Agenda Index City of Vancouver

ADMINISTRATIVE REPORT

TO:

City Council

FROM:

General Manager of Community Services

SUBJECT:

Framework for Action - Status Report

 

RECOMMENDATION

CITY MANAGER'S COMMENTS

COUNCIL POLICY

On May 15, 2001, Council approved the Framework for Action: A Four Pillar Approach to Drug Problems in Vancouver.

In 1998 Council Approved A Program of Strategic Actions for the Downtown Eastside which included developing directions for the City to address substance misuse issues in the Downtown Eastside and the city.

PURPOSE

This report seeks to provide Council with progress to date on the development of an implementation plan for the Framework for Action and to provide an update on the Vancouver Agreement First Focus Health and Safety initiatives.

BACKGROUND

On May 15, 2001, Vancouver City Council endorsed A Framework for Action: A Four Pillar Approach to Drug Problems in Vancouver, including Prevention, Treatment, Enforcement and Harm Reduction, as Vancouver's drug policy. Since May 15, City of Vancouver staff have been working closely with Vancouver Agreement partners and Vancouver's Coalition for Crime Prevention and Drug Treatment to develop an implementation plan for the Framework for Action.

In June of 2001, the Mayor, City Manager and Drug Policy Coordinator met with federal Ministers and their staff in Ottawa to discuss federal support for the Framework For Action and to discuss implementation of the Framework through the Vancouver Agreement. Staff have developed a pilot project approach to the Framework for Action and have completed a draft Pilot Project Proposal for the consideration of the federal and provincial governments.

Health Canada indicated in June, 2001, that an analysis of the actions within the Framework For Action would be provided to the City of Vancouver signifying which actions in the Framework had specific relevance to that department's participation through Canada's Drug Strategy.

This report will outline the Framework for Action Pilot Project (Appendix 1) and provide information to Council concerning the progress to date of the implementation of the Framework for Action, update Council on initiatives related to the four pillars of Prevention, Treatment, Enforcement and Harm Reduction and inform Council on the progress to date of the Vancouver Agreement Health and Safety initiatives.

1. Progress to Date Under the Four Pillars

The following sections outline progress that is already being made under the four pillars of Prevention, Treatment, Enforcement and Harm Reduction through Vancouver Agreement initiatives and Vancouver's Coalition for Crime Prevention and Drug Treatment partners

Prevention

· Power Choices - Drug Awareness and Prevention for Youth. A Vancouver Coalition for Crime Prevention and Drug Treatment Working Group, the Vancouver Sun and TELUS will be publishing and distributing a five-day series on drug prevention education for youth that will run in the Vancouver Sun November 19-23, coinciding with National Addictions Awareness Week. The series will be circulated in the Vancouver Sun, which has a circulation of approximately 250,000, and throughout Vancouver classrooms in grades 8-10. The estimated cost of this series is $12,000.
· National Addictions Awareness Week, November 19-23. The City of Vancouver will proclaim National Addictions Awareness Week as a City event. Activities willinclude media announcements and, through Coalition partner support, classroom distribution of the five-day Drug Awareness and Prevention for Youth series.
· Alcohol-Drug Education Service (A-DES), a leading community partner in prevention education, is working on securing funding for expanding their Making Decisions curriculum. Currently this program is in place in grades 6 and 7 in 1,075 classrooms throughout the province. A grade 4 launch of the program is scheduled for December 2001. Grades 8 and 9 are scheduled to be launched in December 2002.

Treatment

· Four Health Care sites are underway as part of the Vancouver Agreement First Focus Health and Safety Initiatives in the Downtown Eastside. The sites include: a Health Contact Centre at 166 East Hastings Street, a Life Skills Centre at 412 East Cordova Street, a Community Health Clinic at 569 East Powell Street and the Pender Health Clinic at 59 West Pender Street. Funding of $2.1 million is in place and the health care sites are scheduled to open in mid-December 2001, with the exception of the Life Skills Centre which is scheduled to open in April of 2002.
· A Neighbourhood Liaison Committee has been set up by the Vancouver Richmond Health Board to participate in the evaluation and monitoring of the four health sites. The Neighbourhood Liaison Committee will develop criteria by which neighbourhood conditions can be monitored, complete a study of the current conditions in the neighbourhood, and develop a communication strategy for information sharing in the neighbourhood concerning safety issues. The Neighbourhood Liaison Committee is made up of representatives from a range of business organizations, community organizations and client groups and will have its first meeting on November 7, 2001.
· The Vancouver Richmond Health Board is continuing its plans for decentralization of core addiction services city-wide. Core services including: needle exchange, alcohol and drug counselling, home detox support and methadone availability will be located in local Community Health Centres throughout the city.
· The Canadian Institute for Health Research has approved and partially funded the North American Opiate Medications Initiative proposal to conduct clinical trials of Heroin Assisted Treatment in Montreal, Toronto and Vancouver. This project will enroll a small number (240 nationally) of long-term heroin users in order to investigate the efficacy of using heroin in the drug treatment process.

