Category: Blog: Miscellaneous

Jayme Wong, ESPC volunteer

Renewed Focus: A Follow-Up Report on Youth Opioid Use in Alberta was published by the Office of the Child and Youth Advocate Alberta, an independent office of the Legislative Assembly of Alberta, in June 2021. The report was published three years after Into Focus: Calling Attention to Youth Opioid Use in Alberta (2018), a report that offered five recommendations to government bodies and agencies to address the increasingly disconcerting opioid-related deaths among Albertan youth.

Since the 2018 report, little has been done to address the pressing situation, with “young people . . . dying in even greater numbers today than when [the original report] brought this issue into focus nearly three years ago” (p. 5). The follow-up report revisits the original five recommendations and adds a sixth based on interviews with Albertan youths, non-profit and youth-serving agencies, and provincial government ministries and agencies.

The recommendations made in the 2021 report are as follows:

1. “Alberta Education and local school authorities should increase the level of health promotion and age-appropriate substance use education in curriculum from elementary through high school.”

Recommendation 1 focuses on health promotion, calling on schools to provide learning opportunities for substance use education. Notably, the report warns that the curriculum “needs to include the realities and impacts of drug use through individuals sharing their lived experience” (p. 13), pointing to the failures of abstinence-only approaches.

2. “Child-serving ministries should have appropriate substance use intervention training to increase the capacity and knowledge among direct-service professionals to ensure young people get the right services at the right time. This should be part of the provincial youth strategy.”

Recommendation 2 urges agencies and ministries to intervene early, providing key supports—such as housing and culturally-specific programming—to ensure safe and healing environments for youths before they turn to opioid use.

3. “Alberta Health Services should strengthen their substance use related interventions for young people. Special attention needs to be given to interventions specific to youth opioid use and to services for young people with co-occurring issues of mental health problems and/or cognitive disabilities.”

Recommendation 3 advocates for “flexible and creative approaches” (p. 16) within the spectrum of interventions for young people. Strategies such as medical treatment and harm reduction are needed to “meet young people where they are at” (p. 22) and provide respectful, non-judgmental support rather than finding a one-size-fits-all solution.

4. “Alberta Health Services’ Youth Addictions and Mental Health programs should have a more inclusive practice of involving families and significant individuals, with specific attention to substance use prevention and treatment for young people.”

Recommendation 4 highlights the involvement of families in youth substance abuse. This recommendation suggests providing education and resources to families seeking long-term support and looking to create a stable, supportive environment for individuals who are struggling with opioid addiction.

5. “The Ministry of Health should undertake a review of the Protection of Children Abusing Drugs (PChAD) Act and its policies, so the related services better meet the needs of young people and their families.”

Recommendation 5 is a critique of the PchAD Act for being inaccessible and insufficient, citing as primary issues limited spaces in the program, too short a program period, and inadequate treatment services.

6. “The Government of Alberta, with leadership from the Ministry of Health, should establish a dedicated body such as a panel, committee, or commission to develop and support implementation of a youth opioid and substance use strategy.”

The newest strategy recommendation suggests that an evidence-based approach—with contributions by people with lived experience—is needed to develop new ways to support the implementation of youth opioid and substance use prevention. The report notes, “A key part of this youth strategy must include a clear focus on Indigenous young people . . . It is crucial that the cumulative impacts of colonialism, intergenerational trauma, and the opioid crisis be recognized” (p. 26). The hope is that the creation of a diverse panel will generate more comprehensive and accessible legislation and services.

There is a conscious effort to use inclusive language, such as framing findings as “we heard”—making a strong argument for involving youth in youth-based legislation. While the report highlights the “promising” progress that has been made to opioid and substance use legislation in Alberta since the 2018 publication, there is still a long way to go. Rather than creating policies within a vacuum, perhaps listening to the young people currently experiencing the opioid crisis is the first step forward.

Office of the Child and Youth Advocate Alberta. (2021). Renewed Focus: A Follow-Up Report on Youth Opioid Use in Alberta. https://www.ocya.alberta.ca/wp-content/uploads/2014/08/SpRpt2021June_Renewed-Focus.pdf

You can read more research report reviews in the latest edition of Research Update

 ESPC volunteer Jayme Wong graduated from the University of Lethbridge in 2014 with a BA in English and Philosophy, and more recently graduated from the University of Alberta in 2020 with an MA in English and Film Studies. She currently works at a local non-profit, the Learning Centre Literacy Association.

[1] Recommendations one through five are listed on page 7 of Renewed Focus, recommendation six is on page 25. Note that the first five recommendations are from the original 2018 report.

