus and Lyme disease. A new tickID card was distributed in 2017 to raise awareness and help people identify ticks quickly and take appropriate next steps. Fight the Bite information was shared through an interactive display at the EcoFest community event and through displays at three public schools and three community locations in Waterloo Region. Members of the public can call Public Health or visit the Public Health website for general information, questions, complaints, or requests regarding vector-borne diseases. Public Health also shares messaging on social media about vector-borne disease via Twitter and Facebook using the hashtag #FightTheBite and handle @ROWPublicHealth. In 2017, Public Health responded to eight media requests related to West Nile Virus and Lyme disease, including five radio interviews, two newspaper articles and one television interview. Public Health will continue to inform the public about actions they can take to minimize risk of exposure to vector-borne diseases.

Ontario Public Health Standards:

Public Health conducts vector surveillance and control, human case surveillance, and public education as per the Ontario Public Health Standards, to minimize vector-borne disease risk to the public. This report provides information related to the compliance with the Vector-Borne Diseases requirements of the Standards and provides information that supports ongoing education for Board of Health members to help them remain abreast of relevant trends and emerging public health issues.

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Focus Area 3: Environment and Sustainable Growth

Focus Area 4: Healthy, Safe and Inclusive Communities

Focus Area 5: Responsive and Engaging Government Services


The budget for the Vector-Borne Disease program is cost shared 75% by the province, 25% regional tax levy. The 2017 provincially and regionally approved budget of $305,000 ($229,000 from province, net regional levy of $75,000) was unchanged from 2016.


Nil

Attachments

Attachment 1: tickID Card

Prepared By: Jennifer Toews, Health Promotion and Research Analyst Brenda Miller, Manager, Infection Control, Personal Service Settings, Rabies, Vector-Borne Diseases and Kitchener and Area


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Attachment 1: tickID Card

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Report: CSD-CHS-18-05

Region of Waterloo

Community Services

Childrens Services


Date: March 20, 2018 File Code: S02-80

Subject: Increased Staffing for Child Care Fee Subsidy

Recommendation:

That the Regional Municipality of Waterloo approve the addition of up to 3.0 permanent full time equivalent (FTE) child care subsidy caseworkers for Community Services/ Childrens Services to be funded by provincial subsidy at an annualized cost of $275,359 and $0 net levy, as outlined in report CSD-CHS-18-05, dated March 20, 2018.

Summary:

This report is to provide information and to request approval for the addition of up to 3.0 FTE staff in Childrens Services to achieve targets aligned with the Provinces Child Care Expansion Plan (CCEP) and Canada-Ontario Early Learning and Child Care (ELCC) Agreement. In June 2017, Childrens Services outlined for Community Services Committee the CCEP in report CSD-CHS-17-07. The report identified the Provinces plan to increase access to licensed child care for 100,000 more children age 0 4 within 5 years. In addition, through the ELCC, funding was provided to support further access to licensed spaces for an additional 11,200 children across the province over 5 years.

In the 2018 budget, Council approved an increase to the Childrens Services budget of $4,613,239 funded from increased Provincial grants for CCEP and ELCC with no net levy tax impact, as detailed in report COR-FSD-17-36 (December 13, 2017). Up to 10% of the funding provided can be used for administration expenditures.

The funding for the CCEP is tied to performance and the Region of Waterloo must provide access to 500 more children, age 0 4, through access to new spaces or access to fee subsidy, by December 31, 2018. In addition, the target for increased fee 2661710

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27 27March 20, 2018 Report: CSD-CHS-18-05

subsidy for ELCC is 340 children, age 0 12. The increased staffing is necessary to achieve these targets.

Report:

1.0 Licensed Spaces

The funding for the CCEP and ELCC is intended to support increased licensed child care spaces as well as access to licensed child care. In 2017, licensed child care spaces in Waterloo Region in both centres and home child care increased almost 10%, a total of 260 spaces, for ages 0 - 4. In 2018, another 256 licensed spaces are planned for ages 0 4, an increase of approximately 5%, not including increases to home child care.

