1. First Nations Health Manager’s Association Meeting
Vancouver: November 17, 2016
Realizing Jordan’s Principal: What’s next for First Nations Health Managers?
Vandna Sinha
McGill University

2. Basis for presentation
Coordination of Jordan’s Principle Working Group
Assembly of First Nations, UNICEF, Canadian Paediatric Society, Canadian Association of Paediatric Health Centres, Canadian Child Youth Health Coalition
First report – winter 2015
Continuing policy learning function
Project with Pinaymootang First Nation
Documenting community’s experiences in trying to provide services for children with complex medical needs

3. Outline Current understanding of Jordan’s Principle
Current policy context
Historical development of current context
Jordan’s story
Evolving expression of Jordan’s Principle vision
Federal attempts to limit application
Persistence of federal approach
Attempts to limit application
Procedural delays
Unaddressed conceptual issues
Where do we go from here?

4. Jordan’s Principle
Jordan’s Principle is a child-first principle and provides that where a government service is available to all other children and a jurisdictional dispute arises between Canada and a province/territory, or between departments in the same government regarding services to a First Nations child, the government department of first contact pays for the service and can seek reimbursement from the other government/department after the child has received the service. It is meant to prevent First Nations children from being denied essential public services or experiencing delays in receiving them.
Canadian Human Rights Tribunal (CHRT, 2016)

5. Initial questions Have you previously heard of Jordan’s Principle?
Can you think of a Jordan’s Principle case in your community?
When/how did you first realize this might be a Jordan’s Principle case?
In this case, has anyone tried to pursue access to services through Jordan’s Principle?
What, in your understanding, are the defining characteristics of a Jordan’s Principle case?

6. A brief overview of Jordan’s Principle history
Jordan’s Principle Originated 2005
Wen-de report
Unanimous support in house of commons 2007
Development of bi/tripartite agreements
Federal statements -no Jordan’s Principle cases in Canada
Federal ruling in PLBC v. Canada
CHRT rules federal government must implement Jordan’s Principle (2016)
Ongoing CHRT monitoring of short term remedy compliance
3 year period for development of long-term remedy ( )
A brief overview of Jordan’s Principle history

7. Current Jordan’s Principle Policy Context First Nations Child & Family Caring Society et al v. Canada
Canadian Human Rights Tribunal (CHRT) -federal government must implement Jordan’s Principle as originally envisioned
Overseeing short term remedy
Emerging federal response – 3 year plan
Up to $382 million
Service coordination / patient navigation
Service access (JP)
Case tracking
Engagement – develop long term plan
Funds through home & community care
RFPs around Jordan’s Principle extended at the regional level
Development of a national level First Nations advisory committee on child welfare delayed

8. Current Jordan’s Principle Policy Context First Nations Child & Family Caring Society et al v. Canada
CHRT critical of
Pace of federal response
Failure to engage with Caring Society, AFN, Ontario Chiefs, NAN
Continued narrowing of application of Jordan’s Principle
Failure to respond to clearly outlined questions
CHRT overseeing case conferencing/mediation process
House Motion requiring liberal government to comply with CHRT ruling (unanimous support)
3 year window to impact long term implementation

9. Jordan River Anderson’s Story
Federal/ provincial attempts to limit application
Evolving expressions of Jordan’s Principle
Operational understanding of Jordan’s Principle

10. Jordan River Anderson October 22, 1999– February 2, 2005
Born with complex medical needs requiring hospitalization
Hospital team approved his release from hospital when he was 2
Jurisdictional disputes – arguments between federal and provincial government over payment for in-home services
Passed away in hospital – never spent a day in a family home
Family and community committed to helping other children
Jordan’s Principle championed by First Nations Child and Family Caring Society

11. Evolving expression of Jordan’s Principle Vision
Human rights based understanding of jurisdictional disputes includes:
Payment disputes
Jurisdictional ambiguity
Service disparities
Service gaps
Wen de: intergovernmental dispute
House of commons: ‘government or department’ (inter & intra governmental disputes)
CHRT: Human rights based argument focused on inequitable access to services