Enforcement

· The Redesign of the public space at Main and Hastings will begin in January 2001 after the opening of the Contact Centre at 166 East Hastings. Changes to this space will improve public safety, allow greater enforcement on the corner and reduce the level of drug activity on the Main Street side of the Carnegie Centre. Bus stops willbe moved, lighting will be increased, the cement structure above the washrooms will be removed to increase visibility, and washrooms will be upgraded.
· Drug Treatment Courts. The Provincial Government and Justice Canada have been working on the development of an infrastructure and program for a drug treatment court in Vancouver. The program is planned to begin operation in November, 2001 and will start with 25 treatment slots expanding to 50 by the end of 2002. The program is expected to take approximately 10 months to complete and will work closely with treatment programs.

Harm Reduction

· Health Canada has released a Federal/Provincial/Territorial Report: "Reducing the Harm Associated with Injection Drug Use in Canada". The report was released at a meeting of First Health Ministers and Provincial Health Officers in September 2001. The report recommends a series of actions to reduce the harm of injection drug use in Canada including the establishment of a national task group to look at the feasibility of supervised injection sites in the Canadian context. The task group will meet in late November 2001 in Ottawa.
· Research supported by the Vancouver Agreement and the Chief Coroners Office into overdose deaths in Vancouver is nearing completion. A retrospective study of all overdose death files in the Vancouver/Richmond Health Region reported to the Chief Coroners Office in 1998 was carried out by researchers with the Vancouver/Richmond Health Board and the B.C. Centre for Excellence in HIV/AIDS. Results of this research will aid the development of overdose prevention initiatives

Other Related Progress

Vancouver/Richmond Health Board Initiatives

· Access 1 - The Access 1 detox phone line has been operating for approximately six weeks and has decreased waiting times for detox services for males (from 4 days to 2 days or less) and females (immediate availability) in Vancouver. Detox occupancy throughout the city has increased from 75% to 99% in the last six weeks. Access 1 has lead to an overall improvement in coordination, use of space and resources and access to care.
· Daytox - Daytox, an ambulatory detox program operated outside of the Downtown Eastside at Vancouver Detox, provides outpatient detox and is expected to open by mid-November. It is expected to provide care for approximately 40 clients per day. By providing needed outpatient services, it provides additional space for those who need residential treatment.
· Methadone Review - The Vancouver/Richmond Health Board is expected to complete its review of methadone throughout the region by the end of November.
· The City of Vancouver, Vancouver/Richmond Health Board and the Province of British Columbia have worked together to support the development of supportive housing for those with addictions. The recent project approval by BC Housing for a supportive housing project at 5651 Fraser Street is an example of this. The project will be a combination of affordable housing and addiction program services designed to support individuals recovering from addictions within an abstinence based environment.

2. Draft Framework for Action Pilot Project

Following meetings in Ottawa with federal Ministers and officials, staff have drafted a Draft Framework for Action Pilot Proposal for consideration by the Federal and Provincial governments. The draft Pilot Project outlines 18 urgent actions across the pillars of Prevention, Treatment, Enforcement and Harm Reduction from the Framework for Action that would form the first phase of the implementation of the Framework. The draft Pilot Project has been developed in conjunction with the Health and Safety Subcommittee of the Vancouver Agreement. The Vancouver Agreement structure will become the single accountable agent responsible for the implementation of the Framework for Action.

The City of Vancouver and the Vancouver Agreement propose that Health Canada fund the Framework for Action Pilot Project as a demonstration project of the Canada Drug Strategy. The Framework for Action will contribute significantly to achieving the five goals of Canada's Drug Strategy by implementing actions across the pillars of Prevention, Treatment, Enforcement and Harm Reduction. The goals of Canada's Drug Strategy are:

· to reduce the demand for drugs
· to reduce drug-related mortality and morbidity
· to improve the effectiveness of and accessibility to substance abuse information and interventions
· to restrict the supply of illicit drugs and reduce the profitability of illicit drug trafficking
· to reduce the costs of substance abuse to society.

The Pilot Project outlines a collaborative structure and process for implementing the Framework for Action within the Vancouver Agreement. The evaluation of the Framework for Action will become a part of the overall evaluation and monitoring of the Vancouver Agreement initiatives.