Licensed spaces for 4 12 year olds increased 31% in 2017, a total of 777 spaces.

2.0 Child Care Fee Subsidy

Child Care Fee Subsidy provides financial assistance to subsidy eligible families with the cost of licensed Early Learning and Child Care (ELCC). The fee subsidy program enables eligible families to access and maintain employment, upgrade their education, attend training programs, and provide early intervention experiences for children with special needs. Through fee subsidy, families have access to licensed community-based child care centres, licensed home child care programs or before and after school programs.

An optimal caseload is an average of 200 families, which means a range of 240 280 children per caseload. In 2016, before the implementation of the wait list, caseloads had risen to an average of 220 families and a range of 290 310 children. In 2017 with the waitlist, caseloads had decreased to an average of 183 per caseworker. When the waitlist was eliminated, caseloads once again increased and in January 2018 were an average of 223 families per caseworker with an average of 301 children.

In 2018, staff will implement an awareness campaign to ensure that all families who may be eligible for fee subsidy have the opportunity to apply. With this campaign and the increase to licensed spaces the number of families in need of child care fee subsidy is expected to increase.

With the current caseload average of 223 families over 10 caseloads, there is sufficient demand to support adding an additional fee subsidy caseworker now. The remaining 2.0 FTE staffing will be added in a phased-in approach.

Quality of Life Indicators:

Increased child care subsidy staffing aligns with the following Quality of Life key areas: Economic Well-Being; Social Inclusion and Equity (e.g., increasing access to early 2661710 Page 2 of 3

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learning and child care); Physical and Emotional Well-Being (e.g. access to quality child care improves physical and emotional well-being) ; Skills Development (e.g., quality child care builds personal and problem-solving skills); and Relationships (e.g., increasing access to early childhood professionals and interactions with other children and families).


This report addresses the Regions Corporate Strategic Plan 2015-2018, Focus Area 4: Healthy, Safe and Inclusive Communities and Strategic Objective 4.1: Support early learning and child development.


The Province provided $4.6 million in funding for the Child Care Expansion Plan in Waterloo Region and these funds have been included in the Regions 2018 Operating Budget. There is no requirement for cost sharing funds from the Region. Up to 10% of the total allocation can be used to offset administration costs related to the CCEP. The annualized cost for 3.0 full time equivalent staff is $275,359. The 2018 cost is projected to be $205,000.


The assistance of Corporate Services/ Treasury Services staff is required to monitor the Childrens Services budget and expenditures.

Attachments

Nil

Prepared By: Sheri Phillips, Manager, Early Years Funding Administration Barbara Cardow, Director, Childrens Services

Approved By: Douglas Bartholomew-Saunders, Commissioner, Community Services

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Report: CSD-CHS-18-06

Region of Waterloo

Community Services

Childrens Services


Date: March 20, 2018 File Code: A02-30

Subject: The Journey Together Child and Family Centre Service Provider

Recommendation:

That the Regional Municipality of Waterloo take the following actions with respect to the Journey Together Initiative to create an Indigenous-led family and child centre, as outlined in Report CSD-CHS-18-06 dated March 20, 2018:

a) Approve entering into a service agreement for the period April 1, 2018 to December 31, 2019 with Anishnabeg Outreach for the creation and provision of an Indigenous-led child and family centre;

b) Approve operating funding of $300,000 to Anishnabeg Outreach based on the Journey Together provincial allocations to the Region;

c) Approve one time funding of $167,500 to Anishnabeg Outreach for 2018; d) Authorize the Commissioner, Community Services, to execute such

agreements and documentation in a form satisfactory to the Regional Solicitor, as may be required to advance the Journey Together funding.

Summary:

The Region of Waterloo, Childrens Services division completed an expression of interest process to determine a service provider to create and operate an Indigenous-led child and family program. Total funding for the Journey Together initiative is $467,500 for 2018, and $300,000 for 2019. Anishnabeg Outreach is the successful service provider in the expression of interest process to deliver services through an Indigenous-led child and family centre.