12. Contact information for focal points not publicly available

13. Focal point makes decision No appeal process
Required documents:
assessment from a health or social service professional, information on current proposed service plans
report of the issue/reason for referral to the focal point,
summary of steps taken to resolve the issue
Focal point makes decision
No appeal process

14. “there are currently no outstanding jurisdictional disputes involving Jordan’s Principle in Canada”
Minister Bernard Valcourt
February 2015

15. Persistence of federal efforts to limit application
Despite CHRT rulings to the contrary, federal focus remains on:
Focus on disabilities/complex medical needs
Implied focus on health
On reserve children
Normative standards of care
Disconnect between overarching language and emerging implementation
All First Nations children vs.
a disability affecting activities of daily living; OR
[an interim critical condition affecting activities of daily living]
Continued framing of Jordan’s Principle in ways that contradict CHRT ruling and First Nations vision

16. Questions
Looking at the CHRT criteria, can you think of additional Jordan’s Principle cases in your communities?
How can First Nations health managers:
Recognize continued federal efforts to narrow application of Jordan’s Principle?
Respond to/resist narrowing during implementation?
The CHRT has ruled that Jordan’s Principle applies to:
All First Nations children
on and off reserve
Status, status eligible, non-status
Children with disabilities/complex medical needs and all other First Nations children
Domains beyond health (child welfare)

17. Persistence of federal procedural approach
Federal oversight of Jordan’s Principle process
Focal points as primary facilitators of process
Direct contact information available on Caring Society website:
Federal site lists general (regional office) contacts
Case conferencing approach
Initial delays institutionalized in ‘patient navigator’ model
CHRT has clearly ruled: Jordan’s Principle processes must not impose delays on receipt of funding/services through case conferencing/other processes
Unspecified mention of appeals process
Delays in approval/establishment of AFN ‘National Advisory Committee’ on child welfare
INAC engagement process underway
Appointment of Special Representative (Cynthia Wesley-Esquimaux)

18. Unaddressed conceptual issues
How will comparability (to what is ordinarily available to non-First Nations children) be assessed?
In a way that doesn’t impose delays?
In a way that acknowledges and challenges disparities in services ordinarily available to non-First Nations children?
E.g. related to geographic remoteness?
In a way that advances ‘substantive equality’
Does not compound historic disadvantage
How will Jordan’s Principle be linked to systemic reforms in order to eliminate jurisdictional ambiguity, service gaps, service disparities?
Not feasible to solve systemic problems on a case-by-case basis
INAC service coordinator/patient navigator approach only maximizes access to services within a discriminatory service framework

19. Building on FNHM knowledge/experience
Key Questions:
How do you learn about the services that are available to non-First Nations children?
What kind of information do you have/collect about unmet needs of children in the community?
What kind of information do have/collect about the challenges that you face in meeting community needs?
What could this information add to the conversation around JP?
What do you do with this information?
Who might be able to make appropriate use of this information?

20. Documenting experience?
Child information
age
gender
FN status
on/off reserve residence
in out of home care?
Services required
Underlying reason
Service/support/equipment required by child or caregiver
Request first made
to whom
Provided/funded?
Consequences?
One-time service provision (humanitarian)
Denial of services
Delay of services
Disruption of services
Partial/limited service provision
Band paid out of its budget
Family paid out of pocket, fundraised, sought alternate funding
Out of home placement to access service
Family moved to access services
Claim/pursuit of services abandoned
Legal challenge launched
Service provided on request
Parties involved
federal departments
provincial/territorial departments
FN government/service provider
Jordan’s Principle discussed?
Mentioned
Claim of ineligibility
Case conferencing process

21. What’s next? Process unclear – watch for: Next 3 years critical
Development of the National Advisory Committee on Child Welfare (AFN)
Continued efforts to ensure compliance with CHRT rulings
Regional consultation efforts
Development of regional service coordination/patient navigation
Accessibility of ‘focal points’
Data collection/case tracking/monitoring efforts
Next 3 years critical

22.
Thank you!