3. Framework for Action - Council Motions of May 15, 2001

On May 15, 2001 Council approved the Framework for Action. Council also moved several motions instructing staff to report back in the fall of 2001 on a range of issues related to theFramework for Action. This section of the Council Report will outline progress to date on these Council Motions.

Council Motion E i) and ii): That an implementation plan be drafted within 12 months which includes:

i)Defined goals aimed at specific outcomes, including reduced drug-induced deaths, reduced drug-induced morbidity and reduced drug-related crime (that includes: lowering drug-related deaths, reducing the occurrence of HIV in IV-drug users, and lowering the frequency of drug-related robberies)

ii)Measurable indicators identified for each goal, including some indicators focussed on outcome and other indicators focussed on process (to reach the outcomes) and a fully budgeted plan to monitor these outcomes every 2-3 years (Note that an Evaluation Team separate from this administrative monitoring process should independently assess the accomplishments of the drug strategy):

Attached as appendix 2 is a draft evaluation plan for the Framework for Action. This framework outlines inputs, outputs and a sample of the types of indicators that would be measured. Determining the exact outcomes and specific indicators that measure the achievement of outcomes (intended results) for each action within the Framework is one of the next steps in the implementation process and will involve a range of stakeholders including those from government, service providers, clients of services and the community.

An evaluation framework is being developed for the Vancouver Agreement to assist government in determining levels of success in achieving the desired outcomes of the Agreement. The evaluation of actions within the Framework for Action will be an integral part of this broader evaluation. The Vancouver Agreement evaluation will look at the complex interplay of initiatives supported by governments under the Agreement in the areas of Health and Safety, Social and Economic Development, Housing and Community Capacity building.

An initial evaluation steering committee has been set up which includes representatives from the municipal, provincial and federal governments, Vancouver Police Department, Vancouver Richmond Health Board, University of British Columbia and Simon Fraser University. This committee will function as a preliminary steering committee for the development of the Vancouver Agreement evaluation framework.

The Evaluation Committee is presently overseeing the development of a Request for Proposals for a consultancy to conduct a data analysis which will identify existing sources of data available for evaluation research and to identify where there are gaps in the data that various jurisdictions collect. This analysis will be complete by January 30, 2002.

Preliminary objectives for completing the evaluation framework are:

1. To identify and/or clarify the objectives of the Vancouver Agreement.
2. To identify indicators of success.
3. To identify and inventory possible sources of existing data for measuring each indicator.
4. To assess current data for their ability to evaluate the current status of each indicator.
5. To identify indicators for which no available data exist.
6. To collate relevant available data to form the baseline description of the situation.
7. To determine the necessity, feasibility and cost of collecting new data.

Vancouver Agreement staff are currently developing a terms of reference for evaluating the Vancouver Agreement. The terms of reference will identify:

a) the data-bases required, for the ongoing work of the Vancouver Agreement,
b) the agency(ies) that maintain, or should maintain, the data-bases,
c) how data from the data-bases might be collated to form periodic progress reports,
d) the appropriate time periods for, and content of reports.

The evaluation terms of reference will assist the Vancouver Agreement partners to have a clear understanding of which agency is responsible for what actions within the evaluation process.

Council Motion E iii, iv):

E.iii) A single agency to administer, supervise and maintain budgetary control of all programs aimed at the goals and monitored indicators noted above and that program content be based on scientific evidence and outcome wherever possible.

The Vancouver Agreement structure will be the single accountable agency to administer, supervise and maintain budgetary control of the implementation of the Framework for Action. Provision for monitoring and reporting on the achievement of outcomes and delivery of programs and services will be a function of the Vancouver Agreement Secretariate.  Appendix 3 contains a diagram of the proposed structure for the Vancouver Agreement and illustrates how the Framework for Action and other Vancouver Agreement initiatives fit into this structure.

E. iv) The single agency adjusting program priorities, program operation and program budgets based on the results of the monitoring noted in (ii) and on program evaluation.

There will be clear linkages from the Framework for Action to the ongoing evaluation and monitoring put into place by the Vancouver Agreement and other relevant evaluation plansand frameworks that will provide information to allow program priorities, operation and budgets to be adjusted.

Council Motion E. (v)

E. (v) The City invite the Vancouver Richmond Health Board to jointly convene meetings of all existing agencies and organizations involved in delivering the drug strategy within Vancouver to plan the implementation of (i) to (iv) above.