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Report:

On May 30, 2016, the Government of Ontario released the Journey Together: Ontarios Commitment to Reconciliation with Indigenous Peoples. In November 2016, The Ministry of Education announced the availability of funding to support The Ministry of Education early years initiative under the Journey Together. On September 12, 2017, Regional staff submitted the Journey Together proposal for Waterloo Region (Report CSD-CHS-17-14). On December 4, 2017, The Ministry of Education released the Journey Together allocations for 2018 and 2019.

Community Services report CSD-CHS-18-02 dated January 9, 2018, provided an update regarding the Journey Together allocation and the expression of interest process to determine the service provider for the Indigenous-led child and family program in Waterloo Region.

The expression of interest process was completed over February and March 2018, with three organizations expressing interest, including: Anishnabeg Outreach, A Place in the Circle and Healing of the Seven Generations. The selection process included submission of a completed application form and an interview. Scoring was based on two main criteria: 1) experience (e.g., the organizations history, partnerships, and experience delivering service to Indigenous children and families) and; 2) program proposal (e.g., the proposed programs goals, objectives, and work plan align with the Journey Together funding and links to the EarlyON Child and Family Centres).

Following the review, scoring and selection process, Anishnabeg Outreach is the successful service provider being recommended for the Journey Together funding. The Journey Together funding supports the creation of a child and family centre. Total funding for 2018 is $467,500, of which, $167,500 is one-time funding for capital and initial start-up costs. For 2019, the total funding available is $300,000 for operation. It is anticipated that the Journey Together funding will extend beyond 2019.

The new Indigenous-led child and family centre is a component of the provincial Journey Together initiative working with Indigenous partners to address the negative impacts resulting from the legacy of residential schools. It responds to the Provincial expectation that every Consolidated Municipal Service Manager (CMSM) offer child and family programs and services that reflect local Indigenous cultures and needs. Implementation of the Indigenous-led child and family centre also supports the Region of Waterloo Childrens Services Early Learning and Child Care Service Plan (20162020) Strategy 3.1: Work with local First Nations, Mtis and Inuit partners to create culturally relevant child care experiences and services.

The new Indigenous-led child and family centre will be an important part of the local network of early learning and childcare (ELCC) services. Anishnabeg Outreach will be collaborating with the YMCA as the lead agency of the local EarlyON Child and Family

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Centres (Report CSD-CHS-18-01, dated January 9, 2018), Region of Waterloo Childrens Services, and other early years partners. ELCC service providers work in partnership to achieve the Province of Ontario vision for the early years where all children and families have access to a range of high quality, inclusive and affordable early years and child care programs and services that are child-and-family-centred and contribute to childrens learning, development and well-being.


The creation of a new Indigenous-led child and family centre aligns with the following Quality of Life key areas: Social Inclusion and Equity (e.g., increasing access to Indigenous child and family services); Physical and Emotional Well-Being (e.g., participation in meaningful activities will positively impact children and familys daily functioning and how they feel about their life); Skills Development (e.g., the child and family program will help to build personal and problem-solving skills); and Relationships (e.g., increasing access to early childhood professionals and interactions with other families).


This report addresses the Regions Corporate Strategic Plan 2015-2018, Focus Area 4: Healthy, Safe and Inclusive Communities and Strategic Objective 4.1: Support early learning and development.


The Province has approved $300,000 in ongoing funding and a further $167,500 in one time funding, for a total allocation of $467,500, for the Journey Together Initiative. There is no requirement for Regional cost sharing for this program. The Regions 2018 Budget includes the $467,500 for the Journey Together Initiative.


Legislative Services and Corporate Services/Treasury Services have reviewed this report and will be involved with the preparation and execution of the service agreement.