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Written by Sung Min (Amy) Jo, 2021 Canada Summer Jobs, Research Assistant

The provincial budget for 2021 proposed a 4% increase in funding, to approximately $23 billion, to Alberta’s health care system. This is significant, as previous models recommended a 1.5% year-over-year growth in spending to offset pressures to the system, such as population growth and aging, new hospitals, scheduled collective agreement rate step increase (wage increases), and commitments to improve surgical wait times. The proposed $23 billion is not inclusive of costs associated with the impact of COVID-19, which adds another $2.1 billion in spending.

The Government of Alberta’s fiscal plan for 2021–24 reports $98.2 billion in total debt outstanding. This is not news to Albertans, as the province has been accumulating a deficit over the past few years. One of the targeted areas for evaluation in public service efficiencies and cutbacks includes health care, which accounts for 43% of public spending in Alberta, making this the largest expense compared to other domains of the operating budget.

Figure 1 Calgary Herald – source

According to the Alberta Health Services (AHS) Performance Review, an increase in spending does not produce better health outcomes for Albertans. A study from the Commonwealth Fund conducted in 2017 compared health care spending to health care system quality indicators on the international stage among 18 countries. Canada’s health care spending ranked 9^th for percentage of GDP spent on health care and 7^th on health care spending per capita. Out of 11 countries, Canada ranked 10^th in access to care, 9^th in equity and 9^th in health care outcomes. Most significant was Canada’s performance in access to care, with 18% of participants indicating a wait time of four or more months to receive an elective surgical procedure, and 30% indicating a wait time of two or more months for a specialist appointment. As per the results of the study, rankings on the health care system quality indicators does not correlate to the province’s reported high spending.

Figure 2 AHS Performance Review – source

Nationally, Alberta ranks poorly for a number of health indicators, reporting higher than national average rates for infant mortality, deaths from major cardiovascular disease, deaths from intentional self-harm (suicide), and hospitalized heart attacks. This highlights the issue that increased funding in a major sector such as health care does not necessarily result in improved health outcomes.

Provincial measures to produce better health outcomes for Albertans while improving cost efficiencies include three initiatives, outlined in the provincial budget. The three initiatives include a surgical plan, a continuing care plan, and a CT and MRI access plan. The first two are discussed further below. Altogether, these three initiatives will take up to $16 billion to reduce long-term health care costs and focus on improvements for a more sustainable and efficient health care system.

Alberta Surgical Plan Initiative

The Surgical Plan Initiative (SPI) is a province-wide initiative to reduce surgical backlogs and increase elective surgery capacity in the current health care system—which is necessary now more than ever. The surgical backlog that existed before the COVID-19 pandemic has worsened as elective surgeries have been cancelled due to repeated waves of COVID-19-related hospitalizations and an increased strain on health care resources. As a result, the number of patients receiving elective surgical procedures within a clinically appropriate timeline has decreased. Despite increased spending to health care each fiscal year, Alberta’s health care system fails to provide timely health care services. This is indicated in Figure 3, and the trend line suggests worsening capacity measures.

The Alberta SPI aims to reduce the backlog of elective surgical procedures by outsourcing to non-hospital surgical facilities. This could mean 27% (75, 511) more procedures, ensuring more patients receive their elective surgeries within clinically appropriate timelines.

Figure 3 Canadian Institute for Health Informatics – source

Continuing Care Plan Initiative

The AHS Performance Review report revealed that acute care expenses were 32.9% of the total health services budget, representing the largest proportion of clinical care services spending. Considering the high cost associated with hospital stays, AHS has made active efforts to adjust resources in order to diversify clinical services (i.e., long-term care, community-based and home care services). By focusing on comprehensive care in the community to help Albertans receive earlier care and preventions, these efforts aim to maintain health and well-being at an overall lower cost.

Since 2016/17, the percentage of clients admitted to a continuing care space within 30 days has declined. This indicates that wait times for continuing care spaces have increased and resources are sparse, despite growing need. This rate is predicted to increase significantly, shaped by the growing demands of the increasing older adult population. Without adequate bed capacity in continuing care facilities to support this population, health care concerns will likely lead to prolonged stays in acute, hospital-based settings, and result in worse health outcomes and increased spending. Budget 2021 includes $3.5 billion for continuing care, community care, and home care programs in support of Alberta’s aging population.

The Continuing Care Plan Initiative aims to achieve better health outcomes at a lower cost by integrating a continuum of care model that supports healthy living in the community for all ages and that will reduce the need for costly acute hospital resources.

Conclusion

Health care spending in Alberta is under intense analysis, now more than ever. From health care cuts over the past year to the continuing stress of the pandemic on the health care system, decisions related to health care budgeting must be made with careful considerations. When inflating spending to the health care sector is not viable in Alberta’s economy, cost saving efficiencies must be evaluated to preserve Alberta’s fiscal future while maintaining a level of standardized health care for Albertans.

