HANSARD
NOVA SCOTIA HOUSE OF ASSEMBLY
STANDING COMMITTEE
ON
HEALTH
Tuesday, September 9, 2025
LEGISLATIVE CHAMBER
Integrated Youth Services
Printed and Published by Nova Scotia Hansard Reporting Services
HEALTH COMMITTEE
John A. MacDonald (Chair)
Adegoke Fadare (Vice-Chair)
Hon. Susan Corkum-Greek
Ryan Robicheau
Nick Hilton
Lisa Lachance
Rod Wilson
Hon. Iain Rankin
Hon. Derek Mombourquette
[Ryan Robicheau was replaced by Damian Stoilov.]
[Lisa Lachance was replaced by Suzy Hansen.]
In Attendance:
David Hastings
Legislative Committee Clerk
Philip Grassie
Legislative Counsel
WITNESSES
IWK Health Centre
Maureen Brennan, Director, Mental Health and Addictions
Margaret Champion, Interim Director, Integrated Youth Services
Big Brothers Big Sisters of Pictou County - Integrated Youth Services, New Glasgow
Margie Grant-Walsh, Executive Director
YMCA of Cumberland - Integrated Youth Services, Amherst
Trina Clarke, CEO
YMCA of Greater Halifax/Dartmouth - Integrated Youth Services, Halifax
Brian Posavad, President and CEO
Julie-Ann Vincent, Chief Operating Officer
HALIFAX, TUESDAY, SEPTEMBER 9, 2025
STANDING COMMITTEE ON HEALTH
1:00 P.M.
CHAIR
John A. MacDonald
VICE-CHAIR
Adegoke Fadare
THE CHAIR: Order. This is the Standing Committee on Health. I'm John A. MacDonald, the Chair and the MLA for Hants East. Today we will hear from the IWK Health Centre and representatives from New Glasgow, Amherst, and Halifax regarding Integrated Youth Services. Just a reminder to please set your phones to silent. Don't touch your microphones; they will actually give feedback, just so you realize. The mic will go red. That's when you can talk. It's recognized. If I say your name twice, it's not for you; it's for Legislative Television to turn your mic on. I'm learning to let you know that.
I'm now going to ask the committee members to introduce themselves by stating their name and the constituency they represent. I will start with MLA Rankin.
[The committee members introduced themselves.]
THE CHAIR: For the purposes of Hansard, to my left is . . .
PHILIP GRASSIE: Legislative Counsel Philip Grassie.
THE CHAIR: To my right . . .
DAVID HASTINGS: Clerk of Committees David Hastings.
THE CHAIR: Now what I'll do is allow all the witnesses to introduce themselves by their names and who they're here representing, and then I'll go back to your opening statements. I will start with Ms. Brennan.
[The committee members introduced themselves.]
THE CHAIR: I lost my notes on who's doing opening statements, so I'm going to double-check first because at one point I did know. I assume Ms. Brennan, and then you as well? Perfect. I'll start with Ms. Brennan.
MAUREEN BRENNAN: Good afternoon, Chair, members of the committee, and a warm welcome to everyone joining us today. My name is Maureen Brennan, and I have the privilege of serving as the director of the Mental Health and Addictions Program at the IWK Health Centre. I'm pleased to be joined by my colleague Margaret Champion, interim director of Integrated Youth Services Nova Scotia, along with senior leaders from Integrated Youth Services sites across the province.
I want to begin by expressing my sincere thanks for the opportunity to speak to you today about an initiative that marks a transformational shift in how we are delivering mental health and wellness services to youth across Nova Scotia. At the IWK Health Centre, our Mental Health and Addictions Program is committed to delivering high-quality, accessible care for children, youth, and families - care that meets their needs close to home or school, and in partnership with community providers. We know that providing a supportive environment early in life is critical to healthy growth and development, and that prevention and early intervention are essential to ensuring young people receive the right care at the right time, in the right place, from the right care provider.
Early intervention in emerging mental illnesses enables children, youth, and their families to manage everyday life positively in their home communities, and may prevent moderate to severe mental health issues requiring our specialized services.
Over the past several years, our program has focused on co-creating services with youth, caregivers, and community partners. Their insights and lived experiences have helped us improve care and reduce barriers to access. One of the most promising innovations to emerge from this work is the Integrated Youth Services model - a collaborative, youth-centered approach that bridges multiple youth-serving organizations under one unified system.
Integrated Youth Services is a community-based model that is now in almost every province in Canada. It is built on evidence-informed care and supported by a national network, offering low-barrier, community-based services for youth and their caregivers. These services span mental health, substance use, physical health, education and employment, social services, and culturally grounded supports.
At its core, Integrated Youth Services is about meeting youth where they are, providing timely, comprehensive, and coordinated care in trusted, youth-friendly spaces. It places youth and caregivers at the centre of service design and delivery, and it mobilizes community agencies to lead the work on the ground. When implemented well, this model has the potential to dramatically improve outcomes, access, and system efficiency.
Nova Scotia should be proud to be the first province in Canada to fund a full implementation of IYS sites across the entire province. This government investment is a vital step in improving access and building a connected, community-based system of universal mental health and addictions care that integrates services across the community to the formal system of care. This initiative is especially meaningful for rural and diverse communities where access to care has historically been limited. For many youth, especially in rural areas, transportation is a major barrier. Having a local, one-stop shop for care is not just helpful, it's essential.
IWK serves as the backbone organization for IYS Nova Scotia, providing provincial leadership, guidance, training, and support to ensure services are evidence-informed, rooted in best practice, and guided by research and evaluation. Nova Scotia is the first province to have an IYS backbone support team located within the formal system of mental health and addictions care, supporting the creation of a seamless ecosystem of mental health care for young people. In the last two years, we secured over $9 million in funding to advance IYS Nova Scotia research and are key partners with several other provinces in national IYS research projects totalling over $32 million. This research will help us improve our data infrastructure and capacity, as well as our ability to proactively forecast, predict, and respond to earlier changing needs of youth in the community.
I'm excited to share that our official name is Anchor Youth Space, Nova Scotia. This name was chosen after an extensive engagement process with youth, caregivers, and community partners who saw “anchor” as a symbol of strength, safety, and trust. There will be eight anchor youth spaces across the province including sites in Amherst, Bridgewater, Eskasoni, New Glasgow, Yarmouth, Sydney, and two in Halifax. The Cumberland site opened in April. The Sydney site and one Halifax site are now open and providing services with formal announcements happening in the coming weeks. The remaining sites are in various stages of development.
While the IWK maintains a 10,000-foot view, our lead agency partners at each site manage the day-to-day operations, tailoring services to meet the unique needs of their communities. These community agencies are deeply embedded in their local contexts, bringing the agility, expertise, and relationships needed to make this model work. We are very fortunate to have strong, competent, and thoughtful partners across Nova Scotia who are building these spaces with the community, for the community.
This transformation is built on partnerships with government departments, community organizations like the YMCA, Big Brothers Big Sisters, New Dawn Enterprises, our close partners with the Nova Scotia Health Authority Mental Health and Addictions program, and the philanthropic funding community who play a vital role in elevating these spaces to become grand and even more welcoming and youth-friendly.
Each anchor youth space includes youth and caregiver committees, ensuring that lived experience continues to shape every aspect of the service delivery. The model is simple yet powerful: Meet youth where they are in welcoming, accessible spaces with the supports they need. The approach is holistic and proactive, and it aligns with best practice in youth wellness services.
On behalf of IWK Health and our Mental Health and Addictions Program, we are proud to be partners in this once-in-a-generation transformation in youth mental health. We remain deeply committed to ensuring that youth in Nova Scotia can access the help they need, where they need it, and when they need it.
Thank you again for the opportunity to speak to you today. My colleagues and I look forward to answering any questions you may have.
THE CHAIR: Ms. Grant-Walsh.
MARGIE GRANT-WALSH: Good afternoon again. My name is Margie Grant-Walsh, as I expressed earlier. I'm proud to serve as the lead agency for the Integrated Youth Services along with coalition agencies in my community, the John Howard Society of Nova Scotia, the YMCA of Pictou County, and the Pictou County Community Health Centre.
While we've not yet opened our doors, the work is well under way. Over the past year, our team, together with youth, families, and community partners, has achieved important milestones that lay the foundation for success. Among our top accomplishments so far, we have identified and are in the process of finalizing a welcoming space where young people will access service. This space will be designed to be trauma-informed, safe, and focused on mental well-being, so that youth feel supported the moment they walk through the door. Planning is guided by the Rick Hansen Foundation's accessibility principles, ensuring that our site incorporates special features including wayfinding, physical access, sensory accessibility, and staff training.
We have launched our youth and caregiver advisory committees to guide our work and keep the youth voice at the centre.
We have hosted community engagement sessions with youth, families, Pictou Landing First Nation, the African Nova Scotian community, and the Pride community, and so far, we have partnerships with 27 local organizations that will provide wraparound supports, programming, and referral pathways.
We have worked with the IWK to develop branding and communications that reflect inclusivity and resonate with youth while engaging the broader community.
We are preparing currently to hire and train staff, ensuring they are grounded in trauma-informed, culturally safe, and inclusive practice.
Looking ahead, our priorities include finalizing our physical site and renovations, program offerings, and accessibility improvements, and strengthening training for staff. Most importantly, ongoing engagement with our youth and caregiver advisory committees and partners will ensure that the hub remains responsive, youth-centred, and community-driven. Partnership and collaboration with the IWK Health Centre, as the backbone of Integrated Youth Services in Nova Scotia, has been essential in guiding our policies, ensuring consistency, and grounding our work in best practices.