Attachments

Nil

Prepared By: Barb Cardow, Director, Childrens Services Van Vilaysinh, Social Planning Associate Kim Sangesa, Manager, Early Learning Services, Childrens Services

Approved By: Douglas Bartholomew-Saunders, Commissioner, Community Services

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Report: CSD-HOU-18-08

Region of Waterloo

Community Services

Housing Services


Date: March 20, 2018 File Code: D26-01

Subject: Community Housing Waiting List Local Priorities and Status Policy Updates

Recommendation:

That the Regional Municipality of Waterloo approve the recommended changes to Community Housing Program policies as outlined in report CSD-HOU-18-08, dated March 20, 2018.

Summary:

In its capacity as Service Manager under the Housing Services Act (HSA), the Region of Waterloo has responsibility for managing the Community Housing waiting list called the Region of Waterloo Co-ordinated Access System (ROWCAS) for Waterloo Regions rent geared-to-income (RGI) housing. The HSA allows Service Managers to establish local standards for waiting list priorities to reduce the wait times for certain households.

To ensure that local standards continue to reflect Provincial objectives and local needs, it is important that they are reviewed periodically. Following the November 2014 merging of Regional housing and homelessness services and the Provinces update to the 2010 Long Term Affordable Housing Strategy (LTAHS; update released June 2016), Housing Services undertook a review of ROWCAS local standards in 2016. This review included broad consultation with Service Providers within and beyond the Housing Stability System, ROWCAS applicants, and Regional staff. This report provides an overview of the consultation and the resulting recommendations. It also provides broader context to Social Housing modernization, a process that is currently in progress under the direction of the Province. The recommendations included in this report will help the Region better address client needs and further integrate access to housing and homelessness programs as part of ongoing Housing Stability System Redesign (see CSD-HOU-17-24). 2656919

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Report:

1.0Background

1.1History of Coordinated Access to Affordable Housing

In October 2001, the Region of Waterloo (the Region) became the local Service Manager for the delivery of affordable housing programs in the Waterloo Region, referred to collectively as the Community Housing Program. The following year, in accordance with the Social Housing Reform Act (SHRA), the Region became responsible for establishing and maintaining a local waiting list to coordinate access to the Community Housing units. Part of this work included the development and approval of local standards, technology, and operational guidelines.

In 2002, there was only one local standard the provincially mandated Priority called the Special Priority Policy (SPP) for victims of domestic violence. A Priority standing requires that the applicant be considered first for every vacancy in the units for which they have applied.

In addition to SPP, the Province provided policy direction that identified a number of disadvantaged groups for whom access could also be prioritized, including people experiencing homelessness, people with medical needs, and separated families with children in the care of Family and Children Services. While not mandated to do so, the Region chose to offer these groups a level of priority called Urgent Status standing. An Urgent Status standing requires that the applicant be considered for one in every ten vacancies.

After a number of years in operation, the Region conducted its first review of ROWCAS policies in 2005 and then repeated this effort in 2011. These reviews resulted in several changes, including the following two updates:

Creation of three additional Priority groups Terminally Ill, Sunnyside, andOver-housed (referred to as Local Priorities) and

Revising the medical need subcategory of Urgent Status by calling it Safetywith revised criteria (i.e., physical condition of current housing poses a seriousand immediate threat to safety and cannot be repaired or remedied within areasonable time and OR household must relocate due to being subjected toactual or threatened physical harm)

ROWCAS applicants seeking access to affordable housing that meet criteria for SPP, Local Priority or Urgent Status need to apply to be granted these special standings. If approved, applicants are ranked in accordance with their special standing on the waiting list. Community Housing providers are required first to consider all applicants with SPP or Local Priority for each vacancy. If there are no applicants with these standings or they are not suitable for the available vacancies, the housing provider may then 2656919 Page 2 of 19

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consider applicants on the broader chronological list or applicants with Urgent Status (one vacancy in ten).

1.2ROWCAS Update A Phased Approach

While local planning, program delivery, and quality assurance practices in the areas of housing and homelessness have been in place for the last 15 years or more, the pace of change has intensified in recent years to accommodate new policy shifts at each order of government and in response to other influencing factors. This has increased the need for a more unified program delivery approach related to supporting people with housing issues in Waterloo Region funded by the Region of Waterloo (Region, Housing Services) in the local Housing Stability System (HSS)1.