About Sung Min (Amy) Jo

Sung Min (Amy) Jo is a nursing student at the University of Alberta. After previous work experience with community non-profits, she is excited to pursue a career in public health pertaining to policy and program development in response to barriers experienced by vulnerable/marginalized communities. Sung Min worked with ESPC through a Canada Summer Jobs student placement this past summer and fall, and has since signed up as a volunteer with the organization.

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Written by Luis Murcia, ESPC Volunteer

In Alberta, child care is generally regulated by both provincial and federal governments, and rarely by the municipalities in which the facilities are located. Issues around child care often cannot be addressed by municipalities, such as long wait-lists, lack of coverage, affordability, and impacts from COVID-19. As a result, many cities struggle with ensuring access to early learning and care.” In this blog post we will explore the issue of child care coverage, some of the impacts that COVID-19 has had on the child care system, and what a few municipalities in Alberta can teach us when it comes to providing quality child care.

In Edmonton, as in the rest of Canada, child care can be a major struggle for parents. There are many factors that make it a challenge, including availability and affordability. In Edmonton, estimates for child care coverage range from 3 to 3.7 spaces per 10 children under four years old [1, 2]. While there has been an increase in child care coverage in past years, coverage is not evenly distributed across Edmonton [3]. In Alberta, coverage sits at just 36% for all children in the province, with Calgary and Edmonton contributing a combined coverage of 43% despite housing over half of all children in the province [4]. However, even within Edmonton, 33% of children live in a child care desert. We can see from these numbers that long wait-lists have been the norm and are not simply an outcome of the pandemic.

The child care system has been greatly affected by the COVID-19 pandemic. Though this topic deserves its own separate analysis, here are a few key facts:

• LOSS OF CHILD CARE WORKFORCE: In Alberta’s first wave, 55% of centres reported mass staff layoffs [5]. In the first year of the pandemic, Alberta lost 20% of its child care workforce—from 18,818 licensed educators in March 2020, to 14,984 in March 2021 [6].
• INCREASE IN FEES: The Canadian Centre for Policy Alternatives (CCPA) annual report shows that fees for preschool-aged children rose in several large cities in the country as a direct result of COVID-19. These increases ranged from +1% to +25%; Edmonton faced fee hikes of over 6% [6].
• DROP IN CHILD CARE ENROLLMENT: With the rise in cost there was also a decrease in enrollment rates [6]. This created a problem for facilities struggling financially throughout reopening efforts. Between February and September 2020, there was a drop of 43% in child care enrollment in Edmonton (about 10,000 spots). The CCPA report draws a strong negative correlation between declining enrollment and high fees.

At first glance, the pandemic created major challenges in child care.  On closer inspection, it simply brought out the fragility of the system. COVID-19 has highlighted the feedback loop of a dwindling workforce that results in higher fees, causing parents to refrain from enrolling their children in programs [7], causing more staff to be laid off—and the cycle continues. David Macdonald, CCPA report co-author, broadly noted, “relying on exorbitant parent fees to fund services that should be part of the social infrastructure is what got us into this mess in the first place” [8].

So how can communities address child care affordability and accessibility? Fee issues will be easier to fix than availability/ accessibility. We’ve seen that when provincial and federal governments commit to subsidizing child care (such as with the $25/day or $10/day programs, discussed in a previous post on child care in Alberta), options are made available to  low-income families. However, improved affordability means that wait-lists often skyrocket [9]. Making child care affordable but neglecting to address the number of licensed facilities does not actually get more children into care. Even in provinces like Quebec and P.E.I., where fees are set and capped, child care accessibility depends heavily on where parents live. Finding child care in large urban areas tends to be easier than in rural areas [4].

It’s not only a matter of making the system affordable, but also creating initiatives to increase the number of licensed early learning and child care spaces where needed [4]. If municipalities had a major role in child care, would that help deal with the ongoing issue of child care deserts? Currently in Alberta there are four municipalities that are involved in supporting child care: Jasper, Beaumont, Drayton Valley, and the Municipal District of Opportunity No. 17 (located north of Edmonton). Beaumont has a fixed budget to cover about 20% of their child care program, while the other three areas have established annual budgets to support their programs [10]. Additionally, public support in these communities has several benefits:

• Fees are lower than the provincial average for similar level of care, despite the remote locations.
• Services remain affordable for local families.
• Specific needs of the community can be targeted.
• Physical sites are developed purposefully for early learning and care.

Closer to home, the Edmonton Council for Early Learning and Care has made several recommendations in support of better early learning and child care (ELCC) [11]. To ensure child care services remain responsive to local needs and priorities, one recommendation is to support provincial system-wide planning through regional service management. When local communities have the power to plan and manage their child care services, they are better able to provide those services where needed. An example of this exists in Ontario, where 47 municipal governments are responsible for planning and managing licensed child care services at the local level [12]. They partner with schools to provide full-day kindergarten programs for all 4- to 5-year-old children. Despite being non-compulsory, most Ontarian children are enrolled in one of these programs.