We know the need in Pictou County is great. Too many young people are struggling with mental health challenges, addictions, and social isolation. In a survey completed by the coalition in early 2024, 29 percent of the youth surveyed wanted support with mental health and addiction issues.
Rural communities are different. Young people face unique challenges: fewer services, transportation barriers, workforce shortages, and limited opportunities for connection. Social isolation and stigma can further compound these issues. That's why Integrated Youth Services is so very important here. It offers a central accessible hub that brings supports together, reduces barriers, and ensures that youth are not left behind because of where they live.
As an example of a service provider offering at Big Brothers Big Sisters, we are proud to bring the power of mentoring to the IYS model. We know from decades of evidence that when a young person has a consistent, caring adult in their life, the outcomes are transformative. In a Boston Consulting Group study in 2013, it was found that the long-term impacts of mentoring extend well beyond the immediate relationship. This study found that mentored young people are more likely to be employed full time, 68 percent versus 58 percent, and 13 percent earn higher salaries, volunteer more hours, donate more generously to charity, and pursue healthy lifestyles. They also report stronger networks of family and friends, greater financial literacy, and higher levels of leadership in the workplace. Many describe themselves as happier and more confident in making good life choices.
[1:15 p.m.]
What's important in the context of Integrated Youth Services is that mentorship does not stop at formal matches. Every adult who interacts with youth through service providers in this model - whether a nurse, counsellor, youth worker, or program facilitator - has the opportunity to be a silent mentor. Just by showing up with empathy, consistency, and encouragement, these adults create an environment where young people feel valued and supported. Together, formal mentors and these silent mentors help build a community where youth know they matter and can envision a strong, healthy future. These relationships foster confidence, belonging, and resilience, exactly what young people need to navigate the challenges of adolescence and young adulthood.
In my 38 years with Big Brothers Big Sisters, this has been the most transformative change I have seen for young people in this province. The IYS model offers a way forward, meeting youth where they are, reducing barriers, and providing integrated, accessible care.
We're grateful for the support and applaud the government and many philanthropic partners that have brought us to this point, and we look forward to opening our doors soon to demonstrate the positive impact this model can have on young people, families, and the broader health system.
To close, as shared by a youth recently when hearing an IYS site was opening, he says: “Sometimes it feels like nobody sees what we go through in Pictou County. Knowing there will be a place just for us, where people actually listen and help, makes me feel like maybe I really do matter.”
THE CHAIR: Ms. Clarke.
TRINA CLARKE: The YMCA is proud to be a partner in this project. Anchor Youth Space Cumberland has had a positive impact in Cumberland County already, and I'm excited to see this impact grows as spaces open up across the province.
The IWK Health Centre has provided leadership and a collaborative approach through all stages of this project. Now that we are fully operational, their ongoing support is a critical piece of ensuring successful IYS sites across the province. I am grateful for the opportunity to share with you what operating Anchor Youth Space Cumberland over the past four-and-a-half months has looked like, what we have learned, and how we have adapted to ensure Anchor is a trusted space where youth know they can walk in, be heard, and receive the support they need without delay.
Since opening our doors on April 23rd, up to August 31st, we have had over 400 visits to the space. We have 66 registered for services and 31 of those are maintaining counselling sessions on a regular basis. We have had 231 youth participate in a drop-in program offered by Anchor staff or one of our partners.
Being the first to open our doors was very exciting, but it has also created its own challenges. Some of our key learnings and adaptations have been to understand that youth need change quickly, and this model allows us to pivot in real time. We've adjusted program hours, added new workshops, and created more flexible drop-in options based on direct feedback from our youth, caregivers, and partners.
We have learned that we cannot underestimate even the basic needs of our youth. Some of our most utilized areas of Anchor are the cereal and snack bar, the shower, the washer and dryer, and the sensory space - the sensory space so much so that we had to create an additional quiet, restorative area within our space to accommodate that need. Staff are also very receptive to using this room if the youth in counselling requests to meet there or if staff recognize the youth is not ready to sit in an office environment.
Collaboration between service providers and the ability to access programs under one roof makes it easier for youth to move between supports and programs in a safe and trusted space, and this results in better engagement. Our community is committed and excited to have this incredible space to offer more for our youth. Since opening, our community partnerships have grown from these seven original coalition partners to over 20 agencies and organizations, and even local businesses working together.
This has enabled many program offerings. Examples of such programs are:
S.A.F.E.: S.A.F.E. stands for Sexuality, Advocacy, Friendship, and Equity. The S.A.F.E. group prides itself upon its inclusivity of youth aged 12 to 17. It is hosted by the Sexual Health Centre for Cumberland County and offers a safe space for youth to engage with their peers and enjoy fun activities.
The Love & Limits program: This program is offered to youth aged 12 to 18. It focuses on providing skills and hosting healthy discussions which centre healthy relationships, effective communication, boundaries, and safety in familial and romantic relationships.
Full Belly, Clear Mind program: This program offers youth of all ages a delicious hearty breakfast followed by a half hour of mindfulness exercise. This program supports with food insecurity and for youth to build upon their emotional regulation and self-care skills.
The Wellness Wednesdays program: This fall we'll be launching this program, and it will include a series for all ages called Get Anchored. Focus will be on sensory coping strategies for self-regulation, mindfulness techniques, and trying healthy foods.
LeadHER program: This program is facilitated in partnership with SchoolsPlus, the Nova Scotia Health Authority, the Amherst Police Department, and Anchor. It focuses on harm reduction education to at-risk female youth.
There's also once a month a vaccination clinic held by Public Health in the Anchor space.
One unique partnership example is a barber shop that's located within our building. Tim's Barber Shop offers a discounted rate for haircuts for any Anchor youth.
Another learning is that the lack of public transportation is a huge barrier for youth and caregivers. To mitigate this, we pay for taxi services, and if required, we can work remotely in the main towns in Cumberland County. The Nova Scotia Health Authority providing free transportation to Anchor for appointments has been a tremendous help.
This first chapter of operations has shown us that when youth are at the centre of design and delivery, services become more accessible, effective, and meaningful. Anchor has already, in only four months, become a place of belonging, healing, and growth for the youth in our community. One of our students conducted a survey with youth this summer. Through her work, she met with some of the youth accessing Anchor. When asked what they liked about Anchor, the six most common words used were: helpful, food, shower, supportive, safe, and friends.
Having a one-stop, no-wait approach means our youth are not falling through the cracks. The support they need is available right away, reducing stress and building trust. Their response to the question has shown that already Anchor is accomplishing precisely what it is meant to do.
THE CHAIR: Mr. Posavad.
BRIAN POSAVAD: My name is Brian Posavad, and I'm the CEO here of the YMCA of Greater Halifax/Dartmouth and I am joined today by my colleague Julie-Ann Vincent, our chief operating officer. We're here to share with you the story of our new Anchor Youth Space - North End Halifax. It's located within our Community YMCA on Gottingen Street.
The YMCA has a long and proud history of youth development in Nova Scotia. For generations, we've been a trusted partner in the lives of young people throughout HRM and especially in the north end of Halifax. The Community YMCA has been many things over the years; through the intergenerational legacy of the Panthers Basketball program, to the reputation as a basketball hub, safe after-school care, youth development programs, and a host of other youth programs. It is now even a welcoming space for newcomers.
Above all, the YMCA strives to be a place where young people find a sense of belonging, and these are also the goals of our coalition partners: Hope Blooms, One North End, and the North End Community Health Centre. Youth in the north end of Halifax know they have somewhere to go to find connections and support, and putting them all together is an amazing opportunity.
Anchor will be building on that legacy. It represents a new chapter. Anchor responds to a very real and urgent challenge around how we support youth facing mental health struggles and build their resilience for the future.
As a YMCA, we were excited by the Anchor model that aligns with our principle of “each one, teach one,” allowing us to meet young people ages 12 to 25 where they are, whether that's on a basketball court, in a tutoring session, or simply hanging out with friends. From there, they get a new set of opportunities around counselling, peer supports, and health services, all provided in a stigma-free, welcoming space.
The team has built the centre in close partnership with the IWK Health Centre, the community, and most importantly, with youth themselves. This isn't a program created for youth; it's one that's co-created with them. Anchor has the potential to be that true third space: not school, not home, but a place to belong, grow, and access new health services and programs.
We believe the strength of this model lies in its integration. Anchor is not just an IWK or a Y program. It's a collective effort throughout the province. Sustainable funding from the province makes it possible. Clinical expertise from the IWK ensures quality of care. Our coalition partners, plus multiple other community partners, bring grassroots trust and connection. Informal partners like HRM, the Halifax North Memorial Public Library, and HRCE open up even more pathways for us to do good work.
I believe this is what true collaboration looks like. A young person can walk in for recreation, after-school care, or any of the ongoing services, and if and when the time is right, they will be connected to deeper supports without barriers or stigma. If any youth need more service than we can provide, the team on site can help the young person find the support they need to be successful within the community or health care.
A few short weeks ago, we had a quiet soft opening. Yes, my team made them open up the Friday before the long weekend. You know how much - they really appreciated that one. We didn't advertise the opening. We just wanted to test drive. We wanted to see the space and see how it flowed. Well, 12 youth showed up at our doors the very first night - not an ounce of advertising. This tells you what we need to know. The demand is real, the youth are ready, and we're about to go.
Anyway, I can't wait to see the community response once we hold our actual grand opening on September 17th. I warmly invite each of you to join us as we celebrate this addition to the community.