While this report is intended primarily to focus on necessary amendments to ROWCAS for applicants seeking access to affordable housing through the Community Housing waiting list, work is underway to modernize ROWCAS as part of a longer term strategy. This strategy has four phases. The end result will be a seamless, unified, coordinated access system to both affordable housing (ROWCAS) and to housing supports (Prioritized Access to Housing Support - PATHS process).

The first two phases of ROWCAS changes focus on adjusting the way that people access affordable housing and housing support, through separate consultations and policy changes, to better serve client needs (see Section 2.0 for descriptions of each phase). It was necessary to consider the evolution of these access systems separately given that they were created with different funding and governing legislation, over a decade apart.

Full integration through phases 3 and 4 depends on a number of influencing factors and relies on a number of other initiatives. Factors supporting a phased approach include;

Impacts of Social Housing Modernization are still largely unknown. While theProvince moves forward with its consultations, work can begin at a local level toprepare by addressing current issues and pressures as well as engaging inlocally-led consultations.

There is a need to move forward with addressing issues that are creating currentpressures on ROWCAS and a need to create greater efficiencies in currentadministrative processes (e.g., through a LEAN project). Reducing these

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.

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pressures and gaining efficiencies will assist integration. The PATHS Framework will be implemented over 2018/19 through a new

PATHS Team. At the same time, a redesigned portable housing support programwill come into effect called Portable Home-Based Support (HBS). The learningfrom implementation will help to inform next steps related to integration, includingchanges required to meet the goal of ending chronic homelessness.

Technology used to manage ROWCAS is changing in late 2018. Before thelaunch of the new database, some amendments to existing policy are required.

Efforts are shifting to becoming more data-informed. More time is needed to buildcapacity in this area, so that integration can be evidence-based.

More time and resources are required to effectively research, frame andrecommend the most appropriate model for ROWCAS that integrates all of thepriorities and approaches (e.g., need-based, client-ready, chronological).

Outcome of Auditor Generals report to Ministry of Housing to look for ways toimprove the rules around social housing waitlists is unknown.

2.0 Phases of ROWCAS Update

2.1 Phase 1 ROWCAS Consultations and Release of PATHS Framework

Following the merging of Regional housing and homelessness services through the Regions structural review in 2014 and release of the Provinces update to its 2010 Long Term Affordable Housing Strategy, Housing Services undertook a review of ROWCAS local standards beginning in 2016. This review included broad consultation with Service Providers within and beyond the Housing Stability System, ROWCAS applicants, and Regional staff. The purpose of the consultation was to gather feedback about how local standards could be improved.

Around the same time, Housing Services was engaging in the development of a new approach to coordinating access to housing support for people experiencing homelessness who have a greater depth of need related to finding and keeping a home (PATHS process). The PATHS Framework (CSD-HOU-17-27) was approved by Regional Council in December 2017. PATHS implementation will begin in April 2018 with full implementation anticipated by September 2018. Bringing forward ROWCAS recommendations was deferred until the PATHS Framework (CSD-HOU-17-27) was completed to better understand PATHS delivery and standards before recommending policy changes within ROWCAS.

2.2 Phase 2 Interim Policy Shifts

Phase 2 proposes to amend local Priorities and Status standings in ROWCAS to reflect the community consultation conducted in Phase 1, the current demand for affordable housing, and the mandate to end chronic homelessness. The changes will also address some current waiting list pressures in the areas of Urgent Status and the Overhoused 2656919 Page 4 of 19

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Priority. Phase 2 also intends to adjust ROWCAS access policies so they are properly positioned to start integration in Phase 3. Concurrently, the Office of Corporate Performance at the Region is conducting a LEAN process with ROWCAS to assist with streamlining ROWCAS processes.