In June of 2001, the Vancouver Richmond Health Board released a draft strategic framework for alcohol and drug services in Vancouver for broad review and input. The final framework is expected in early 2002. In addition the VRHB is beginning a process to develop specific alcohol and drug action plans for each of its Vancouver community health areas that fit into the regional approach to addictions. Consultation is an integral part of this work. The process will involve service providers, community health committees, resident and other organizations as well as representatives from other levels of government and from other agencies providing related services. The Vancouver Agreement partners will engage those services involved in delivering the drug strategy within Vancouver.

Council Motion F. That the implementation plan as stated in Recommendation E also include an accountability team, separate from the single accountable agent to monitor not only the drug-related crime rate but also the general well-being of the residents and the business people, the effect on tourists and the progress of revitalization in the community.

There are several mechanisms being established that are relevant to this motion. Within the Downtown Eastside a Neighbourhood Liaison Committee has been set up in accordance with the Good Neighbour Agreement signed by the Vancouver Richmond Health Board and the City of Vancouver. This committee will monitor the community impact of the four health facilities opening in the coming months. A second mechanism separate from the Framework for Action will be the Evaluation and Monitoring committee that has been created which includes at present representatives of the University of British Columbia, Simon Fraser University, The Vancouver Police Department, Vancouver Richmond Health Board and representatives of the Municipal, Provincial and Federal governments.

A third mechanism for achieving the intended outcome of this motion is to put into place a performance reporting component that monitors the general well-being of residents and the business community which would include: a) small number of indicators to track key social and economic trends in Vancouver and the Downtown Eastside in particular, such as the effect on tourism and the progress of revitalization in the community, that will be influenced over time by the cumulative effect of the Framework for Action and the Vancouver Agreement and the b) annual or bi-annual monitoring and reporting on these socio-economic indicators.

Council Motion G. That the City of Vancouver seek the cooperation of the Vancouver Richmond Health Board to keep a database inventory register in each health facility in the Downtown Eastside so that clients other than the local residents may be referred to other parts of Vancouver or other municipalities where they reside.

The Vancouver Richmond Health Board is implementing a Community Health Information System for all Health Centres in the Vancouver/Richmond region. This includes the Health Facilities in the Downtown Eastside. This information system will contain registration, referral, assessment, service, care plan and schedule information for all community clients.
Registration and referral functions will be implemented during 2002.

Council Motion H: Noting that the Framework for Action is a city-wide framework, that Council direct staff to work with the Vancouver Agreement partners and the community to complete an inventory of government funded services in the Downtown Eastside and develop a model for the evaluation of their effectiveness; the latter to be done in conjunction with the objective, third party evaluation and monitoring processes being considered for other initiatives in the area including the Framework for Action and the First Focus Health and Safety initiatives; and that this work be done in a transparent manner with public and service provider input.

As a first step toward developing an evaluation framework the Vancouver Agreement partners are developing an inventory of government services delivered in the Downtown Eastside. This will assist governments to better understand the amount and nature of current government commitments in the area. The inventory of services will obtain information from government departments and ministries on services delivered by non-profit agencies that receive government funding and are operating within the Downtown Eastside and of those services not located in the Downtown Eastside but providing services to people in that community. The inventory will provide an accurate "snapshot" of government services currently being provided in the community.

The information to be collected will include: levels of funding to organizations, a clear understanding of the nature of the services provided and an understanding of the clients served. The inventory will include non-core services (services not provided by government staff) provided by non-profit agencies and funded by governments through agreements such as contracts, contribution agreements and grants. The inventory will include services funded by governments in their fiscal year 2000 or 2000-2001 for those with a year end of March 31, 2001.

An intergovernmental team has prepared a funding survey instrument that will be sent to all government ministries and departments. Results of the survey will be collected by the end of November, 2001. Analysis of the information will then occur and the completion date for the inventory is targeted for January 30, 2002.

Council Motion I: That in recognition of economic viability as a critical component of Downtown Eastside revitalization, Council direct staff to report back by the Fall of 2001 regarding progress on economic development initiatives underway and any potential new initiatives.

A report to Council on economic development initiatives underway and any potential new initiatives in the area will be coming to Council separately in November.

Council Motion J: That staff report back on the merits of the establishment of a Healthy City Office outlining structure, estimated costs and timing.

Staff have prepared the following information on Healthy City initiatives:

Healthy City initiatives have emerged in Canada as a result of the Healthy Toronto 2000: Beyond Health Care symposium. Since that time there has been a global movement that has resulted in more than 3000 municipalities having some form of Healthy City initiative. A full report on the definitions of Healthy Cities and the development of Healthy City initiatives in Canada is attached as Appendix 4.

Healthy City initiatives generally focus on five major policy areas of concern for urban communities: Public Health, Crime and Safety, Community Development, Sustainable Environmental Design, and Transportation. The main premise of a Healthy City approach is that problems in any of these areas stem from interrelated causes in the areas of economics, social equity, and the environment.