I'm grateful to speak to you today and really thank you for your time.
THE CHAIR: The normal process is 20 minutes for each caucus. At 20 minutes, if you're still speaking, I'll say “Order.” I'm not being rude. I just have to keep it going.
It will be the NDP, starting with MLA Hansen.
SUZY HANSEN: I want to start off and say thank you so much for the service, and as well for the presentation that was given. I know there's so much more to talk about, but within the time constraints, you have to kind of slip it in.
I want to say I was glad to hear that all of these things are happening within the IYS model - are building upon prevention for our young people, to make sure that they have those accesses. I was also impressed by hearing about accessibility features and the youth voices that are centred and community consults. To me, those are all really big pieces when you have an organization or service provider within a community. You have to work with the community. The community directs you to do that work. I want to say thank you.
My questions are for the IWK Health Centre initially. We are almost the last jurisdiction across Canada to implement Integrated Youth Services in that particular model. What are the challenges and roadblocks that still need to be addressed to get these centres up and running?
THE CHAIR: Ms. Brennan.
MAUREEN BRENNAN: Nova Scotia has, after COVID, entered into some challenges with respect to space and construction challenges as a result of the increased cost of construction. That's certainly a limitation that many have worked around. Outstanding - it's really ensuring that the spaces - it does require 7,000 square feet to actually operationalize the site. Securing those spaces is essential to make sure it's the right space.
The other component is that we've learned from other jurisdictions to really thoughtfully engage our communities to make sure that at every point of the process, we're engaging youth, caregivers, and communities about what would be meaningful for them to make that successful. We spent a lot of time investing in that and we continue to do it.
Currently, the outstanding bigger challenges for us are the ongoing challenges that all Nova Scotians have with the increase in cost of construction, labour shortages, and labour strikes with respect to the space. There's an extensive renovation to make these sites a welcoming and trauma-informed space.
I'd say those are the primary ones. We have been able to work around many of those by escalating and pulling in key construction leads across the province to help us to pull in leasing agents to help with securing some supports for sites. We'll continue to escalate and work with sites where they are.
The last thing I'll say: Because the investment across Nova Scotia is tremendous - eight sites - it does take time. We're now at the point where we expect ongoing openings over the next two years.
[1:30 p.m.]
SUZY HANSEN: My question is - well, you'll probably have to answer the next question as well. Seventy-five percent of ongoing mental health illnesses develop between the ages of 12 and 25. This is a pivotal time in their lives and young Nova Scotians can't wait for care. So far, two sites have opened, and we hear more are coming, which you just mentioned. Why do these Integrated Youth Services sites keep being delayed? I understand the construction - we're seeing that across the province - but I think at the end of the day, why are we announcing things before we even get close to breaking ground? It gets people's hopes up and the anticipation becomes frustrating at times.
I'm just wondering: Can you give us a detailed timeline for when all eight promised centres will open? You said that within the next three years there will be a few more opening. Can you please give us a little bit more of a detailed timeline?
MAUREEN BRENNAN: When the government invested in this, it was over a four-year period. By the end of that four-year period, we were expected to have eight sites launched. Although the first few sites were a bit delayed because of things like COVID and engagement, we're now getting back on track with those. We have one site that is currently open - actually, three sites that are currently open, and we expect that two more sites will be opened - one by the New Year and in the spring, and then concurrently, we would have the remaining three sites open over the next year and a half after that. We're still within the four-year plan, and we're happy that some of those barriers are being worked around to accomplish the sites.
SUZY HANSEN: For the IWK as well, can you walk us through what happens when a young person who is 20 years old arrives needing support with early signs of psychosis? How would you direct them through the system? Would they be sent to the central referral list, or do the hubs use different processes? How would that process be different for a young adult versus someone who is under 18?
MAUREEN BRENNAN: Part of the opportunity that the IYS model brings us is to scale across that transitional age of 19 up to 25. So a 20-year-old can now walk in through the door and be hooked to someone who can provide a level of support. There is core staffing that is attached to each of those lead agencies who have the skills and competencies to support them where they're at, and it's a stepped approach, recognizing that every youth requires different elements of care and support. Meeting them where they're at, we've actually introduced an ability to triage them through evidence-based measures to understand where their level of need is and what their goals are.
If someone is coming in who is identified as in need of support for psychosis, then they very quickly go into what we call the mental health track. There is an evidence-based measure that helps them understand the level of urgency or severity that they may be experiencing. IYS sites will have immediate access to mental health support because we not only have a clinician within that core staffing model who can provide that level of support, we also have a pathway and a close connection with the formal mental health and addictions system, both with the IWK and Nova Scotia Health.
We have been creating ongoing engagement and discussions about how we can integrate: so not having a separate wait-list, you're not going to a different line, and how do we have that integration happen in that site? Those pathways are in place. We're able to connect people to the right care that they need. We'll be having some of those staff be integrated within the actual sites. Some folks from the IWK or Nova Scotia Health will have time to spend in that IYS site to have immediate access and will have transparent, predictable schedules when that happens.
There's more work to do as we continue to evolve to see the trends, but we do have the ability to step up that care. If someone needs care beyond what an IYS site can provide, we can do an immediate connect to our formal system of care and match them to another clinician in our community. If they need psychiatry, that process immediately happens as well. It's really a stepped approach, pulling in the right expertise to respond to those needs.
SUZY HANSEN: I'm just going to pass it on to my colleague.
THE CHAIR: MLA Wilson.
ROD WILSON: Good afternoon. Thank you everyone for coming. I know some of you, and I know your resources, your challenges, and the hard work that you do with the limited resources, so I have to say from the bottom of my heart, thank you for doing - and thank you for taking on a new project. Start-ups are not easy, and I'm particularly happy to hear about your community engagement, which is crucial.
Having worked in rural emergency, I saw the lack of resources, whether it's diagnostic imaging, trying to get people access for youth into mental health services. My first big motherhood question is: Is it fair to say that there is a shortage of mental health services across the province, particularly more in rural areas? On the back of that: What's been your experience so far as you staff up your programs - in recruitment and retention mental health or the right resources that you need to get these Anchors outside of the city to meet their maximum potential in terms of service providers? Is it my anecdotal observation that we are struggling with mental health services outside of Metro? Can you tell us about your experiences with recruitment and retention of people to staff up your sites?
THE CHAIR: I didn't hear a person so who wants to take a stab at it? Ms. Clarke.
TRINA CLARKE: I'm happy to speak to the staffing piece. I can't speak for all of rural Nova Scotia, but I can say that in northern Nova Scotia it was a challenge for staffing, particularly the mental health clinician position. We actually posted the position a couple of times before we were able to secure someone. We were fortunate enough to have an amazing person apply who moved from the Northwest Territories to our community to take the position. It was a struggle, but we have an amazing team, and I think we're very fortunate. Everybody is strong and they're qualified in their roles, and they're doing an amazing job, but it did take time. It did take more time than what we had anticipated.
ROD WILSON: I'm just wondering if Ms. Grant-Walsh had any thoughts on your experience.
THE CHAIR: Ms. Grant-Walsh, did you want to comment?
MARGIE GRANT-WALSH: Sure, thank you for the question. I can't yet comment on hiring of staff, but the challenge, I think, as everybody in this room would know and all of Nova Scotians is that mental health for youth has been a real, huge concern. COVID has just thrown a wrench into everything.
One of the things that I have noticed, working in a mentoring organization, is the lack of being isolated - or actually being isolated, not the lack of - and interacting with responsible, caring adults for young people. We have young people who have come to us who currently have parents who are together, who are fairly successful in school, yet they are lacking that social interaction, particularly with friends and other responsible adults. That was one of the requests that I know we've had over the last few years, and it came directly from youth: We want to see more mentors who can come in and spend time with us. We were actually shocked, but that came directly from youth.
ROD WILSON: Certainly, I would agree. During COVID and post-COVID, as you probably are all aware, seeing the number of eating disorders in youth that just skyrocketed in the severity of when youth are presenting - how ill people are following the COVID isolation period. We know from a recent study that youth surveyed in Antigonish reported finding it difficult when there's a lot of changeover in mental health service providers. Turnover, unfortunately, will be a reality.
I'd really like to hear from your point of view: What can government do to not only recruit but also retain the service - the mental health professionals - that you need across the spectrum to keep the sustainability of the Anchor programs? Staffing up is great, I just wonder what is going to be necessary for the sustainability in five or 10 years besides money, of course. I think I'm speaking to our colleagues who are in the rural areas. Again, we know that rural recruitment and retention is a huge challenge, so what are your thoughts?
MARGIE GRANT-WALSH: Just giving some thought to that question. I know one of the things that I think in any workplace atmosphere is creating a culture in your workplace that's accepting and accessible, having help with the retention of employees who come, recruitment of employees - I think the Province has done a fairly good job with recruiting, say, new health professionals. Perhaps they could look through that lens to assist us. When you talk about funding, that can be difficult for many organizations, especially from a grassroots level. There's some funding available through different departments. It depends on the service provider as well.
When we work in a collaborative model, we try to include all our service providers in the community, so we have a lot of expertise as well that will come together. I know my colleague in Amherst had difficulty recruiting. It's possible we'll have that issue when we go to recruit a clinician, but what I found over the years of recruiting, particularly for staff the last four or five years, is that you may recruit for a clinician today and have no applications and then recruit in three months' time and have 20 applications. It's almost like it runs in a bit of a cycle.
ROD WILSON: If I'm understanding it right, the IWK is the sponsor of the programs, the hubs. I'm wondering, Ms. Champion: What are your thoughts about sustainability, as far as recruitment and retention of diverse-skilled mental health professionals?