2.3 Phase 3 Integrate Housing and Homelessness Access Systems

In Phase 3, the Region will complete a Community Housing Framework to align with the other Housing Stability System Frameworks. This work will more fully integrate coordinated ROWCAS and PATHS access policies..

An influencing factor is Social Housing Modernization being led by the Ministry of Housing (MHO). When implemented, Social Housing Modernization will replace the current prescriptive rules and regulations for Service Providers with a new more flexible approach that includes simplified rent assistance calculations with a focus on improving housing outcomes for Ontarians living in, and trying to access, Social Housing. The MHO is currently consulting with Service Providers and Service Mangers about their vision for a more people-centred, streamlined and sustainable housing sector. The Province intends to work with a broad range of partners to build the capacity of the sector to ensure the continued vibrancy and sustainability of social and affordable housing in Ontario. The intent of the current phase of work (Phase 2) is to move forward with service improvements that position ROWCAS to align with the known MHO policy directions and prepare for Modernization.

2.4 Phase 4 Align ROWCAS with Social Housing Modernization

In Phase 4, Region staff will explore alternative coordinated access models through a comprehensive consultation and evaluation. This work is expected to extend into 2019/20.

3.0 Results of ROWCAS Consultation Process

In 2016, community service agencies, and housing providers and Regional staff were consulted on the local priorities whether they were still relevant and what changes should be made to them. They were invited to attend a series of three sessions. Each session included a one-hour information event, a full-day consultation workshop, and a two-hour report back session. In addition, interviews were done with both an intentional and a random selection of households currently waiting to access affordable housing on ROWCAS to gather their feedback.

During the information event, participants were provided with data to help set the context (e.g. the number of applications received for each local priority/status, the number of people granted a local priority/status and how long it takes for people with a priority/status to be housed). The full day consultation workshop included large and small group discussions, real-time polling, and written or electronic feedback. At the 2656919 Page 5 of 19

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report back event a summary of the key findings from the consultation workshop was shared. Participants also identified some principles to help guide the recommendation making process

Once the consultation process was concluded, Housing Services staff used the feedback to propose the policy amendments as outlined in What We Heard below.

3.1 What We Heard

There were many conversations about the positives and negatives of each Local Priority as well as each Urgent Status category. A detailed summary can be found in Local Priorities and the Community Housing Waitlist summary document.

Below are some examples of what we heard during the consultations, but not all of these comments have been incorporated in the recommendations. The recommendations for policy changes incorporate the general consensus on the issues, alignment with other policies, and possible suggestions for improvement. Additional issues for consideration are noted in the Next Steps section of this report.

3.2 Principles

Participants identified and voted on principles to help guide the recommendation making process. The five principles with the most votes included: person-centred, simplicity, informed participants, consistency, and balanced & inclusive communities.

3.3 Local Priorities

1. The Terminally Ill Priority should be maintained but modified to allow someone whois terminally ill to stay in their current housing with a subsidy if they wish, rather than move to a new home. The priority should also be retained by the household if the person with the priority standing dies before housing can be secured.

2. The Overhoused Priority should be maintained so that the Service Manager canmake the best use of the housing that is available, however, the process of relocating someone must involve engaging them in the process, providing supports, and explaining options. New housing stock should be created with a variety of unit sizes so that in the future people will not have to move out of their community if they become overhoused. There was also a suggestion that a household which is overhoused have their application be dated on the date they become overhoused, not their original date of application for their current RGI housing unit.

3. The Sunnyside Priority should be maintained because it is easy to determineeligibility, only involves two Regionally-owned buildings, and does not receive many applications. However, there was feedback that it would be more equitable if other long term care facilities could have similar arrangements with community housing in their area.