Ontario’s model suggests that having municipalities involved in delivering child care is an achievable goal. Bigger cities, such as Edmonton, could benefit from getting municipalities and schools involved, as the city would have better control over accommodating local needs and vulnerable sectors, thereby making it easier to target areas at risk of child care deserts. Likewise, the four Alberta municipalities mentioned demonstrate that it is possible to provide child care in communities that are not able to support and sustain child care through a market model. Areas where child care services tend to have higher costs, such as small, isolated communities or communities with special cultural and social needs, could also benefit from having similar child care programs run by their municipality to provide better options for parents.

Municipally managed child care is not free from challenges. Currently, Albertan municipalities have no legislated obligation to play a role in funding, planning, or managing child care services. As such, any municipality that wishes to contribute to their local child care must justify expenditures for these programs during times of financial difficulty (such as the current pandemic). Provincial and federal support for regionally managed ELCC programs would go a long way towards easing that burden and providing communities with improved child care options. This is a worthwhile goal to achieve, as that support goes back to the community—for every dollar spent on child care, the general economy receives between $1.50 and $2.80 in return [13].

Other resources that may be of interest:

• https://cupe.ca/child-care-profile-alberta
• https://childcarecanada.org/taxonomy/term/7859?page=1
• https://www.ecelc.ca/publications-archive/rising-early-learning-and-care-in-calgary

About the volunteer

Luis Murcia is a volunteer with ESPC. His goal and passion is the pursuit of knowledge for the betterment of society. In 2013, he came to the University of Alberta from El Salvador and graduated with a BA in psychology and a minor in philosophy. He is striving to develop into a person that can help others become their best self.

References

• Edmonton Council for Early Learning and Care. (2020). Infographic 04, licensed full-day early learning and care spaces in Edmonton per 10 children aged 0-4. https://www.ecelc.ca/infographics/7samoydxcitxm67ems40c5f26artls
• Buschmann, R., & Partridge, E. (2019). Brief: A profile of child care in Edmonton, 2019. Edmonton Council for Early Learning and Care. https://www.ecelc.ca/publications-archive/profile-of-edmonton-child-care-in-2019
• Canadian Centre for Policy Alternatives. (2018). Child care deserts. https://www.policyalternatives.ca/childcaredeserts
• Macdonald, D. (2018). Child care deserts in Canada. Canadian Centre for Policy Alternatives. https://www.policyalternatives.ca/publications/reports/child-care-deserts-canada
• Johnson, Lisa. (2021, July 16). Fragile child care sector in Alberta hit hard by COVID-19: National survey. Edmonton Journal. https://edmontonjournal.com/news/politics/fragile-child-care-sector-in-alberta-hit-hard-by-covid-19-national-survey
• Macdonald, D., & Friendly, M. (2021). Sounding the alarm: COVID-19’s impact on Canada’s precarious child care sector. Canadian Centre for Policy Alternatives. https://www.policyalternatives.ca/TheAlarm
• Statistics Canada. (2021). Survey on early learning and child care arrangements, 2020. https://www150.statcan.gc.ca/n1/daily-quotidien/210407/dq210407b-eng.htm
• Childcare Resources and Research Unit. (2021). New report shows child care fees in Edmonton and Calgary remain high, enrolment dips due to COVID-19. https://childcarecanada.org/documents/child-care-news/21/03/new-report-shows-child-care-fees-edmonton-and-calgary-remain-high
• Childcare Resources and Research Unit. (2018). Affordable child care on the horizon for Alberta parents – but who will get in? https://childcarecanada.org/documents/child-care-news/18/04/affordable-child-care-horizon-alberta-parents-who-will-get
• The Muttart Foundation. (2011). Municipal child care in Alberta: An alternative approach to the funding and delivery of early learning and care for children and their families. https://muttart.org/reports/municipal-child-care-in-alberta-an-alternative-approach-to-the-funding-and-delivery-of-early-learning-and-care-for-children-and-their-families/
• Edmonton Council for Early Learning and Care. (2021). Recommended actions for Alberta Children’s Services in support of early learning and care. https://www.ecelc.ca/whats-new-archive/recommended-actions-for-alberta-childrens-services
• Friendly, M., Larsen, E., Feltham, L.E., Grady, B., Forer, B., & Jones, M. (2018). Early childhood education and care in Canada 2016. Childcare Resource and Research Unit. https://childcarecanada.org/publications/ecec-canada/18/04/early-childhood-education-and-care-canada-2016
• Department of Finance Canada. (2021). Budget 2021: A Canada-wide early learning and child care plan. Government of Canada. https://www.canada.ca/en/department-finance/news/2021/04/budget-2021-a-canada-wide-early-learning-and-child-care-plan.html