THE CHAIR: Ms. Champion.
MARGARET CHAMPION: I just wanted to share some perspective also from the team that's in Bridgewater, because they have just gone through this process and have actually now hired their team. They will start in October. I think to Maureen's point, it does take maybe more time than we might have initially thought to just do that work, work with our youth and caregivers, and find the right team members for community to do this work.
I think on the sustainability, we know that there is an ongoing need for there to be training, learning, and opportunities at each site, but between the sites. We are working with the managers of each site right now, whether they have a team or they're about to have a team, and talking about ways that we can have a learning circle situated. I think our Cumberland team has very wisely, with a team, created space and time for wellness for the team - where they are actually making space for that. I think that will go a long way in helping us with retention, because as we know, the needs are extensive. We need to nurture the folks who are working in these environments so they have the support that they need.
ROD WILSON: An open question: While the centres are staffing up and team-building and learning, which takes time in creating culture, what are you think are the major gaps in mental health that are still not being addressed in this kind of transformation interim session, where the model is there, the model's got evidence, but it's not up and running? If you were to describe any type of service or gap, what do you think youth are most in need of now while the build-up process is happening?
THE CHAIR: You said open - you flinched first. Ms. Grant-Walsh.
MARGIE GRANT-WALSH: A couple of thoughts come to mind. I know you mentioned earlier about young people struggling with food issues, addictions, and those things. That's something that I think we have to spend a little bit more focus on. One of the things I think we are seeing today, which runs the gamut right across all youth, is anxiety. The issue of anxiety. I know obviously since COVID, even we as adults have struggled. How are we handling this new strange world we're in? We are seeing young people as young as seven and eight who are suffering from anxiety. If we're not able to get in there at a young age and offer some preventive services, it's going to be more difficult as these young people get older.
I know our services start at 12 and go to 25. We can certainly have those preventive services, which I think are all in that collaborative model that we have, but we can also have those other services, perhaps, that can be offered more down the road that can tackle some of the crisis situations that we will have if we don't get these young people at an earlier age.
[1:45 p.m.]
TRINA CLARKE: I would agree with all of that, and one of the things I would add is that it does go up to age 25 and we're seeing a higher rate of homelessness in our communities than we've ever experienced before. Providing the supports - we have another team at the Y that helps secure housing for folks who are either precariously housed or homeless. The lack of affordable housing, although it is getting better, particularly in our community - we have had some development there, but there's not nearly enough to meet the need if we have youth - 22, 23, 24 - who have no place to live, for us to secure a safe place for them.
THE CHAIR: Mr. Posavad had something? Forty-five seconds.
BRIAN POSAVAD: Sure - just quick. It's trust and permeability too. What I really appreciate about this is that there are already a number of youth workers out there. There are a number of people connected. This gives a real permeability to those youth who maybe don't want to go to a hospital. They don't want to tell a parent or tell their school. I think this is where that really happens. Putting some of that expertise into the community - we're not going to be able to handle it all. It's Level 1, Level 2 - we help direct. I think adding navigators to youth is going to do a lot to help the process early.
THE CHAIR: MLA Wilson, six seconds.
ROD WILSON: I just want to say that I can't say thank you enough. I know that in the communities you all have full-time jobs . . .
THE CHAIR: Order. MLA Rankin.
HON. IAIN RANKIN: Interesting conversation so far. I do want to talk a little bit about transportation, but I had some questions around staffing as well. I'll continue with that. Maybe we can start by getting a picture of the operating sites now today. What are the staffing levels? Are there vacancies at the existing operating sites? This would be for the IWK Health Centre. Are those vacancies contributing to delays in Nova Scotians getting services?
THE CHAIR: Ms. Brennan.
MAUREEN BRENNAN: I have a clarification question. Are you asking about IWK Mental Health and Addictions or are you asking about Integrated Youth Services staffing?
IAIN RANKIN: We can start with the integrated clinics, but certainly I'd be interested in at the IWK as well.
MAUREEN BRENNAN: I think what I'd like to do is defer to my colleagues - the lead agencies. The model is based on a community-led model, so the staffing models are actually hired and overseen by the lead agencies. I'm happy to pass to my colleagues to update on those teams and follow up with the IWK after.
THE CHAIR: I'll start with Ms. Grant-Walsh.
MARGIE GRANT-WALSH: Currently, our site is not fully up and running yet, but we have just recently developed our job descriptions. We have our policies and procedures in place ready to go in terms of staffing. I know with the IWK's lead, they are assisting us with providing training for staff.
Recently, I know, as an agency in Pictou County, we've hired a couple of our own staff. At that time, we didn't have any difficulty. I don't foresee that we will have any difficulty. I'm also taking the lead in the best practices from some of my colleagues who have already hired, so that shouldn't be an issue.
THE CHAIR: Ms. Clarke. I'll do all three, MLA Rankin.
TRINA CLARKE: Your timing of the question is impeccable. We now have a vacancy. All of our positions were full, but our part-time youth peer support worker actually has given her notice, but for all the best reasons: she's working on her master's, so she will come back to our community as an even stronger advocate for the youth. We have posted that position.
Those positions hadn't been difficult to fill previously, so we're hoping we'll be able to fill that soon. Honestly, other than our mental health clinician, the other positions we were able to fill from within community with many strong applicants.
THE CHAIR: Ms. Vincent.
JULIE-ANN VINCENT: Maybe I'll just give a little bit of an overview for those who aren't familiar with some of the key staffing in the site. What's unique about the Anchor model is not only the clinical services that are offered, but also the community services and the partners as well. We're also fully staffed. That includes a site lead, an administrative support worker - somebody friendly whom the youth see when they first come in, and whom we have hired from within the community for that - a mental health and addictions clinician, a family outreach worker. You had mentioned, Trina, the youth outreach worker, a family support worker, a recreational therapist.
More than that, the staffing is there, and we were incredibly lucky in that we have some of our staff who are actually youth themselves - the Government of Canada definition of under the age of 30 - as well as those from the north end community which is fantastic. We also have to supplement those - a lot of community partners. There are formal coalition partners whom my colleague mentioned in his opening statement but also partners like Nova Scotia Works. They come in and they're providing employment services. We're bringing in the Department of Justice as needed. The IWK did a great job of getting commitment from a number of government departments to help supplement services. The staffing model's really important and we are fully staffed there, but I think it's also important to recognize that services are being provided by partners as well which is one of the really fantastic elements of the model.
IAIN RANKIN: I'm interested from the whole-system level. If the IWK could answer that, and maybe I'll just add: What is the current average wait time that youth seeking mental health services have to wait for each health zone? How did that go into the thinking for the two new sites that have been released?
MAUREEN BRENNAN: The average wait time for urgent care services for children and adolescents across the province is less than seven days depending on which region you're in because we have a target. Within the IWK, it ranges from four to five days. Within the Western Zone, I believe it's three days. It averages, but we're consistently meeting those targets for urgent care about 97 percent of the time.
In the non-urgent wait time band which is a target of 28 days, it's all over the place depending on where you live. I would say that currently - I'll speak to the IWK - on average, a non-urgent appointment is 42 days for that appointment. We're repeatedly working at ways to improve those wait times. They are higher in the Eastern Zone waiting for times, but we're meeting wait times, mostly meeting targets close to 60 percent of the time in the other two districts.
IAIN RANKIN: How do you publicly report on those metrics that you mentioned? How do you track that performance measurement? How do these clinics fit into that whole initiative in trying to speed up the process for both urgent and non-urgent?
MAUREEN BRENNAN: We have a well-developed process for measuring wait times, both at the IWK and Nova Scotia Health. We publicly report those through our decision support teams and our policy and planning offices whereby quarterly those wait times are submitted to the Department of Health and Wellness and they publicly post those on the website and break those down. That's very accessible. I believe there was another question, but I'm not sure.
IAIN RANKIN: Maybe I'll get into the transportation piece because I think that is a big barrier. Somebody referenced it - I think Ms. Clarke referenced what is happening in Amherst and the idea of taxi chits, which is great. I was going to ask today: What kind of programs and subsidies exist across the province? It's great that Amherst has a program.
I would be interested if youth have access for that kind of system, or if there is a consistent way that we can get particularly rural communities - even here in HRM; I represent Timberlea-Prospect, and there's no bus that goes out there. How do they get out to some of the HRM-available services? It's a barrier that I hear about, but particularly for rural and Indigenous communities as well, to access outpatient mental health - just assessments alone. Maybe I can ask - I think the IWK would probably be the right one to answer this, because I'm talking about a province-wide consistent approach to providing programs and subsidies for transportation.
MAUREEN BRENNAN: Transportation is a very real challenge across Nova Scotia, not only for folks seeking mental health and addictions support but seeking support period. Part of the opportunity of this model is to locate those services that are walk-in in communities and locations that can be accessible for youth. That's one solution.
We have established a wonderful philanthropic partnership through our IWK Foundation in which nationally they secure funds. To date, they've secured over $10 million to support those basic needs of engagement and to support additional items that would not necessarily be covered through operations. There are opportunities through those grant fundings. We work with our colleagues across Canada for solutions around this. Within part of the evolution of the model, they'll be looking at flexible solutions that might involve mobile outreach to meet folks where they are. We continue to evolve the model. We look for different solutions and continue to understand those needs.
The model also provides outreach so we can go into community that might be closer to where they might be located, so they can travel around. They're not limited to stay on that location of IYS; they actually can go out into the community and travel. There is a transportation fund to support staff to go into a location that might work better for youth.