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3.4 Local Status

There was consensus that the Urgent Status policy needs significant modifications. The name Urgent is misleading and implies that housing will be granted quickly, which is not always the case. There are many applications for Urgent Status which are declined. Despite eligibility criteria indicating that they are not eligible many households apply for Urgent Status because they need housing more quickly than the chronological list allows. Some applicants and service providers find it difficult to differentiate between a Status (offer 1 in 10 vacancies) and a Priority (offer first for every vacancy) and expect similar outcomes. Lastly, there is confusion about the relationship with other Housing Services initiatives such as Priority Access to Housing Support List (PATHS), and this Urgent Status policy. More clarity is needed on these intersections and which policies are applicable under which circumstances (Phase 3). We heard the following relating to the Urgent Status subcategories:

1. Homeless: In terms of suggestions for improving Local Status subcategories, mostfeedback suggested that Homeless needs to be a stand alone policy and that allHousing Services staff should work together for a common definition ofHomelessness (Phase 3). The other Urgent Status subcategories also need to bereframed into separate stand alone policies with clearly defined criteria. There wasstrong support for including a residency requirement so that only those who havelived in the Region for at least one year are eligible. This will bring affordablehousing waiting list practices in line with both the Emergency Shelter and SupportiveHousing frameworks and standards (CSD-HOU-17-07, SS-14-030 and CSD-HOU15-08). In addition, the existing income thresholds for Urgent Status should beamended to reflect the high need household income limits set out in Provinciallegislation. These indicators are indexed annually by the Province and reflect upperlimit income levels for households with the greatest depth of need. This threshold ishigher than the current threshold, so using this indicator would allow more applicantsto be eligible for this Status.

2. Safety: The Safety subcategory within Urgent Status should be removed andreframed as a new Status. The Safety subcategory currently includes two elements:i) Property - where the physical condition of the applicant households currenthousing poses a serious and immediate threat to the applicant households safety and cannot be repaired or remedied within a reasonable time; OR ii) Actual or Threatened Harm - the applicant household must relocate as a result of being subjected to actual or threatened physical harm.

i) Property - Many of the applicants are seeking placement on ROWCAS as a resultof unresolved property standards, by-law or Residential Tenancy Act (RTA) enforcement and a landlords responsibility to accommodate needs of the tenants (duty to accommodate). There are other better, more timely, and appropriate

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mechanisms for resolving these types of housing issues without adding pressure to the community housing waiting list. These issues require immediate and short term resolution that are not addressed by assigning a Status to wait to move to another unit (with the current wait now exceeding 1.5 years). A more appropriate response would include preparing tools for households seeking assistance with addressing unresolved property standards, by-law or Residential Tenancy Act (RTA) enforcement. This is considered more responsive to the households true needs, which is to make current accommodation meet local property standards and using appropriate systems to do so.

ii) Actual or Threatened Harm This element of Urgent Status - Safety includes applicants who do not qualify for SPP because they do not reside with their abuser and those experiencing exceptional risk due to criminal activity. A new stand alone policy for this element has been recommended titled Escaping Violence.

3. Separated Family: Separated Family subcategory should be maintained but consideration should be given to possibly including families that are accessing other supports where housing is not the only barrier to reunification.

Priority and Status standings are intended to reduce the wait time for targeted households with specific eligibility criteria. If an applicant is denied a Priority or Status standing, they are still eligible for placement on ROWCAS in chronological order.

4.0Recommendations

The final recommendations relating to implementing Phase 2 of the access integration reflect the community consultations and policy alignment with Supportive Housing and the Emergency Shelter frameworks. The recommendations are summarized below and the revised policies are included as Attachment A.

4.1 Local Priorities

There are no recommended changes to the eligibility criteria for the three Local Priorities. The changes noted below relate to extending delivery options for clients.

Local Priority Category Eligibility Criteria Recommendation

1. Terminally Ill Household member with a life expectancy of 2 years or less

Maintain Priority and extend the policy to allow for priority consideration for other rent assistance programs.

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Local Priority Category Eligibility Criteria Recommendation

2. Sunnyside Senior household with a family member in Sunnyside Home Long Term Care

Maintain the Priority and explore the potential to expand this priority to other Long Term Care Facilities in the region where Community Housing units are closely situated.

3. Overhoused Current rent-geared-to-income household that has experienced a change in household composition and requires a smaller sized unit based on the local occupancy standards.