Healthy City models as outlined by the Ontario Healthy Communities Coalition include four characteristics:

1. Wide community participation - people from all walks of life working together towards the goal of a healthier community.
2. Broad inter-sectoral involvement - people across sectors come together with residents to form a common vision of a healthy community.
3. Local Government commitment - political support and coordinated efforts by the bureaucracy to work towards a shared vision of a healthy community.
4. Healthy Public Policy - Healthy City initiatives focus on development of public policies that are intended to have a positive effect on the health of people.

Healthy City initiatives take a variety of forms across urban settings. In some cases Healthy City initiatives are processes that focus on creating a greater awareness of how to coordinateefforts to address issues involving interdepartmental work. Others may involve creating an infrastructure and staffing comprised of full time planners, researchers, assistants and others. Budgets for Healthy City initiatives reflect the diversity of forms that these types of initiatives take and range from relatively small budget items to significant line items in a City's budget.

Vancouver has a strong history of providing services that are typically found in Healthy City initiatives. The integrated work that is carried out through the Social Planning, Planning, Cultural Planning, and Engineering departments over the years has provided a sound basis for the City's response to resolving complex urban issues.

Currently the City of Vancouver has several existing mechanisms and in some cases an existing infrastructure to address the kinds of issues that typically fall under the mandate of a Healthy City office:

a) Recently the City of Vancouver has started an internal process across departments to look at the ways the City is addressing issues of environmental, social and economic sustainability and to identify particular areas for future sustainability work. Council will be receiving a report from staff early in the new year on existing social, economic and environmental policies and practices, gaps and opportunities for further initiatives, and a process to advance sustainability in the City. This work will coincide with the GVRD update of the Livable Region Strategic Plan (LRSP). The GVRD has started a "Sustainable Region Initiative" to review the LRSP with a view to moving Greater Vancouver towards a more sustainable future in economic, environmental, social and political terms. The ongoing work by Planning, Real Estate, Engineering and Parks in modelling urban sustainability at the neighbourhood level is also an example of the kind of work the city departments do in the area of Healthy City policy development. The Planning and Engineering departments have been instrumental in the development of a regional, city and central area transportation plan which is typically the type of work that Health City initiatives focus on.

b) The Neighbourhood Integrated Services Teams (NISTs) are another example of an existing mechanism to address specific problems related to neighbourhoods in Vancouver.

c) Another recently formed mechanism for dealing with complex urban issues is the Vancouver Agreement. The Agreement is an effort to not only work across disciplines in addressing serious urban issues, but across jurisdictions. Many of the pressing issues such as community health and safety, economic development and housing are ones that are clearly addressed through appropriate partnerships that cross jurisdictional lines. The intent of the Vancouver Agreement is to coordinate, monitor and evaluate the efforts of the municipal, provincial and federal governments indelivering programs and services to citizens of Vancouver and to bring a spirit of problem solving to the array of complex issues that face Vancouver today.

Many of the functions that a Healthy City Office would perform currently exist within the array of mechanisms available to the City at present. Recent discussion with the City of Toronto indicate that Toronto is investigating new methods of achieving some of the cross departmental or interdisciplinary work that often is required in complex urban settings. The Healthy City office at the City of Toronto has been absorbed into the Chief Administrator's Office and staff have been reallocated to other departments. The City of Toronto is considering models such as the Vancouver Agreement for addressing issues formerly within the mandate of the Healthy City Office.

There is a need for the City of Vancouver to improve coordination of efforts to respond to inquiries and complaints from the public regarding neighbourhood issues and concerns.

There should be improved clarity within the various City systems as to how to route, refer and address many of the neighbourhood and community issues that come to the attention of staff, NISTs, City Councillors and others within the City system. It is the opinion of staff that reviewing existing mechanisms already in place would be a logical starting point for determining what enhancements if any should be considered by Council. Creating a separate office to perform this work such as a Healthy City Office is not viewed as necessary at this time given existing mechanisms and processes currently available to the City.

Conclusion

The first phase of implementation of the Framework for Action is underway. Rational evaluation and monitoring frameworks are being developed and put into place as part of the planning process of the Vancouver Agreement. The Vancouver Agreement will be the accountable agent for the implementation of the Framework for Action. The Federal Government response to the Framework for Action is expected in the coming days and Provincial ministries are presently reviewing the Framework document. Vancouver Agreement Health and Safety initiatives are underway and will be implemented beginning in mid-December. Progress is being made across all four pillars of Prevention, Treatment, Enforcement and Harm Reduction.

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