IAIN RANKIN: All of that sounds great, but again, are we tracking the data so that these initiatives are informed by where the gaps are? Again, I'll ask similarly what I asked before: Do you break it down by health zones? Do you have a list of where appointments are actually missed because of transportation barriers, which we as MLAs hear about?
MAUREEN BRENNAN: Yes, we do track. All of that data is captured not only at the IWK but also across the IYS sites. Part of the preparation process is to establish what we call a measurement-based care platform system. That system allows us to track comprehensive intake of who's coming through the door. We have an inventory of services that they're coming in for. When they come in, they're registered for that particular service, and through that electronic platform, we're able to extract that data to look at what services they're here for, who's showing up, and what the barriers and challenges to access are.
Because that platform is the same right across Nova Scotia for all IYS sites, we will be able to pull that data to understand what the barriers are. The opportunity that platform provides is immediate access to that information for us to pivot and understand what those barriers are to address them. That is part of the model within a learning health system. We get access to immediate information and act on it. I think there are opportunities before us to understand those barriers in a deeper way and respond.
IAIN RANKIN: What is the percentage of missed appointments due to transportation barriers?
MAUREEN BRENNAN: Are you referring to the Integrated Youth Services?
IAIN RANKIN: Yes.
MAUREEN BRENNAN: I'd have to get back to you and pull that data out, because it would be a very specific pull. I can get back to you with that information.
THE CHAIR: Our clerk will make a note of anything that needs to be brought back.
MLA Rankin.
IAIN RANKIN: Any information would be helpful. Really, it's just about accessing outpatient assessments more than anything else. I want to ask this question as well: What proportion of youth are accessing care within the clinically recommended guidelines in the province?
MAUREEN BRENNAN: I'm sorry, I'm not sure I understand the question. Youth are accessing care?
IAIN RANKIN: What proportion of youth are actually able to access the care within what a clinician would recommend they be accessing that care?
MAUREEN BRENNAN: I hope I understand this correctly. At Integrated Youth Services, anyone can walk through the door and get service. Everyone, 100 percent, can go through and get connected to understand their needs. If they have to go outside the Integrated Youth Services team or what a partner might offer, they can come into the formal system of care. It depends on their needs. All of those youth who require a clinical intervention would be met through that process. There wouldn't be anyone with a closed door; there would be a matched intervention that would be connected to them.
[2:00 p.m.]
IAIN RANKIN: Yes indeed, and they have to get to that door. What proportion of youth are accessing care - sorry, I asked that question. The issue of overnight stays in the Halifax area: Does the department provide support to families that need support when they need to stay overnight in the Halifax area?
MAUREEN BRENNAN: Anyone requiring in-patient services across the province would come into one of our in-patient services. Yes, we have various ways to support the caregiver system that might be coming as well. One of our psychiatric in-patient units, we actually have a family room that they can stay in. Our rooms are large enough where families stay with their youth who are coming in for treatment.
IAIN RANKIN: With respect to psychiatry access and involuntary decertification, specific to the Cape Breton area, how many youth in Cape Breton were transferred to the IWK in the last year solely for psychiatric decertification?
MAUREEN BRENNAN: I can follow up and get you that exact data. We do have that information, and I can follow up after the session to get that to you.
IAIN RANKIN: Do you have the current average wait time for transportation from Cape Breton Regional Hospital to the IWK for decertification?
MAUREEN BRENNAN: We do track the involuntary status, and it's information that I can follow up and bring back to you. I wouldn't have the exact time that it would require for transportation, because it would require data from Cape Breton Regional Hospital to the IWK, but we could explore what we can get to you around that process.
IAIN RANKIN: How many child or adolescent psychiatrists currently serve in the Cape Breton region?
MAUREEN BRENNAN: The child and adolescent psychiatrists in the Eastern, Northern, and Western Zones are under the Nova Scotia Health Authority. IWK has the HRM mandate and provincial and Maritime mandate for complexity. I believe I understand that there are two FTE allocated for child and adolescent psychiatry to the Eastern Zone.
IAIN RANKIN: Do you have a handle on how many vacancies there are across the province, specifically for youth mental health?
MAUREEN BRENNAN: With psychiatry or allied health?
IAIN RANKIN: Specific to psychiatry. We hear that this is a big issue in Cape Breton and they have to come to get services in Halifax.
MAUREEN BRENNAN: I can speak to the IWK. I can certainly get data to follow up with you on Nova Scotia Health. We currently have an FTE of 17.5 child and adolescent psychiatrists for the IWK that has a Maritime academic and provincial mandate. We are full, of those positions.
IAIN RANKIN: Has there been consideration going into virtual appointments for psychiatric assessments, or mobile youth health teams? I think you referenced something in that vein in terms of going out to communities so that we reduce the reliance on these transfers through ambulance - that can take days - to Halifax.
MAUREEN BRENNAN: Virtual care is one of those flexible options we do offer. Certainly, psychiatry does access and provide virtual services. The science and evidence would suggest that when there's someone who is at risk and they don't have eyes on, in particular with an adolescent with many other complexities going on, it is best practice to see those youth in person for the first time, and then build a plan where they might be safely assessed in a virtual capacity to provide that care. I would say the best practice approach always is to see that person in an assessment in person first, and to consult with the other health facility that's referring to consult with the team to inform and to make a plan to be responsive.
IAIN RANKIN: Finally, I have lots of conversations with people who work in law enforcement and community services and stuff. Anecdotally, they're saying that they're getting increasing calls about self-harm, suicide, these types of things, unfortunately. I wonder how our provincial rates of emergency room visits or hospitalizations for these types of things that happen compare on a national stage. Are we in the middle of the pack with this? How are we doing? What I hear is quite alarming. The stats are out there. It was referenced today post-COVID - really, the start of post-2010, with the advent of strong social media use and things like that.
I just want to know what's happening at our own provincial emergency room, in terms of the frequency and how we're tracking that and how we compare nationally.
MAUREEN BRENNAN: Nova Scotia is actually doing quite well in that space, in that there are decreasing emergency room visits and we're seeing a decrease in in-patient care that's happening. We do track everything. We track when they're coming, who's coming, what time of day they're coming, and where they're coming from. Looking at the data, what we understand is that because of the investment in community, because of the collaborative care network that's happening, youth are being seen sooner and being connected sooner and then not escalating in the degree of crisis that is happening.
I think the investments with the school mental health model, the collaborative shared care partnerships that the health authorities have with community organizations, and the IYS model that leverages and connects that community - it's focused on prevention and a continuous service that actually prevents some of those higher numbers that other national - and across nationally - that they are seeing that we are not seeing. They don't have that level of connectivity. They don't have a system that is under one system of care. Both the IWK and Nova Scotia Health work on a provincial model of care that has clear pathways and responses that no other province has.
THE CHAIR: MLA Rankin, with 8 seconds.
IAIN RANKIN: Thank you very much for your answers today.
THE CHAIR: MLA Fadare.
ADEGOKE FADARE: I want to say a big thank you to the witnesses for your thoughtful, very detailed answers that we've heard here today. I think it's very clear - what we've heard loud and clear is that anchor youth space services are more than a set of clinics. They're becoming trusted - what we would call youth friendly - places where young people are able to meet, whether it's for food or showers, as we've heard, or simply a safe place to just be and to belong in.
I think it's also apparent here about what we hear about Cumberland regarding 400 visits in just four months. That is tremendous. This shows us that the demand is real. It shows what we can achieve together when the provincial government collaborates with community groups and partners like that to build this model that truly responds to the needs of the youth. I wanted to really appreciate the honesty about the challenges, whether it's about construction delays, about staffing in rural communities and transportation barriers, and the commitment to finding creative and local solutions.
I think we're building the solution here. I think we should really be proud of what we're doing.
My question is simple. I just want to ask, how does this conversation we've had regarding the Integrated Youth Services - how does it fit into the broader scope of things regarding mental health and addiction services? Obviously this is just part of it. How does this uniquely move us forward towards achieving the universal goal we're trying to achieve here?
This can go to the IWK, or anyone who feels like responding.
THE CHAIR: Ms. Brennan.
MAUREEN BRENNAN: If I understand the question correctly, you're asking about the progression of care across the age of 19 and the model itself. Currently, mental health and addictions services are up to the age of 19. What we understand through the experience is that is a huge gap with the transition going into another system. The opportunity of IYS is that we have both the IWK and Nova Scotia Health mental health and addictions as key partners with the expertise of the Integrated Youth Services coalition and lead agency services to actually meet the youth where they are to co-create a plan, to collaborate around the plan, and to provide information that is helpful for the youth, whether they're 13 or whether they're 24. That opportunity doesn't currently exist, and now will exist through Integrated Youth Services.
It'll be a shared pathway for us to pull in the right level of care in that one location, rather than going to another door, to another location. Currently we don't exist without having those different services, because we're unintentionally siloed. This is an opportunity for us to really share care, to come together for the better interest of youth, to capitalize on the collective expertise of my colleagues in the lead agencies provide. There are wonderful youth-serving organizations that have expertise that can come to meet youth and to really wrap around in a way that I think leverages and improves skills, resiliency, and opportunity for the youth to thrive in ways that they currently haven't been able to without going to different lines.
ADEGOKE FADARE: It's so exciting hearing that, because I'm seeing and hearing collaborations across all borders, whether it's the more traditional way, the way we see in the health sector. I think that's really good. I'm still on partnerships. We've heard a lot here today. Partnerships have come up, from community mentors, to grassroot organizations, to local businesses, to schools and health care services. How does this collaborative model make it easier for youth - and families, I would add, because sometimes they don't exist all by themselves or in silos - to navigate services, especially in the rural and diverse communities where transportation access has always been a challenge. How is that helping?