Maintain the Priority but amend the policy so that the application date an overhoused household is given for placement on the waitlist is the date the household became overhoused instead of the original application date for their current housing unit.

4.2 Local Status

Based on the feedback received in the consultation process, revised policies are attached as Appendix A and reflect the following recommendations:

a. Eliminate the existing Urgent Status as one policy and create three new stand aloneStatus groups.

b. Create a Status called Homeless. Allow for Homeless status to be considered onlywhere other options have been attempted, such as diversion.

c. Create a Status called Separated Families.d. Create a Status called Escaping Violence, by reframing Urgent Status element ii)

actual or threatened harm. The status would only apply to local applicants who meetthe criteria of the Provincial SPP policy activity with the exception of the cohabitation requirement, do not meet the Homeless Status requirements or areexperiencing exceptional risk due to criminal activity.

e. Eliminate Urgent Status element i.) propertyf. Amend eligibility criteria for all Local Status so existing income thresholds are the high

need household income limits set out in Provincial legislation and include all sourcesof household income when applying the income thresholds.

g. Amend eligibility criteria for all Local Status to add a requirement that the householdmust reside in Waterloo Region for 12 months

In implementing the recommended changes outlined above, the intent is to ensure alignment with Provincial priorities, the local 10 year Housing and Homelessness Plan, other local initiatives such as the Emergency Shelter and Supportive Housing Frameworks, PATHS Framework, and new funding opportunities.

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5.0Implementation

Subject to Council approval, Housing Services staff recommends that current applicants Status is reviewed applying the new criteria and Status amended to reflect the new policy direction. Effected applicants will be supported to address any landlord related concerns.

Housing Services staff will work internally to implement and operationalize any approved policy changes by updating processes, forms and providing training to relevant staff.

All community housing providers and local partners will be formally advised of the changes and be provided with implementation requirements and timelines.

6.0Next Steps

Pending approval Housing Services staff will continue to work towards implementing the other Phases, exploring options to align eligibility and access processes relating to the ROWCAS, PATHS, Emergency Shelters and Housing Resource Centres. The primary goal is to ensure all applicants for affordable housing and/or housing support are addressed through a streamlined system that assesses the household needs for the most appropriate housing services.

In addition, Housing Services staff will work to address other issues and suggestions identified through the consultation process, including:

1. Develop tools and resources to assist applicants to address landlord relatedconcerns (e.g. eviction prevention and support to help damage costs)

2. Ensure that modifications are person-centred and addresses the applicantshousing needs;

3. Extend the Sunnyside status to other Long Term Care Facilities in the regionwhere Community Housing units are closely situated;

4. Implement a housing allowance/rent supplement option for Terminally Ill;5. Including those seeking status to escape violence in a shelter diversion protocol6. Develop new and innovative ways to collect and assess applicants information

during the intake process;7. Complete the LEAN process analysis and explore a modified approach involving

more one on one time with the applicant to better understand their specifichousing needs and challenges prior to submitting an application;

8. Develop an overall approach of waitlist diversion that creates formal links with thecommunity to help serve common clients;

9. Explore using a common assessment tool to determine ability to liveindependently.

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Any required policy changes related to these additional recommendations will be the subject of a future council report.


The recommend policy amendments aligns with Economic Well-Being (e.g. increased access to affordable housing for targeted households) and Social Inclusion and Equity (e.g. prioritized access to housing).


The recommended policy changes will help achieve the 2015-2018 Strategic Plan in the following areas, 4.3.1 Implement the Homelessness to Housing Stability Strategy and 5.4 Ensure regional programs and services are efficient, effective and provide value for money.


The recommendations included in this report and the associated work related can be accommodated within the Housing Services operating budget.


Nil

Attachments

Attachment A Waiting List Policies: Terminally Ill Priority, Sunnyside Priority, Overhoused Priority, Homeless Status, Separated Families Sta

regional municipality of waterloo community services ... car dated march 20, 2018. cs agenda - 2...

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