THE CHAIR: Is that to the IWK, or . . .
ADEGOKE FADARE: A bit of IWK, but I'd also like to hear from the rural YMCA.
THE CHAIR: Who will start? I should remember this. Ms. Grant-Walsh.
MARGIE GRANT-WALSH: Living in a rural community can make it really difficult in many respects in terms of transportation and such, but I think one of the benefits of being in a rural community is we establish really close relationships with other community partners and organizations. We're able to provide services together. I think what happens with this particular model is that it brings everybody together in the same space. When you have community organizations in a rural area, that can sometimes be a challenge. We meet on a regular basis and so on, but having them have their staff and program offerings at that particular site brings us together. It's amazing what kind of synergy can happen when you get three or four staff from community organizations that may not see each other for two or three months at a time. They end up perhaps on the fly either developing new programs, new initiatives and so on.
I think that's a huge benefit for a rural community. I'm sure my colleague from Amherst can add to that.
THE CHAIR: Ms. Clarke.
TRINA CLARKE: I think one of the things we're seeing with our partners is that, as Margie had mentioned, it's a meeting place, and it's a place to build trust. Some of our partners such as SchoolsPlus may bring youth there to just be in the space. They've identified that this youth may need some help, but they're not ready to talk about that or articulate that. What I like the most about this is they can just come and utilize the space. They can just be. They can have something to eat, they can have a shower, get their basic needs meet - and we've seen it already. They don't express that they need anything else except those things, but as they build trust, and then through conversation, they get comfortable, and things come out. That's how they then seek the support and conversation with the clinician.
Many of those youth wouldn't come through the doors if it wasn't for those partners helping us to establish that relationship and bringing them in to Anchor.
THE CHAIR: Ms. Vincent.
JULIE-ANN VINCENT: I'll just quickly add to what Trina said. It's very similar. A lot of times, accessing health care of any kind, much less mental health or addiction support, is intimidating. It often involves institutions. Particularly in north end Halifax, there's a long history of challenges with the health care system. By us housing it, for example, in the Community YMCA that is a safe, trusted space in the community, and having all the partners there, the youth are already comfortable in the space. Like Trina said, whether it's within Anchor or whether it's within, as Brian mentioned earlier, Panthers Basketball, they're there. They can just be hanging out and say, “I'm just going to run upstairs for a minute,” and then they can do a drop-in appointment. They could have a scheduled appointment.
The collaboration of the partners so that a youth doesn't have to be stigmatized for why they're accessing those services or even what services they're accessing is a really important part for youth to gain access who wouldn't otherwise either be comfortable or know how to do it.
[2:15 p.m.]
MAUREEN BRENNAN: In addition to what my colleague said, I would mention another key partnership that happens within our government system. The Department of Opportunities and Social Development, the Department of Justice, and the Department of Education and Early Childhood Development are key partners where they give in-kind time and services. They will also get opportunities for these services which actually will help with efficiencies across the system.
Also, we know these youth are in school. They cut across community. They might be receiving services through these departments. It's essential that we come together and that IYS can provide that safe location for those services and for our staff to come into that setting to meet youth at that place. It's why I think the opportunity for those partnerships can really improve their outcomes with that as well.
THE CHAIR: MLA Corkum-Greek.
HON. SUSAN CORKUM-GREEK: When we speak of health care in this Chamber, regrettably but understandably we are often speaking using terms like “crisis.” We're talking about illness. We're talking about access to treatment. It's all very important, and indeed, I'm not questioning the use of those kinds of phrases and words, but as our Minister of Health and Wellness likes to say, she doesn't want to be the “minister of illness.” Nor does Minister Comer. What we want to get to is wellness.
The thing that makes me the most excited about this model is the ability to engage with youth before the crisis point. I'm wondering if either of the representatives of the IWK, perhaps, could speak to how the Integrated Youth Services model helps to equip young people - you can tell people in my family have accessed the system - to put tools in their toolbox and to develop the resilience that we would want our young people, in particular, to have.
THE CHAIR: Ms. Brennan.
MAUREEN BRENNAN: IYS Anchor Youth Space is that solution to actually have prevention services upstream. The model itself, with the different services early on, can look at building those resilience skills, those life skills that oftentimes are not adequately being realized by youth, particularly with the impacts of COVID.
If I were to wind back the clock five and 10 years ago, you would see an increase in those crisis visits. You would see an increase in in-patient admissions. You would see that and feel that in our system. We're seeing a lessening of that because we're going more upstream and we're understanding the important connect between prevention and future long-term outcomes for youth. We're also seeing the importance of collaboration and coordination of those services early on, so that regardless of what that youth might need, they're getting matched to the right service.
IYS provides what we call a very clear flow of access where the youth needs it - by walking in. Many times, these youth might not be seen. They might not be interested in coming to our formal health care system. They might be the very youth who are suspended from school. The opportunity that IYS has to provide day and evening programs and access to walk through the door - maybe not looking for mental health but looking for some type of social support, some type of connection, perhaps some food security, but recognizing that there is a lot going on underpinning that. Once we develop that opportunity to build that relationship and connection, as my colleagues said, we're able to connect them to services that match it very early on, preventing those crisis episodes. Crisis is a part of illness as well, so with the relationship and the established ongoing support of the issues, when youth might escalate in a level of crisis, we can be responsive to that. We can be responsive within that site and/or match them to the right service that might provide that level of support.
What we hear from families and what we hear from stress on clinicians is that it's the lack of agency in our system, the lack of flow, that causes the problem. It's not that the ability for - one person can't provide all the solutions for these youths, but how we partner and create the right connects and flow, that's what builds retention in our staff, resiliency in our youth, and improved function of the programs. I think that's the solution that Anchor Youth Space provides to avoid the crisis and to be responsive to the youth needs.
SUSAN CORKUM-GREEK: I have spoken in this House before about the fact that my late mother was diagnosed very late in life with bipolarism. I grew up with a very, at times, unhealthy mother. Her depressive state was one that was recognized for a long time. Only years later did we understand, and I've often thought what might have been different if that full diagnosis had been discovered earlier.
I don't talk, and will not today go into detail about other members of my family, including my children, because frankly, those are their stories to tell. I have been a parent anxiously trying to navigate this system in the past. I remember there was a moment when, because of my mother's history, in particular being a child whose parent had done self-harm and attempted suicide, even hearing my child utter the words, “I don't know if I can take this anymore,” it wasn't necessarily truly suicidal ideation, but it triggered me enormously.
I remember speaking to my child's psychiatrist and saying, “I think I need to see someone.” At that time - and this was awhile ago, and I was not in politics - I was told there was quite a separation between child and youth psychiatry and mental health and the adult services; i.e., this individual said, “I'm going to find a way to help you, but I actually can't give you that referral.” That, to me, at the time, was a shocking disconnection when we consider this broad relationship of support that is necessary to help people through these very difficult times.
I wanted to ask about the Integrated Youth Services system in terms of how it includes - I believe I understand correctly that it does have more of an inclusion. It's not exclusive to a parent or another caregiver. Perhaps if you could, Ms. Brennan, give a little insight into how it works in that regard.
MAUREEN BRENNAN: The model itself is not only focused on youth, but it is focused on the caregiving system. As such, we intentionally identify staff as a family support worker to provide that level of service. We know outcomes are stronger when families are at the centre and engaged in the care plan and supporting them. We also know that we need to provide a level of support in response to the caregiving system, sometimes separately, to ensure their skills, resiliency, and supports reflect their reality, and then the opportunity to do that with the youth and with the caregiving system, and then again with the focus to bring that youth and caregiving system together.
Thinking about a child-based approach versus an adult-based approach, sometimes there is a different approach, assuming that once someone hits the magic age of 19, they have full skills and competencies to proceed. We know that's not true. I think that ensuring an aligned, shared approach of what those needs are from all systems and from all partners at the table, and having clear processes that build in and normalize how we come together as a system, rather than waiting for a situation that might require it, that we assess what the roles are, how we bring those partners, how we bring families and what their needs are, and make sure a comprehensive plan with the right supports and services are matched onto that. I think as we begin to evolve and evaluate how we're doing, those will be tremendous improvements in our system of care.
THE CHAIR: MLA Corkum-Greek with two minutes.
SUSAN CORKUM-GREEK: I will pass to my colleague, MLA Hilton.
THE CHAIR: MLA Hilton.
NICK HILTON: Thank you all for being here and for sharing information on this wonderful initiative.
I'll just take a moment to focus on the Anchor Youth Space name. To be honest, it's the first time I've heard it today. What a perfect name. It kind of creates that attachment to youth for youth in the mental health space but also pays a little bit of homage to our seagoing heritage. I look forward to seeing that in Yarmouth in the next couple of years. Being named the eighth site was exciting for my community and exciting for me. Mental health and addiction - I've worked a number of years in health care, many of those on the mental health and addiction in-patient units in Yarmouth. I can tell you that this is important work and we're looking forward to seeing where the community goes with that.
I spent yesterday with a number of colleagues in Yarmouth - around 20 of us - planning a youth summit in Yarmouth. We're really looking forward to the work that's bringing together. I think it will go well with the work that you're doing here. Specifically, my role is to create some time where we are going to let youth experience what it's like to take part in governments and kind of switch roles. We'll help provide them some information and then we're going to put them on the spot to see what's important to them and how they see the work moving forward. That's something that will be new for me. I'm looking forward to working with the youth in Yarmouth.
Something that you said - it's important to be seen and heard, and in a timely manner. That work - that can be more accurate for the way the world is today. I'm happy to hear that that's how you're moving the work forward.
I only have four seconds, so I think we're going to wait for the next round to ask some questions. Thanks again for being here.
THE CHAIR: Order. We're going to do seven minutes.
MLA Wilson.
ROD WILSON: Thank you again for coming. I was excited when I came here to learn more about the Integrated Youth Services. It reminds me of the shared care model we used at the North End Community Health Centre. However, being honest, my anxiety has risen listening to your first line point of experience. What I heard - and correct me if I'm wrong - is that it's going to take probably four years to have the sites fully up and serviced. The wait time in rural areas is only meeting the target 60 percent of the time. At the same time, we heard about increased anxiety and homelessness. It doesn't paint a pretty picture today.
I think of the parents I have worked with and have seen in emerg. A day with a teenager or a family in crisis is the longest day of their year - of their life. Things are changing - again, my anxiety is - there's still a big gap out there in our province, particularly in rural Nova Scotia. You highlighted that bit. Access to care really differs depending on your postal code.
Trying to be an optimist - while these targets are moving, to relieve the anxiety of those parents who may be listening today - what do you need from government to make a difference today, next week, as your site grows? A big question, but I think parents can't have delayed hope that good things are going to come when they're experiencing such stress in their individuals today. What do you need in that vacuum we have today?
THE CHAIR: Ms. Grant-Walsh.
MARGIE GRANT-WALSH: Really, continued sustainability - investing in the sustainability of this project long term is very important. But I also think that investment in community organizations that are doing grassroots work - some are funded in different models from different departments, and if they're not able to do the work, it makes it more difficult over that long term.
[2:30 p.m.]
One thing I can say - for example, our site is yet to have opened. But having said that, one of the things with this process that has brought our community together more - the community organizations are now working together more, and for example, our project manager has been working tirelessly and communicating with some of the organizations as to what we can do to work together now until that site is open.
I think we're now offering more support and more programming and so on. Hopefully, that will continue down the road, but I would recommend that the government continue their financial investment. We're always open for more.
THE CHAIR: Anyone else? Ms. Clarke? No? Okay. MLA Wilson.
ROD WILSON: IWK, what do you need?
THE CHAIR: Ms. Brennan.
MAUREEN BRENNAN: As you're talking about that, I'm thinking a couple of things. Not everyone needs to come into the formal system of care. Right now, I think we need to make sure that our broader community understands service in a continuum so that they're not thinking that only treatment can happen in our formal system of care. I think education and literacy about early intervention and matching treatments early on, that support and those key messages in your sphere of influence would be really important because we have to train and understand the system in the same way. I think that would be a really key piece of what we need.
Continued ongoing financial support to do what we do and work on these models in collaboration because the future is about coordination and collaboration in a system of mental health and addictions care of which IWK is only one aspect. There's a huge aspect within community and ongoing partnerships with not only youth-serving organizations but our education system as well. Those opportunities to invest more in those collaborative models.
ROD WILSON: The reason I ask is it's real for me. I remember working in a rural site in June and saw a 17-year-old who left school during COVID and had rarely left the house in the last two years. They only came to emergency because of an acute inflammatory process. I spoke to the mom, and the mom was just at a loss and almost resigned to the fact that this is the best they could do. I'm sure you'd all agree it's not the best we could do.
I defer to my colleague.
THE CHAIR: Okay, MLA Hansen.
SUZY HANSEN: Listening today, I'm always very impressed that we are putting our youth first and foremost because we know that for a long time, they've been left in the wind, not that we haven't tried our best. I'm so grateful to be the MLA for Halifax Needham because the north end of Halifax has been doing this for years and we are continuing to do that work. I know that other communities are doing so as well in their own way. I was glad to hear those wonderful collaborations, the community conversations, and the things that are necessary.
This is going to be for the YMCA of Greater Halifax/Dartmouth, and you can answer the question after the time is up because I know my colleague will give me the time. The Halifax north end hub opened up last week. I would like for you to talk about how you're making sure the services are relevant and culturally competent to the community in which you serve. I know that we mentioned a welcoming space. I know that; I'm in the Y every other day, so I understand the dynamics of the community space and the people who work there.
I'm just curious to know how many Mi'kmaw folks or African Nova Scotians or community-centred folks who are truly engaged in community will be a part of the work that's happening in the hub in the North End.
THE CHAIR: Which one? Ms. Vincent.
JULIE-ANN VINCENT: I think it's been alluded to or specifically mentioned a few times today how much work has gone to . . .
THE CHAIR: Ms. Vincent, just hold one second. I'm going to say, “Order.” He's going to reset the clock, and then you're going to be able to finish because MLA Rankin has already said you can finish. I'm a process person; they're used to this. Ms. Vincent.
JULIE-ANN VINCENT: Youth have been put at the centre of all stages. We've talked about the design of it. One of the things that hasn't really come up today is we also have a Youth Advisory Committee. Each site has one, as well as the overall IYS model. The IWK facilitates one - a Youth Advisory Committee with youth from all eight communities. Each site, including ours, also has a Youth Advisory Committee made up of youth from the community who come together. They inform programming needs, programming desires, what they would like the space to look like, and what services they're looking for.
We also have a caregiver advisory committee. Again, the IWK facilitates a provincial one, but we have our own site one. Caregivers, parents, and other invested members of the community sit on that and help to inform the activities, the programming, and even just the feel of the space. All of that is very community-informed and community-driven. We do have members of the African Nova Scotian community on staff, as well as, as I mentioned, a couple of youth members on staff.
All of that has been a very thoughtful, deliberate approach on the part of our site lead to really make sure that that space is informed by, and also that the programming is continuously informed by, community and is with community and not for community.
THE CHAIR: MLA Rankin. Oh, you defer all your time. MLA Hansen.
SUZY HANSEN: I can't wait to be able to come in and see the space. We're fortunate to be able to have a space within our own Community YMCA. It's literally a non-stigma moment where you can drop your kid off at basketball or drop your kid off at a program and just walk upstairs to have conversations - or your brother or sister, vice versa. I think we're unique in that way, and I'm grateful that we were able to have those opportunities.
I'm going to defer my next question to my colleague.
THE CHAIR: MLA Wilson.
ROD WILSON: I have tons of questions. I could keep us here for hours, but I won't.
THE CHAIR: You have four minutes and 32 seconds.
ROD WILSON: As you've mentioned, which I thought was excellent: With youth come families in various shapes, forms, and ability to function and not function, and it depends on resources. My (inaudible) is one of those. What resources will Integrated Youth Services have to support those similar to your model - those families and caregivers, grandmothers, aunts, uncles who are trying to help that youth, or several youth in one family, to make it to the next day and make it on to school?
THE CHAIR: Mr. Posavad.
BRIAN POSAVAD: It's a really great question. I think that's where some of the community organizations really come into play and come to bear. The other piece is most of us have some challenges with resources on occasion. There are 100 problems and we can solve none, or we have enough energy to do certain things. This gives us resources to actually put the community together a little better. When we have a site lead that's actually - back to MLA Hansen's question, too - when we have a need that's identified by the youth or the caregivers, we now have the opportunity, because we have groups that are already signed on with us. We have access to the other agencies that want to be a part of it.
We can drive some of that solution, and that becomes community based. If it's a real need for parent groups, we've got the spaces and we've got someone who's going to go and start to coordinate some of that work. We don't have to wait for a volunteer to appear from out of nowhere to start that process. We can facilitate a little bit more beyond just that one path for that one youth. I think that's a real advantage to these centres.
ROD WILSON: Is there anything else in rural or in the IWK that's in the process, either now or long-term, to help support families of youth who will use these services?
THE CHAIR: Ms. Brennan.
MAUREEN BRENNAN: I think this is where we bring our partners of the Department of Opportunities and Social Development, who have made a commitment with their new continuous service on prevention and promotion, who have actually partnered up to provide those services earlier on for families. It gives us an opportunity to access those particular services and funding at places that might not ordinarily have an opportunity to. I think that certainly would be additional services.
We've invested in roles that focus on the family and caregiving system that can provide that direct support as well. In addition to that, we have supports and services within Mental Health and Addictions that would partner up and provide that specialized support to the caregiving system as needed. I think there's more to develop and grow as we begin to understand the needs of who's coming to the door, and we'll explore how we can continue to improve. I see the future in that as understanding the needs of those coming through the door, partnering with our service providers who are doing this work, and looking for opportunities to invest more in those needs that we're understanding families have.
ROD WILSON: My last question, and it's a big one. What does success look like, and how will you know when you get there? It really speaks to evaluation, in terms of which benchmarks are you using and how are you measuring your success? Is it standardized for all the units, or are you taking in some regional differences? Tell me about the evaluation process.
MAUREEN BRENNAN: There's been a lot of time engaging across Nova Scotia to understand impact. We also have learned, nationally and internationally, from the IYS model of what has worked and best-practice approaches. Through the process, we across Nova Scotia have identified a minimum dataset that will help us understand - to provide measures of those coming through the door to what those needs are. We'll have that data, and we'll be using that data through the Greenspace Mental Health Ltd. platform I talked about.
As we pull that data, we'll be able to do a couple of things. We will be able to understand what . . .
THE CHAIR: Order. Sorry. At the end of the 20 - oh, MLA Hilton is saying that he's going to let you finish when I call him. The clerk will start the clock.
Ms. Brennan.
MAUREEN BRENNAN: The platform will allow Nova Scotians to understand what's happening to youth across Nova Scotia. Whether in Sydney or Yarmouth, you'll be able to see in the same way, understand those needs in the same way, and use that data.
Part of our outcome measurement also looks at the goals the youth have, so we have evidence-based measures to understand those goals. We'll have that data. Through multiple data sources in real time, we'll be able to understand the impact. We'll be able to understand how we're performing for Nova Scotia, across the Maritimes, and nationally to understand impact.
Success, I think - as a system, if we can reverse the system to be upstream and to flow and for youth and families to have the right care at the right time by the right care provider and that's universally understood, that would be success.
THE CHAIR: MLA Hilton.
NICK HILTON: I'm really excited by what I'm hearing here today and talking about the continued investment and continuing to put youth first. Those are the things that I'm taking away from that today. I think those are the things that our government is doing. Just in my community recently, I became part of the Youth Wellbeing Network - talked about the youth summit that's coming. You've mentioned the Youth Advisory Committee in the Anchor Youth Space services. There's so much going on and so much to be optimistic about with our youth.
One quick question, and I'll pass it over to my colleague. Nova Scotia has been trying some innovative initiatives in health care. How is Integrated Youth Services informed on best practice? I know you touched on that, but maybe you could share a little bit more.
MAUREEN BRENNAN: The opportunity is that this has been in operation for well over 10 years and 15 years. In B.C., we have Foundry BC. In Ireland, we have Jigsaw. In Ontario, we have wellness hubs. We can learn from those services that have evaluated and have lots of data to help us understand the evidence and the impact that these sites made.
I've mentioned that we have a minimum dataset. We're part of research studies to make sure we're accountable, so we understand both from an economic point of view as well as an impact - are the youth getting better? Are the services effective? Those are some key questions that we have built into an evaluation plan to understand effectiveness and impact across Nova Scotia.
We also have the opportunity - I referenced it in my earlier remarks - we're partners of over $32 million through the Canadian Institute for Health Information to actually partner up with other IYS providers, to be part of national and international evaluation projects, so that we can build on that expertise and continue the conversation.
[2:45 p.m.]
As you heard today, we also have the qualitative - and experience of our lead providers who are providing the services of our youth in our community. Building on that knowledge and helping to understand the impact will be part of that evaluation as well.
THE CHAIR: MLA Stoilov.
DAMIAN STOILOV: I just want to echo what my colleague said earlier: great responses to the questions. We've certainly learned a lot, and there's no more dedicated people than you folks on these issues. I just want to say thank you.
You've answered a lot of questions. We certainly have a better understanding. I'll put this question to the individual who I met outside in the parking lot coming in here - Ms. Clarke, I believe. We've opened up the new location in Amherst. Just curious, it's always been my expectation in my past life when we launched a new product in a market that you always want to learn from that and say to yourself, “What have we done well? What have we done poorly? When we launch it in another market, how can we be better?” I guess the question is: What have we learned, good and bad, so that when we open up the new site in my colleague's area of Yarmouth, it's executed a lot better than what we did in Amherst?
THE CHAIR: Ms. Clarke.
TRINA CLARKE: I think that, as I had said in my opening remarks, going first was very exciting but it definitely had a host of challenges because going first, you don't know what you don't know. Opening the doors, we saw a flurry of activity, obviously - 400 folks through the doors since we've opened. Understanding how we design this to make sure that youth are actually - it's a fun, cool place to be. Make no mistake, it's amazing. How do we make sure that it's actually serving the youth and doing what it needs to do?
I think one of the incredible benefits from this - or that I hope from this - is that all of my colleagues at the seven other sites will be able to exactly benefit from what we now know. Every community is unique, so that is the wonderful thing about this. We are making sure that we are filling the needs of the youth in our community.
However, there are many learnings that we can share. The project managers across all eight sites meet on a regular basis. We have actually put together a package of what we've faced and here's how we overcome it. I can't share them all with you because I think we definitely would be out of time because there have been numerous things. Everything from intake process to program delivery, to the types of programs, to separating the ages because 12 to 25 is massive. Making sure that we have age-appropriate programs, so we don't alienate the 23-, 24-, or 25-year-old who doesn't want to hang out with the 12-year-old.
There's been a tremendous amount of learning, but I think we all benefit from each other. I think we will continue, even as more sites open, to learn from each other because there will be things that come up in other sites that we will then learn from.
THE CHAIR: Order. That concludes the questions. What we'll do is closing statements. If you haven't been here, everybody gets a shot. Ms. Vincent, do you have any closing comments?
JULIE-ANN VINCENT: I just really wanted to say thank you to everybody here for your engagement and your questions. I think I speak for all of us when I say we're thrilled to be able to talk about this. We're thrilled that we're now open. I'd like to reiterate Brian's invitation for everybody to come to our grand opening on September 17th at 8:30 a.m. Thank you very much for the opportunity to speak.
THE CHAIR: Mr. Posavad.
BRIAN POSAVAD: With Julie-Ann, come see us on the 17th and see what it's all about.
THE CHAIR: Ms. Clarke.
TRINA CLARKE: I also just want to reiterate my thanks for this opportunity. This is, I will admit, my first time. It was a little nerve-racking, but you've all been very kind so thank you. I will say, I do want to give a shout-out to Cumberland. We really went at this hard. We had an incredible construction manager, and we had an incredibly dedicated team. I'm just really proud that we were able to pull this off. Seeing and hearing from the youth now what this means to them already has made all the pain of getting the doors open worth it.
THE CHAIR: Ms. Grant-Walsh.
MARGIE GRANT-WALSH: What I want to do is say thank you on behalf of all the youth in Pictou County. In a rural community, it's very difficult at times to access service. This is huge, and I'm sure my colleagues would agree the youth right across this province thank you. I would also like to give a shout-out to all our community partners, coalition partners in Pictou County, and to my project manager, Sara MacKay-Spears.
THE CHAIR: Ms. Champion.
MARGARET CHAMPION: I did just want to let you all know, I have stepped into this role on an interim basis and have only been in this work for three months but have worked in our formal health system for over 30 years. I am incredibly moved and so fortunate, finally in my career, to be working in something that is grounded upstream, in community and led by community. I am just very privileged to be here. I am on a learning journey, and I know I'm going to continue to learn with all these wonderful partners, the youth, and our caregivers.
THE CHAIR: Ms. Brennan.
MAUREEN BRENNAN: I'd also like to thank you all for your thoughtfulness and genuine interest in the model. Within my career of being in the IWK department of Mental Health and Addictions for over 30 years, it has always been about partnership, connection, and coordination of care within that system. This is a real opportunity. I would be remiss if I didn't talk about the amazing leaders and the lead agencies that we have that are leading this initiative right across the province. Thank you and kudos to all of them.
THE CHAIR: It's my part to say thank you for coming and thank you for what you're doing. I have Treasury Board so I don't think I'll make it, I'm sorry. If they cancel it, I'll be there. Your part is over. What I'm going to do is recess for three minutes for you to get out and then we'll come back. We're in recess for three minutes.
[2:52 p.m. The committee recessed.]
[2:56 p.m. The committee reconvened.]
THE CHAIR: Order. I call the meeting back to order. Going back to our agenda, there's a letter that's been received from Kim White. Is there any discussion on this letter?
MLA Wilson.
ROD WILSON: Yes. We think the letter highlights a number of issues and feel strongly that we'd like to introduce a motion to the committee for its consideration. Does that make sense?
THE CHAIR: The motion that was shared is in response to this letter?
ROD WILSON: Are we talking about the same motion?
THE CHAIR: I don't know. There was a motion that came in after the meeting started that's been distributed to all the members, if that's the motion you're talking about. I didn't realize it was part of it. I have it listed under additional business.
If you have a motion regarding this, I guess I'll let you read your motion. MLA Wilson.
ROD WILSON: In response to the letter of Kim White, I'd like to introduce the motion:
Whereas breast cancer is the most common type of cancer impacting women and accounts for 25 percent of all new cancer cases each year; and
Whereas the care women without family doctors are receiving for their breast care is fragmented because the health care system was not built for patients to navigate on their own; and
Whereas Nova Scotians with breast cancer deserve better from this government;
Therefore I move that the Standing Committee on Health urgently write to the Department of Health and Wellness requesting a comprehensive plan outlining concrete steps that will be taken to close gaps in breast cancer care.
THE CHAIR: I believe that was the motion that was shared. Discussion on the motion?
MLA Corkum-Greek.
SUSAN CORKUM-GREEK: I read the letter with interest. I've certainly sat with women in my constituency office in regard to this issue.
The PC caucus does feel that asking for this motion at this time could undermine the work that teams are currently undertaking. Specifically, recently the IWK Health Centre hired a nurse navigator on a one-year pilot modelled after our lung cancer screening program. This would offer a central point for unattached patients to be able to ensure they receive timely results, referrals, diagnoses, and care. The creation of a breast health research unit is also under way at the IWK.
We believe that with more time and the development of these initiatives - and in the case of the pilot, to be able to look at results - is valuable. For that reason, we will not be supporting the motion.
THE CHAIR: MLA Hansen.
SUZY HANSEN: Thank you, Chair.
THE CHAIR: Order. The time for the committee has finished. The next committee meeting is Tuesday, October 14th, as the House is sitting, from 9:00 a.m. to 11:00 a.m. The topic agenda is Agenda-Setting. There are no witnesses scheduled.
This meeting is adjourned.
[The committee adjourned at 3:00 p.m.]
